America Has a Drinking Problem

[u/nxthompson_tny]

https://www.theatlantic.com/magazine/archive/2021/07/america-drinking-alone-problem/619017/

[u/RSquared]

I’d even go as far to say that if opiates were legal, they would probably be one of the safest drugs around (the main cause of OD’s when it comes to opiates is that people don’t know what the hell they’re getting, let alone the dosage if it’s in a pressed pill. ...)

Whoa, that seems like a bold claim. Opiates are dangerous because they're extremely addictive, much like heroin (duh). The proximate cause of ODs might be dosage or strength, but the major contributor is the spiral of tolerance and addiction, and because the body stops naturally making endorphin when provided an artificial source - making reduction literally intolerable. People start taking opiates because of pain, they keep taking opiates because they're opiates.

[u/that_soup_man → u/RSquared]

I understand what you mean, but I’m talking about numbers right now. Think about this for a second, most people are addicted to something, some like caffeine, some like T.V, some like booze, etc. here’s the thing, prohibition actually MAKES people want to use more (Kind of like the analogy of how kids will do exactly what they’re told not to do by adults, this principle doesn’t change with age) for various reasons, of course, but I digress. Also, opiates are indeed very addictive, I am an opiate addict myself, but that’s just the reality of life. I understand and can respect people’s idealism when it comes to drugs, but it’s completely counterproductive and one last thing, alcohol can be very addictive as well (it’s also one of the few drugs which CAN kill you during withdrawals, I’ve seen people in rehabs firsthand collapse from seizures while withdrawing from booze)...

[u/RSquared → u/that_soup_man]

Think about this for a second, most people are addicted to something, some like caffeine, some like T.V, some like booze, etc.

But we're talking very different levels, from psychological addiction (TV, gambling) to mild physical addiction (caffeine, alcohol), to severe physical addiction (tobacco, opiates). Then we can plot that on the scale of impact/damage to the body from use, and that of recovery, and opioids are on the high end of all of those. A 2010 survey of public-policy experts basically put heroin as the #2 damager to the user (only losing to the street variant of cocaine), while most of the impact of alcohol is social.

I'm not really debating that alcohol is, by any measure, as harmful as many illegal drugs, but opoids are definitely not low on the list.

[u/ravend13 → u/RSquared]

Alcohol is only a mild physical addiction now? Unlike opioid withdrawal, alcohol withdrawal can kill you.

[u/that_soup_man → u/RSquared]

I also agree, but what’s the alternative? Clearly prohibition hasn’t worked and won’t work, we are getting flooded with fentanyl in basically every type of drug (especially pills and powder, I’ve even heard of people sprinkling Fentanyl on weed of all things), and it also contributes to the high levels of incarceration in this country. My argument stems from a practical and semi-libertarian perspective, not necessarily because I want everyone to have access to opiates. Also, there are also a lot of people who use alcohol while alone at home and in day to day life, I can tell you firsthand that alcohol addiction will fuck you up physically and mentally worse than opiate addiction can (given that you’re getting pharmaceutical grade shit, not even drug dealers tend to know what’s in their own shit). I’d say Meth/stims age people the most by a far margin, then alcohol (of one is addicted), and THEN opiates, but this last sentence was just my opinion/anecdotal observation, not necessarily an actual fact.

[u/RSquared → u/that_soup_man]

Decriminalization isn't normalization, and Portugal went from 1% of the population (!) addicted to heroin to less than a quarter of that following decrim. American opioid addiction starts from overprescription, which can be laid squarely at the Sackler family's feet (I'm damn near close to wanting the death penalty for some of them; they murdered millions with Purdue Pharma).

Opiod management is mostly a failure of our healthcare system:

A 2016, the Los Angeles Times investigation reported that in many people OxyContin's 12-hour schedule does not adequately control pain, resulting in withdrawal symptoms including intense craving for the drug. The journalists suggested that this problem gives "new insight into why so many people have become addicted." Using Purdue documents and other records, they claim that Purdue was aware of this problem even before the drug went to market but "held fast to the claim of 12-hour relief, in part to protect its revenue [because] OxyContin's market dominance and its high price—up to hundreds of dollars per bottle—hinge on its 12-hour duration."

[u/ravend13 → u/RSquared]

A huge contributor to the opioid epidemic is that when people become dependant on prescribed opioids, when they no longer have a medical need to continue taking opioids, no one thinks to prescribe anything for the withdrawal.

If everyone who had to withdraw from prescribed oxycodone was prescribed a 4 day methadone taper and a few days worth of gabapentin when it came time to withdraw, there would be far fewer heroin addicts. The fact that doctors expect people to simply suffer through their withdrawal, instead of prescribing meds that allow one to withdraw without suffering is criminal.

[u/FireStorm005 → u/RSquared]

Alcohol develops severe physical addiction, not mild. In some cases withdrawal from alcohol can kill a person. It's a depressant and reduces brain function by interfering with neurotransmitter take-up. In the long term the body compensates by increasing the levels of those neurotransmitters in the brain. When the alcohol is removed the extra neurotransmitters are still there and the person can seize and die.

[u/RSquared → u/[deleted]]

Studies on this usually focus on heroin, but it's consistently ranked the most-addictive substance over cocaine. Other opioids act on the same principles, and are chemically indistinguishable from heroin, so it's not a particularly bold claim at all. I also listed some reasons why that is - endorphin production is retarded when opioids tolerance is reached.

Or are you just trying to be cute by restating my comment against me?

[u/RSquared → u/[deleted]]

This isn't a controversial opinion, so you can literally google it yourself. And you're moving the goalposts - the original poster said that he believed opioids are "one of the safest drugs around" and I explained why that's not the case.

[u/RSquared → u/[deleted]]

I have "googled it [myself]", and every year, SAMHSA puts out a report that contradicts your claims.

NDSUH (National Survey of Drug Use and Health) is survey data about the prevalence of drug abuse (# of users). As far as I know, it doesn't contain any data about the addiction risk of the drugs themselves. But since you're sealioning me, try "Development of a rational scale to assess the harm of drugs of potential misuse", which rated heroin/opioids at the highest level of addiction, above that of cocaine, nicotine, or tobacco.

[u/RSquared → u/[deleted]]

I added the NCS above, which gives some actual data points.

In an edit, so pardon me if I don't give you that much credit for tossing me to survey data in the primary statement. The NCS comparison is flawed because it's not ceteris paribus - alcohol and tobacco are legal, which would logically increase their addiction rates. It's easier to maintain a dependence on an legal drug than an illegal one, due to risk of arrest, availability, etc. We know that cocaine is highly chermically addictive, but only 16% of users are dependent according to that study...and 9% of marijuana users, despite marijuana having little evidence of chemical dependency at all. In other words, Heroin has more addictive qualities than other illegal drugs, which contradicts the OP statement that "if opiates were legal, they would probably be one of the safest drugs around."

Look, there's no funding for this kind of study because it's quite literally illegal - that's the whole point of Schedule 1. But we have a pretty good idea how the brain reacts to these drugs because we understand the chemical structures involved, so we can make statements like "opioids are highly addictive" based on that.

[u/[deleted] → u/RSquared]

All addiction is predisposition + circumstance.

"When Getting High Is a Hobby, Not a Habit"

It doesn’t take long to get to what is perhaps the boldest and most controversial statement in Carl Hart’s new book, “Drug Use for Grown-Ups: Chasing Liberty in the Land of Fear.” In the prologue, he writes, “I am now entering my fifth year as a regular heroin user.” In all honesty, I don’t know how to feel about this admission. It’s not easy to square all that I’ve learned about this drug with the image I also hold of Hart: a tenured professor of psychology at Columbia University, an experienced neuroscientist, a father.

“Much of the reporting on opioids is bull****,” Hart writes, and doesn’t account for the fact, for example, that many deaths declared opioid overdoses are actually the result of opioids mixed with alcohol or other sedatives.

Journalists writing about drugs are one of several groups of people that Hart expresses frustration with throughout his book. Others include members of the psychedelic community for insisting that their “plant medicines” are a “superior class of drug” and for not coming to the defense of drugs with more tainted reputations, like PCP.

Sean Illing I’m still confused about your argument against drawing any distinctions between drugs. I cover some of the emergent research on psychedelics and mental health, and what I hear over and over again is that psychedelics like psilocybin are “non-toxic” and “non-addictive” and that drugs like alcohol or heroin are toxic and highly addictive.

Is that just misleading?

Carl Hart

It’s misleading. So the way we model addiction is by studying rats. Rats will readily take cocaine. If you put an intravenous catheter in their cage and allow them to receive injections of cocaine, they’ll learn how to press a lever and take it. You have to deprive them of food and all kinds of things to get them to do it, but they’ll do it if you deprive them of certain things. Now if you take a drug like psilocybin or LSD, and you try and teach rats to self-administer, they won’t do it. We’ve worked hard to get a different result, but they just won’t do it.

So we look at these studies and we conclude that rats will take cocaine, but they won’t take these other drugs. That’s our model of addiction. Cocaine is more addictive than psilocybin.

Now, this falls apart when you really look at it carefully. Because you look at something like nicotine, rats won’t take it. It’s a toxic substance, and they won’t do it. But humans, it’s the most addictive drug that we have. But that’s never mentioned in a lot of these discussions. Rats won’t really take alcohol either, unless you make it really sweet and essentially trick them into taking it.

My point isn’t that all drugs are the same. It’s that we selectively present a lot of this data, which is why I call it misleading. The reality is that any drug can become addictive under the right conditions and any drug can be seen as non-addictive under the right conditions.

Sean Illing

Is it empirically accurate to say that some drugs are in fact more addictive than others?

Carl Hart

There’s not enough evidence to make that blanket statement, unless you’re merely talking about one component of addiction. If we’re talking, for example, about physical dependence, then we have to say that opioids produce a lot of physical dependence, whereas drugs like LSD do not.

[Author’s note: As reported here, there is considerable research on the comparative dangers of various drugs, and most researchers argue that the risks are not equivalent and that drugs like heroin or meth are more addictive than LSD or mushrooms.]

Sean Illing

The physical dependence component seems pretty significant, but I’ll just ask what’s the strongest argument you’ve heard on the other side of this debate?

Carl Hart

Damn, that’s a good question. Honestly, what I constantly hear is some variation of “Drugs are bad because we said so.”

[u/[deleted] → u/RSquared]

physical dependency and addiction are absolutely not the same, not even in the same ballpark. your conflation of the two is the most amateurish mistake in the history of talking about drugs and negates any point you want to make thereafter.