"How about you move there, instead of implying that you find its system superior to the US?"
1) Because there is more to Singapore then crime.
2) Because it's on the other side of the planet and I'm not a citizen, nor are any in my family. Because it's not clear we could get jobs there.
"Setting aside the totalitarian implications of that endorsement"
Yes, people who visit Singapore routinely refer to it as a totalitarian hellhole. It's like they are in North Korea.
Myself, I enjoyed my visit. You should get out more.
"Singapore has 280 square miles of land area."
Singapore is a city. The appropriate comparison for Singapore would be large American cities. However, we could basically substitute any Asian country including big ones like Japan. Tough drug laws and criminal justice systems, lack of crime.
"you know, the dereliction of enforcement that allowed the legal opioid problem to get out of hand so badly in the 1990s,"
You are all over the place here dude. Opioids were legal and regulated like you want and they became a total mess. Is the problem legality or illegality? You can't seem to make up your mind here. Except that somehow an exactly perfect system should have done exactly the right thing, and you call me utopian.
What we learned is that doctors will push drugs that are bad for people if they have an incentive and that they can create their own demand (just like drug dealers). In fact it was worse because lots of people with better sense then to deal with drug dealers would trust their doctors.
If you think legal opioids were a mess I don't see how legal meth is going to go down any easier for you. The same dynamic will go down.
I expect basically every attempt to legalize drugs to go down the way opioids did, but worse the worse the drug is.
"Shotgun dry law enforcement killed more than 1200 people in raids across the country over the course of the mid-1920s."
Like police killings today, this is dramatically less then the # of people being murdered during the same time.
Total spending on prohibition enforcement in 1923 amounted under $9,000,000 in 2023 adjusted dollars. This amounted to $0.08 per person in 2023 dollars using the 1923 population. 0.0006% of GDP. This was not a serious attempt.
But more importantly I'm asking a simple question. Given that the period from the late 1800s until 1920 saw some parts of the country go dry and some stay wet, shouldn't we see a difference in crime rates between them? Shouldn't the dry areas have seen a huge increase in crime during this era? Shouldn't the crime in wet areas outperform them? This is as closed to a randomized trial as we can get.
I don't like prohibition because I think it was the wrong law and it failed most in the places that never wanted it in the first place. But I don't think drug prohibition is the reason for crime, and if you legalized every drug I would still expect to see crime (perhaps worse since addicts are more prone to criminality).
Your tourist endorsement of the Singapore regime of perpetual panopticon surveillance is duly noted. Singapore fans would probably embrace North Korea, too, if it were Rich. In that regard, I'm also definitely noting much more sympathy for the PRC system than ever before.
"You are all over the place here dude. Opioids were legal and regulated like you want and they became a total mess. Is the problem legality or illegality? You can't seem to make up your mind here. Except that somehow an exactly perfect system should have done exactly the right thing, and you call me utopian."
No, you've failed to comprehend my comment, and you're supplying your own misreading of its inferences.
Opioids (excepting heroin- a decision of caprice rather than rational justification) were- and still are- legal substances intended to be controlled by prescription. That control failed, because the DEA was tasked to emphasize raiding marijuana plantations over providing Federal supervision of the regulation of those substances- that control was left to the individual States!
I'm still looking into the particulars of the origin and development of the centralized Federal database- but the important thing to note is that the participation of the States was voluntary! As recently as the mid-2010s, the majority of the 50 States had not signed on to compliance with it! (My most recent reading indicated that there were still two holdouts.) Some of the states that had the least accountability on controlled substance prescriptions and pharmacy stocks were the states with the most draconian laws against illicit drugs. In those states, doctor shopping, multiple prescriptions, and script-doc profiteering became an industry overnight. (Meanwhile, California, which had much more liberal attitudes toward marijuana, had very tight accountability controls- and a low rate of Schedule II prescribed substance diversion and use.)
The DEA tried to tighten controls to obviate the problem of diversion, but the Congressional committee responsible for funding that effort refused to fund it adequately.
So the problem of inconsistency you're noticing isn't my fault; it's the fault of lawmakers with their heads up their ass. And that problem cuts in more than one way.
The origin of the prohibition of addiction maintenance goes back 100 years, to Supreme Court decisions that forbade physicians prescription for that purpose. The individual cases that led to that decision do appear to have involved profiteering "script docs"- but the blanket ban on allowing ANY physician to prescribe for addiction maintenance went too far, and that's what inaugurated the lucrative illicit marketplace for opioids in the US. ALL of that demand was driven from the doctor's offices into the streets.
The problem of slipshod enforcement of Schedule II prescription substances began in the aftermath of the DEA Schedule system- a Federal regulatory regime where enforcement was left entirely to the whims of the States. It was only a matter of time before that system was exploited- and that time came when the Sacklers- the original innovators in the mass-market advertising of prescription drugs (now widely accepted in TV ads)- applied their sales expertise to their newly ordained product, Oxycontin. Oxycontin became so ubiquitously prescribed- and, crucially, so easily diverted- that in only a few years, it generated an opioid problem that dwarfed the heroin market.
And then, some time in the 2010s, with the horse having already left the barn and millions of addicts having been generated, the Feds decided to crack down on opioid prescriptions. And since the rule against addiction maintenance still applied, all of those addicts were consigned to the heroin market- and, following the Gresham's Law analog that applies to illicit drug markets, eventually to fentanyl (which, in due time, is likely to be followed by carfentanil, and similarly superpotent opioid analogs...)
Yes, I'm in favor of prescription controls over opioids, and tight accountability over prescriptions. But I'm also in favor of addiction maintenance by qualified professionals who provide regulated supplies to confirmed addicts- not just to anyone who shows up claiming that they have a back sprain.
That isn't being "all over the place." I'm advocating rational controls over some particularly powerful substances in line with the goals of harm reduction. The inconsistency is to be found in the insistence on over-controlling substances in a punitive moralist attempt to punish addicts, coupled with a history of patchwork lax enforcement and non-enforcement of the provisions intended to prevent profiteering and diversion.
That history isn't just a matter of less than perfect enforcement of the rules. It's studied negligence by institutional power, disdaining the practical necessity of stabilizing addicts in one breath while deferring to a paradigm that maximizes the profits of Big Pharma through enabling mass-marketing campaigns, shilling, and physician rewards for maximizing prescription on the other.
If you think Singapore is North Korea your basically off your rocker.
I like freedom. Getting mugged is the opposite of freedom. Having huge portions of cities being considered places you can't go isn't freedom. You can ride the subway in Singapore and not live in terror. Anarcho-tyranny is not freedom.
And being a drug addict is not freedom, its being ensalved to a drug.
"because the DEA was tasked to emphasize raiding marijuana plantation"
This is getting pathetic.
I worked in the drug insurance industry. And I worked on finding pharmacy fraud. Marijuana had ZERO to do with it. People were making money and consumer were happy (for a time). Nobody asked questions until so many bodies piled up that political hill could be made out of it.
Pharmacy fraud is still ultra rampant in everything that isn't opioids because they don't care how much money the government loses as long as nobody is calling their senator because their husband died.
And it will go exactly the same way with the next addictive drug we let people sell legally.
"it's the fault of lawmakers with their heads up their ass."
They always have their heads up their ass! Have you met a lawmaker? A regulator? YOU CAN NOT TRUST THEM TO DO ANYTHING COMPLICATED OR SUBTLE OR PREDICT THE FUTURE IN ANY WAY OR CARE ABOUT ANYONE! That's why we write simple laws that are hard to loophole...like that dangerous addictive drugs are illegal.
You're the one who brought up North Korea. If only North Korea was wealthy, it would resemble Singapore more than it does the US.
You obviously prefer to extract stray statements out of context in preference to centering an argument on the issue content (fwiw, I have zero interest in being drawn into an off-topic exchange on the merits of Singapore vs. the DPRK). You also moan nonsensical takes like "this is getting pathetic" to yourself, as if you were mounting a germane argument.
fwiw, this really did happen in the year 2000, just as the Oxy epidemic was getting out of hand:
"I worked in the drug insurance industry. And I worked on finding pharmacy fraud...[deleted as irrelevant and superfluous] People were making money and consumer were happy (for a time). Nobody asked questions until so many bodies piled up that political hill could be made out of it."
I'm not sure what "political hill" is. I'm also not sure that you had any business working to find pharmacy fraud, if you're going to be that cynical about it.
"Pharmacy fraud is still ultra rampant in everything that isn't opioids because they don't care how much money the government loses as long as nobody is calling their senator because their husband died."
That doesn't really sound like the sort of pharmacy fraud that I've been referring to. But are you ever cynical. Although when it comes to the War on Drugs, you continue to be a...well, you don't really sound like a convinced idealist on that, either. You're more like a terminally cynical apologist for Power, exercised on behalf of punitive moralism. As long as it doesn't hit too close to home. As long as it focuses on the "low IQ" menace.
"They always have their heads up their ass! Have you met a lawmaker? A regulator? YOU CAN NOT TRUST THEM TO DO ANYTHING COMPLICATED OR SUBTLE OR PREDICT THE FUTURE IN ANY WAY OR CARE ABOUT ANYONE!"
Whoa.
It's interesting to hear that vote of utter and complete lack of faith in government's ability to do anything right. Anything other than punish with draconian prohibitions, that is, which is when somehow everything suddenly works so much more efficiently:
"That's why we write simple laws that are hard to loophole [sic]...like that dangerous addictive drugs are illegal."
LOL!!! You actually wrote that garbage!!!
@fp123...even given the recent over-tightening of restrictions on opioid prescriptions, they're still some of the most heavily prescribed substances in existence. Hydrocodone, oxycodone's slightly less powerful cousin, is the 16th most heavily prescribed drug (of any kind) in the US:
You want a ban on that? If you want a ban on all "dangerous addictive drugs", that's what you support. Because that's what a "simple law" would prohibit. Along with a complete ban on morphine, Dilaudid, Demerol, Methadone, buprenorphine, Tramadol, Oxycodone (still available with prescription), fentanyl (still available with prescription)...to say nothing of the benzodiazepines, which produce a worse physical dependency than opioids when used daily for extended periods of time; or the psychostimulants like amphetamines and methylphenidate, which also qualify as addictive substances, although they aren't nearly as lethally dangerous as the opioids or the benzos; and the SSRI medications, which can produce such seriously mind-bending psychic withdrawal symptoms on discontinuance that it's now admitted that many long-time SSRI users who wish to get off of them require a slow tapering off period of a year or more.
You sound like the White Queen, from Alice In Wonderland: the only thing a government can possibly accomplish is "OFF WITH THEIR HEADS!!!"
But, well, you have a link to pictures of some bootleg meth users who were criminalized, pushed into a corner and poked with sticks, after consuming unregulated and poisonous products made with a witches brew of bootleg chemicals like hydriotic acid, muriatic acid, iodine, mercury chrloride, P-2-P, and lye. So, case closed, according to that weighty logic:
"I really do not think something that does this should be legal."
On that we're agreed: I don't think that poisonous bootleg meth should be legal, either. Fortunately the methamphetamine sold in American pharmacies doesn't have those problems. Because its manufacture is regulated by the FDA, as an approved Schedule II drug that's legal by prescription. A fact that I've already mentioned, that you've evidently overlooked.
fine to stop discussing. your equivalence talk just makes me think your deranged and ideological. please talk to some people from both places.
"You want a ban on that?"
I don't think Oxycontin ever should have been sold to people that weren't chemo patients or had back surgery. The Sackler's convinced everyone that "pain" was under diagnosed and under treated, and they were able to convince people because it just happened that everyone's incentives were to do so. Doctor's were given "discretion" to determine what people needed outside of those clear cases, and it turned out they needed whatever made the doctors money. Insurance was bought off with manufacturer rebates. Patients obviously liked how it made them feel.
I could say a lot of the same about SSRIs. Way more people are allowed on them in the first place than should be. All the financial incentives are the same.
The basic problem is that these medicines should only be used in extreme medical cases, but it was decided everyone with an achy shoulder or a bad thought should get whatever they want. We gave doctors "discretion" and they always exercise discretion in the direction of their pocketbook.
That's what I think will happen with any drug that makes people feel good. The patients will want it. The doctors, manufacturers, and insurance companies can be bought off with government insurance money. In general I think the entire incentive structure that makes it profitable for all these parties to engage in this needs to be attacked. As long as people make money there will only be pushback against "discretion" after the bodies pile up.
"I don't think that poisonous bootleg meth should be legal, either"
So you're a PROHIBITIONIST. Bootleg meth has willing suppliers and willing buyers. And you're off prohibiting it, you puritan. Don't you know that if you make things people want illegal they will turn to crime and gang wars.
Once you've decided that it's GOOD to make certain drugs illegal we are just arguing over what those drugs are and what the regulations should be. And unless your answer is "everything legal and no regulations" then there is going to be an incentive for an illegal drug trade of some kind. The question is what to do about it.
"I don't think Oxycontin ever should have been sold to people that weren't chemo patients or had back surgery."
Chemically, Oxycontin is merely time-released oxycodone- which was prescribed for decades for acute pain relief as Percodan, typically in 5mg amounts. It's only marginally more powerful than hydrocodone- 20%-50% more powerful. Hydrocodone is Vicodin- the more common mainstay for acute pain problems like wisdom tooth extraction, back sprain, and shingles outbreak. As with Percodan, 5-10mg is typically all most people require for those pain conditions.
The problem that launched the Oxy epidemic was not related to any sinister property of oxycodone, per se. It's due to the fact that it was compounded for extended release, often in amounts as large as 40mg, 80mg, or even 120mg. And all users had to do to get the instant release was to chew them!
5-10mg of oxy makes for a good pain reliever. When chewed for fast release, 40mg of oxy compares favorably with a bag of street heroin.
"The Sackler's convinced everyone that "pain" was under diagnosed and under treated, and they were able to convince people because it just happened that everyone's incentives were to do so."
Not "everyone's incentives." The real problem there isn't any particular drug- it's the "marketing innovations" of the Sacklers, which go back to the 1950s, when old man Sackler got the brainstorm that prescription pharmaceuticals could be marketed just like soda pop, by using full-page ads in magazines and commission-sales pitches to physicians. I think this was an idea gone horribly wrong. But the answer is not to ban the drugs- it's to ban the commercialization, advertising, and commission sales pitch techniques. And the doctors need to get a lot more education about medications- particularly about pain and addiction medicine.
"Doctor's were given "discretion" to determine what people needed outside of those clear cases, and it turned out they needed whatever made the doctors money."
Many of the doctors were sincerely misled- they trusted the sales people, and the threadbare, slipshod studies that provided the basis of the sales hype for Oxy. The doctors should have had more skepticism, simply due to the amounts of opiods compounded in each pill. But pain, addiction, and pharmaceutical side effects have been given such short shrift in the curricula of medical schools that the doctors were naifs. (Except for the unethical ones.)
There are no direct kickbacks to physicians from every prescription that they write. But pharma companies have been known to reward physicians who prescribe brand-name products beyond a given level with bonuses all the time. That's another practice that needs to be banned. But it isn't the fault of any particular drug.
Scrip docs make their money as private practitioners catering to one particular clientele (like "pain patients") with cash visits, in and out, as fast as possible, like an assembly line. It's an unethical practice that would have easily been detected if a nationwide database of accountability had been in place in the 1990s and 2000s. The fact that it wasn't is not a failure of regulation- it's a failure of un-regulation. A bug in the regulatory scheme, not a feature. And overcompensating by choking off supplies after the damage has been done is not an evidence-based response; it's political posturing.
"Insurance was bought off with manufacturer rebates."
This is more like a problem of the US health care system in general. Notwithstanding my support for private markets for consumer products, pharma is different: I'm not averse to the notion of nationalizing pharmaceutical manufacture. Drugs are not soda pop, or televisions, or shampoo. They're generic chemicals, identical except for occasional minor changes in compounding. We should consider a public option for their manufacture. We definitely don't need ads for them on TV.
"Patients obviously liked how it made them feel."
Yes, but that sometimes came as a surprise; the way Oxy (and fentanyl) got marketed in the 1990s is approximately as deceptive as the way opioid-based patent medicines were marketed, prior to the 1906 Pure Food and Drug Act. Read the book Dopesick. I've read hundreds of books on drugs, but that book had me staring at the ceiling all night after I read it. Read the book Dreamland, too- it isn't quite as harrowing, but it's a telling account of what happens when powerful substances with supplies that are supposed to be controlled and accountable slip the leash, due to a complete failure to effectively implement a regulatory system.
In my opinion, the subtext for that failure was Respectability and Prestige Power (including campaign donations.) Congress failed to take the DEA seriously, because they couldn't quite comprehend the notion that opioids manufactured and sold by their Big Pharma donors and lobbyist buddies could actually be as harmful as the opioids sold by "the gangs" on the illicit street market.
After all, like Peter Schweizer says, the real corruption in Washington isn't what's illegal- it's about what IS legal. Surely you've read Roger Morris' 1996 book Partners In Power...remember the three chapters entitled "Washington I/II/III"? Here- refresh your memory with this free download: https://archive.org/details/partnersinpowerc0000morr_c3r1
The Oxy epidemic- and its aftermath- isn't the fault of any particular chemical compound. Opiods- including fentanyl and oxycodone- continue to be the legitimate mainstay of pain management medicine. Because they're the most effective class of compounds, for many pain sufferers.
"And all users had to do to get the instant release was to chew them!"
Sounds like a pretty easy thing to get around, and people did.
"it's to ban the commercialization, advertising, and commission sales pitch techniques."
"That's another practice that needs to be banned."
I don't have a particular problem with this line, but the fact that all this stuff is still around is an indication of its staying power.
Here are the parties that can prevent a drug from getting dispensed.
1) The patient
2) The doctor
3) The insurance company
4) The government
When the drug is pleasant and addictive, the member doesn't stop it from getting dispensed. That is by far the #1 line of defense, when patients want something they tend to find ways. Its easier to control abuse when its not a drug the patient would enjoy.
The doctor and the insurance company can get paid off. Ultimately, this money comes from the government. Yes, manufacturers give rebates, but rebates are only effective because
A) The government allows them &
B) the government has designed its insurance programs in such a way that rebates can be abused.
The government does this because they don't give a shit. Trust me, I know these people, they don't give a shit. Sometimes it's even the point (they want to backdoor subsidize Pharma because key constituencies want cheaper drugs.
The government only cares when it causes a political problem. Opioids caused enough bodies to show up that congress couldn't ignore it anymore. Then they made the agencies do something because there was a political advantage to do so. This is the sort of thing that will only be done AFTER THE FACT, and usually only in high profile cases with lots of dead bodies.
I think it would be better to have a baseline skepticism of drug classes where usefulness is hard to prove and patients have bad incentives. Relying on doctors/insurance/government to nuance things in those cases is probably going to have a bad track record.
"Yes, I'm in favor of prohibiting some substances. And tightly regulating others"
So you've agreed with my the whole time.
"However, I think that civil confiscation of unsafe products is typically a more practical solution than getting the criminal courts involved."
If you mean possession, yes. I'd be fine with decriminalizing small possession.
If you mean manufacture and sale, I think that's criminal.
A lot of people in on possession charges are really plea bargains down from bigger crimes. I don't think it will impact incarceration much to decriminalize possession, cops will find something else if they think it's a real criminal.
"No one would buy the bootleg garbage if they could get a pure supply"
It seems to me that people will buy almost anything. You can't just decide that people can make a drug whose purpose is addiction.
"The basis of my drug policy positions is that I follow the evidence."
We all do.
It seems to me we have a few differences:
1) I think that we should take a skeptical look at drugs whose benefits are unclear and whose harms are addictive. We should generally assume that in cases were the patient will have bad incentives it's hard to get the other players to reign things in.
2) I don't think drugs drive crime to the same degree most "legalize drugs" people do. I think that crime is mostly dumb low IQ young men that want to participate in a violent tournament and drugs is just an excuse. If you made one drug legal they would find another. If you made all drugs illegal they would fight over something else.
I think the "solve crime by legalizing drugs" crowd is distracting from the real issues with crime (clearance rates and punishment). I think crime gets solved by solving crime, and that various "root causes" have more excuse to them than truth value.
3) I think that a lot of drug addiction can be incented. That is street dealers, manufacturers, and doctors can find ways to create new addicts if they've got an addictive substance they can use. If they can't use one, I think they will just move on to another, until we get one even you balk at. Hence, this will always be a problem.
"Sounds like a pretty easy thing to get around, and people did."
15 years too late, Purdue eventually reformulated the pills with some gummy substance that makes the pills impossible to snort or shoot. It's undoubtedly still possible to dissolve the active ingredient by leaving it in a glass of water overnight, or something like that.
"When the drug is pleasant and addictive, the member doesn't stop it from getting dispensed. That is by far the #1 line of defense, when patients want something they tend to find ways. Its easier to control abuse when its not a drug the patient would enjoy."
So what's your obsession with defining and controlling other people, simply on the basis that they find a substance pleasurable? Coffee is pleasurable- and addictive, too. If someone isn't broken- giving pronounced evidence of a problem for public health and safety- what's with your insistence on forcibly fixing them? You must be familiar with the term "iatrogenic problem." You don't seem to know how to apply it to evidence right in front of your face, though.
People who became addicted to opioids due to the massive over-prescription by their doctors often eventually lose all perspective on any pleasure they might obtain from them, incidentally. They aren't primarily driven by the situation that you're so het up about- chemically derived feelings of euphoria. Opioid addicts perceive a need for the substance the way that thirsty people in the desert perceive a need for water. And I really wish that the APA hadn't gone off into arcane jargon neologism land, by redefining the term "addiction" as something less than what it means for opioid addicts. Because the new rules make it seem like everything enjoyable is addictive. For people with authentically serious drug dependencies, addiction feels like life or death. Not the same thing as being "addicted" to a smartphone.
Speaking for myself, I'm wary of opioids. I've gotten them for acute pain, and I take the minimum. But few people heed even accurate information from officialdom, given that officialdom is on a hypocritical crusade to terrorize the citizenry into modifying their personal behaviors. I mean, so much for education. And that goes for illicit-drug naive people, too- there's such a cult of Expertise in the US that most people are conditioned to do anything a licensed physician says, and take anything the doctor orders, without doing so much as a single keyword search on the possible hazards on what they've just been told to swallow.
So yes, I agree that it really is ultimately the patient's lookout. But you can't inject an overhaul of societal attitudes into people like a vaccine. That leaves it to the doctors to act responsibly in their prescribing- neither too punitively or too recklessly. And yes, addiction medicine with prescription maintenance ought to be an approved practice, with care available to the public at large, not just the wealthy addict population.
"Government only cares when it causes a political problem."
"The government" has spent over a trillion dollars on the Drug War in the past 50 years. Presidential administrations have gone out of their way to avoid the related "political problems" by pandering to the ignorance of the citizenry and indulging in chicanery and hypocrisy to cultivate mass public cognitive dissonance on these topics. That is not the fault of the movement to reform the drug laws.
You just sound ridiculous at this point. Don't take it personally: the position you're arguing for in this case is so weak as to be indefensible. You might actually be capable of making valid points in a critique of, say, single-payer health insurance. But you're twisting yourself into knots with hypothetical arguments and unsupported fantasy conjectures in order to justify the status quo of drug criminalization and cannabis prohibition.
"eventually lose all perspective on any pleasure they might obtain from them"
Yes, that is how drug addiction works. People start it because it feels good, they need more and more, and it fries them up. That's why dealers (legal and illegal) often give the first dose free. They know how addiction works. They create their own demand.
"So what's your obsession with defining and controlling other people"
When people become drug addicts they become a menace to themselves and society. I care about how addiction makes live worse for everyone. They become criminal and dependent. They cost the government a lot of money.
"If someone isn't broken- giving pronounced evidence of a problem for public health and safety- what's with your insistence on forcibly fixing them?"
Coffee doesn't predictably turn people into criminal street addicts with probability X% that is above the threshold at which the substance should be allowed. Meth and other drugs do. I'm not going to give people meth, wait until they destroy themselves and become a burden and danger to society, and then start worrying. If a substance has little benefit a predictable high cost then it shouldn't be allowed. If it has strong benefits in rare contexts (pain killers and back surgery) then they should be tightly controlled and only allowed in those narrow lanes (most hard street drugs don't have benefit in any context).
The same way we don't allow all sorts of things we know lead to trouble. We don't even allow people to drink alcohol after the 7th inning because we know it leads to more drunk driving on the way home from the game.
"has spent over a trillion dollars on the Drug War in the past 50 years"
A trillion dollars over 50 years is not a whole lot. That's why they've got to add it up over 50 years to make it look big. And if you're using the article I googled, they are counting a lot of costs which are dubious to be part of the war on drugs. Is the incarceration costs of everyone with a drug charge in prison a cost of the war on drugs? None of those people would be in prison anyway? When marijuana was legalized it didn't put a dent in incarceration, because people on drug charges are usually violent criminals too.
But let's say the government was spending a lot of money. Would that prove that the government "cares"? The government spends a lot of money on a lot of things and doesn't give a flying fuck about the results. The spending is the point, interest groups are getting paid, not whether it works.
Singapore "cares" about its War on Drugs. That's why it won its war on drugs. I suspect they spend less on their War on Drugs than we do.
The bottom line is simple. Nobody has the "freedom" to destroy themselves.
When they do they inevitably become a problem for themselves, others, and society. Some substances statistically lead to self destruction at unacceptable rates relative to the benefits and thus shouldn't be allowed.
You understand this is a problem, but you can't quite get around this "freedom" hang up. It's why you fly off the handle and call places like Singapore as being like North Korea, or call anyone wanting to stop people from becoming meth addicts of wanting to ban coffee. Freedom to engage in behavior likely to lead to self destruction is just something you think Makes America Great. It's regrettable, maybe something should be done, but we should always air on the side of allowing self destruction and not be judgmental.
I don't. I don't see any freedom in being and addict. I don't see any freedom being victimized by an addict. I don't see any freedom in paying for an addicts public benefits.
I believe in freedom because I want to be my best self, not my worst self.
Yes, I'm in favor of prohibiting some substances. And tightly regulating others- that process that you seem to regard as a corrupt feature of government, rather than a process with some bugs. However, I think that civil confiscation of unsafe products is typically a more practical solution than getting the criminal courts involved.
"Bootleg meth has willing suppliers and willing buyers."
I've already told you twice: amphetamines- including methampetamines- are LEGALLY REGULATED. No one would buy the bootleg garbage if they could get a pure supply. Come on, this is basic. But we're dealing with a medical-legal regime that won't even attempt to experiment with amphetamine maintenance for meth addicts- not even a program like methadone maintenance, where users would show up for a daily dose of oral medication. Many of those folks have undiagnosed ADD (which is a real ailment, fwiw.) But if someone is criminalized prior to diagnosis, they're sunk. They're "meth freaks."
I'd be a lot more dubious about Schedule II amphetamine prescription- something like 13 million Americans have an amphetamine or methylphenidate script- if it was driving large numbers of people on to the street to bang 100mg loads of crystal ten times a day. But it isn't a problem the way over-prescribed Oxy was. Because it isn't the same substance. Dependency and ill health effects from amphetamine pills are a personal liability- the warning signs of overuse need to be heeded. But it isn't a public health menace. Whether over-prescribed or not, people aren't dropping dead left and right from their Adderall prescriptions. There isn't an epidemic of doctor shopping and wholesale diversion of industrial quantities to the street market so that people can gobble/snort/shoot mass quantities of amphetamine pills to cope with an escalating tolerance and an intensifying addiction.
The basis of my drug policy positions is that I follow the evidence.
"Once you've decided that it's GOOD to make certain drugs illegal we are just arguing over what those drugs are and what the regulations should be."
Well, yeah. But unlike myself, you've just spent half of your post content arguing that regulatory controls are corrupt and ineffective, and that the only answer should be "simple laws, with no loopholes" to work as blanket prohibitions over a wide array of substances, including marijuana, a nontoxic herb that's less poisonous than many of the products in stock on a kitchen spice rack.
Which is to say, you're all over the place on this.
So am I- but I'm basing the differences in my policies on rational assessment of harm to public health and safety. Whereas you're still thrashing around like the White Queen from Alice In Wonderland.
Hopefully, my last post cleared up your confusion in regard to my position on the proper regime for controlling opioid prescription.
Now, on to another point:
"If you think legal opioids were a mess I don't see how legal meth is going to go down any easier for you. The same dynamic will go down."
Meth (aka methamphetamine aka Desoxyn) is already legal. Schedule II*. What, nobody told you? The statistics on how many legal meth prescriptions are written annually have proved resistant to my inquiries. But it's well-known that as a class, the amounts of prescribed amphetamines are in the hundreds of millions annually- they're almost as common as they were in the 1950s and 1960s. Fortunately, there's little evidence of a public health problem resulting from that situation. Notwithstanding the fact that amphetamine pills aren't exactly free of harm or addiction liability, their widespread prescription in recent decades hasn't led to the disastrous effects of the Oxycontin epidemic. However, if the Drug Warriors want another illicit street drug disaster on their hands, they'd get one soon enough if they were to decide to choke off the prescription of amphetamines the way they did prescription opioids.
It's worth noting that the last time the Federal government took measures to drastically limit the prescription of amphetamines in the early 1970s, the user demand swiftly shifted over to another product that was coincidentally just arriving on the heels of the burgeoning nationwide retail marijuana market: cocaine. This time around, the illicitly sourced methamphetamine market is much more mature. So I'd anticipate that the two commodities would have to fight it out for the newly expanded street demand. The increase in the consumer base resulting from a crackdown on amphetamine prescriptions would almost certainly be massive, however.
Meanwhile, the current medical-legal regime in the US is even more rigidly opposed to providing a daily regime of oral amphetamine maintenance for people with meth problems than it is to providing controlled amounts of opiods to opioid addicts. Go figure.
[ *Cocaine and fentanyl are also DEA Schedule II controlled substances, fwiw. ]
"How about you move there, instead of implying that you find its system superior to the US?"
1) Because there is more to Singapore then crime.
2) Because it's on the other side of the planet and I'm not a citizen, nor are any in my family. Because it's not clear we could get jobs there.
"Setting aside the totalitarian implications of that endorsement"
Yes, people who visit Singapore routinely refer to it as a totalitarian hellhole. It's like they are in North Korea.
Myself, I enjoyed my visit. You should get out more.
"Singapore has 280 square miles of land area."
Singapore is a city. The appropriate comparison for Singapore would be large American cities. However, we could basically substitute any Asian country including big ones like Japan. Tough drug laws and criminal justice systems, lack of crime.
"you know, the dereliction of enforcement that allowed the legal opioid problem to get out of hand so badly in the 1990s,"
You are all over the place here dude. Opioids were legal and regulated like you want and they became a total mess. Is the problem legality or illegality? You can't seem to make up your mind here. Except that somehow an exactly perfect system should have done exactly the right thing, and you call me utopian.
What we learned is that doctors will push drugs that are bad for people if they have an incentive and that they can create their own demand (just like drug dealers). In fact it was worse because lots of people with better sense then to deal with drug dealers would trust their doctors.
If you think legal opioids were a mess I don't see how legal meth is going to go down any easier for you. The same dynamic will go down.
I expect basically every attempt to legalize drugs to go down the way opioids did, but worse the worse the drug is.
"Shotgun dry law enforcement killed more than 1200 people in raids across the country over the course of the mid-1920s."
Like police killings today, this is dramatically less then the # of people being murdered during the same time.
Total spending on prohibition enforcement in 1923 amounted under $9,000,000 in 2023 adjusted dollars. This amounted to $0.08 per person in 2023 dollars using the 1923 population. 0.0006% of GDP. This was not a serious attempt.
But more importantly I'm asking a simple question. Given that the period from the late 1800s until 1920 saw some parts of the country go dry and some stay wet, shouldn't we see a difference in crime rates between them? Shouldn't the dry areas have seen a huge increase in crime during this era? Shouldn't the crime in wet areas outperform them? This is as closed to a randomized trial as we can get.
I don't like prohibition because I think it was the wrong law and it failed most in the places that never wanted it in the first place. But I don't think drug prohibition is the reason for crime, and if you legalized every drug I would still expect to see crime (perhaps worse since addicts are more prone to criminality).
Your tourist endorsement of the Singapore regime of perpetual panopticon surveillance is duly noted. Singapore fans would probably embrace North Korea, too, if it were Rich. In that regard, I'm also definitely noting much more sympathy for the PRC system than ever before.
"You are all over the place here dude. Opioids were legal and regulated like you want and they became a total mess. Is the problem legality or illegality? You can't seem to make up your mind here. Except that somehow an exactly perfect system should have done exactly the right thing, and you call me utopian."
No, you've failed to comprehend my comment, and you're supplying your own misreading of its inferences.
Opioids (excepting heroin- a decision of caprice rather than rational justification) were- and still are- legal substances intended to be controlled by prescription. That control failed, because the DEA was tasked to emphasize raiding marijuana plantations over providing Federal supervision of the regulation of those substances- that control was left to the individual States!
I'm still looking into the particulars of the origin and development of the centralized Federal database- but the important thing to note is that the participation of the States was voluntary! As recently as the mid-2010s, the majority of the 50 States had not signed on to compliance with it! (My most recent reading indicated that there were still two holdouts.) Some of the states that had the least accountability on controlled substance prescriptions and pharmacy stocks were the states with the most draconian laws against illicit drugs. In those states, doctor shopping, multiple prescriptions, and script-doc profiteering became an industry overnight. (Meanwhile, California, which had much more liberal attitudes toward marijuana, had very tight accountability controls- and a low rate of Schedule II prescribed substance diversion and use.)
https://www.rollingstone.com/culture/culture-news/the-dukes-of-oxy-how-a-band-of-teen-wrestlers-built-a-smuggling-empire-226940/
The DEA tried to tighten controls to obviate the problem of diversion, but the Congressional committee responsible for funding that effort refused to fund it adequately.
So the problem of inconsistency you're noticing isn't my fault; it's the fault of lawmakers with their heads up their ass. And that problem cuts in more than one way.
The origin of the prohibition of addiction maintenance goes back 100 years, to Supreme Court decisions that forbade physicians prescription for that purpose. The individual cases that led to that decision do appear to have involved profiteering "script docs"- but the blanket ban on allowing ANY physician to prescribe for addiction maintenance went too far, and that's what inaugurated the lucrative illicit marketplace for opioids in the US. ALL of that demand was driven from the doctor's offices into the streets.
The problem of slipshod enforcement of Schedule II prescription substances began in the aftermath of the DEA Schedule system- a Federal regulatory regime where enforcement was left entirely to the whims of the States. It was only a matter of time before that system was exploited- and that time came when the Sacklers- the original innovators in the mass-market advertising of prescription drugs (now widely accepted in TV ads)- applied their sales expertise to their newly ordained product, Oxycontin. Oxycontin became so ubiquitously prescribed- and, crucially, so easily diverted- that in only a few years, it generated an opioid problem that dwarfed the heroin market.
And then, some time in the 2010s, with the horse having already left the barn and millions of addicts having been generated, the Feds decided to crack down on opioid prescriptions. And since the rule against addiction maintenance still applied, all of those addicts were consigned to the heroin market- and, following the Gresham's Law analog that applies to illicit drug markets, eventually to fentanyl (which, in due time, is likely to be followed by carfentanil, and similarly superpotent opioid analogs...)
Yes, I'm in favor of prescription controls over opioids, and tight accountability over prescriptions. But I'm also in favor of addiction maintenance by qualified professionals who provide regulated supplies to confirmed addicts- not just to anyone who shows up claiming that they have a back sprain.
That isn't being "all over the place." I'm advocating rational controls over some particularly powerful substances in line with the goals of harm reduction. The inconsistency is to be found in the insistence on over-controlling substances in a punitive moralist attempt to punish addicts, coupled with a history of patchwork lax enforcement and non-enforcement of the provisions intended to prevent profiteering and diversion.
That history isn't just a matter of less than perfect enforcement of the rules. It's studied negligence by institutional power, disdaining the practical necessity of stabilizing addicts in one breath while deferring to a paradigm that maximizes the profits of Big Pharma through enabling mass-marketing campaigns, shilling, and physician rewards for maximizing prescription on the other.
If you think Singapore is North Korea your basically off your rocker.
I like freedom. Getting mugged is the opposite of freedom. Having huge portions of cities being considered places you can't go isn't freedom. You can ride the subway in Singapore and not live in terror. Anarcho-tyranny is not freedom.
And being a drug addict is not freedom, its being ensalved to a drug.
"because the DEA was tasked to emphasize raiding marijuana plantation"
This is getting pathetic.
I worked in the drug insurance industry. And I worked on finding pharmacy fraud. Marijuana had ZERO to do with it. People were making money and consumer were happy (for a time). Nobody asked questions until so many bodies piled up that political hill could be made out of it.
Pharmacy fraud is still ultra rampant in everything that isn't opioids because they don't care how much money the government loses as long as nobody is calling their senator because their husband died.
And it will go exactly the same way with the next addictive drug we let people sell legally.
"it's the fault of lawmakers with their heads up their ass."
They always have their heads up their ass! Have you met a lawmaker? A regulator? YOU CAN NOT TRUST THEM TO DO ANYTHING COMPLICATED OR SUBTLE OR PREDICT THE FUTURE IN ANY WAY OR CARE ABOUT ANYONE! That's why we write simple laws that are hard to loophole...like that dangerous addictive drugs are illegal.
https://www.datocms-assets.com/59248/1648782386-faces-of-meth-3.jpg?auto=format&q=89&w=720
I really do not think something that does this should be legal.
You're the one who brought up North Korea. If only North Korea was wealthy, it would resemble Singapore more than it does the US.
You obviously prefer to extract stray statements out of context in preference to centering an argument on the issue content (fwiw, I have zero interest in being drawn into an off-topic exchange on the merits of Singapore vs. the DPRK). You also moan nonsensical takes like "this is getting pathetic" to yourself, as if you were mounting a germane argument.
fwiw, this really did happen in the year 2000, just as the Oxy epidemic was getting out of hand:
https://www.motherjones.com/politics/2001/02/drug-war-comes-rez/
https://journalstar.com/business/lakota-hemp-farmer-left-broke-by-dea/article_4588e603-e0ce-5beb-ae93-0afb463926ca.html
"I worked in the drug insurance industry. And I worked on finding pharmacy fraud...[deleted as irrelevant and superfluous] People were making money and consumer were happy (for a time). Nobody asked questions until so many bodies piled up that political hill could be made out of it."
I'm not sure what "political hill" is. I'm also not sure that you had any business working to find pharmacy fraud, if you're going to be that cynical about it.
"Pharmacy fraud is still ultra rampant in everything that isn't opioids because they don't care how much money the government loses as long as nobody is calling their senator because their husband died."
That doesn't really sound like the sort of pharmacy fraud that I've been referring to. But are you ever cynical. Although when it comes to the War on Drugs, you continue to be a...well, you don't really sound like a convinced idealist on that, either. You're more like a terminally cynical apologist for Power, exercised on behalf of punitive moralism. As long as it doesn't hit too close to home. As long as it focuses on the "low IQ" menace.
To get back to specifics, this the regulation problem that I was referring to: https://www.cbsnews.com/news/60-minutes-ex-dea-agent-opioid-crisis-fueled-by-drug-industry-and-congress/
To which your reply is:
"They always have their heads up their ass! Have you met a lawmaker? A regulator? YOU CAN NOT TRUST THEM TO DO ANYTHING COMPLICATED OR SUBTLE OR PREDICT THE FUTURE IN ANY WAY OR CARE ABOUT ANYONE!"
Whoa.
It's interesting to hear that vote of utter and complete lack of faith in government's ability to do anything right. Anything other than punish with draconian prohibitions, that is, which is when somehow everything suddenly works so much more efficiently:
"That's why we write simple laws that are hard to loophole [sic]...like that dangerous addictive drugs are illegal."
LOL!!! You actually wrote that garbage!!!
@fp123...even given the recent over-tightening of restrictions on opioid prescriptions, they're still some of the most heavily prescribed substances in existence. Hydrocodone, oxycodone's slightly less powerful cousin, is the 16th most heavily prescribed drug (of any kind) in the US:
"Hydrocodone/acetaminophen (Lortab, Norco, Vicodin, various others), a narcotic analgesic. Total prescriptions: 30,100,356 representing 8,587,152 patients" https://www.healthgrades.com/right-care/patient-advocate/the-top-50-drugs-prescribed-in-the-united-states
You want a ban on that? If you want a ban on all "dangerous addictive drugs", that's what you support. Because that's what a "simple law" would prohibit. Along with a complete ban on morphine, Dilaudid, Demerol, Methadone, buprenorphine, Tramadol, Oxycodone (still available with prescription), fentanyl (still available with prescription)...to say nothing of the benzodiazepines, which produce a worse physical dependency than opioids when used daily for extended periods of time; or the psychostimulants like amphetamines and methylphenidate, which also qualify as addictive substances, although they aren't nearly as lethally dangerous as the opioids or the benzos; and the SSRI medications, which can produce such seriously mind-bending psychic withdrawal symptoms on discontinuance that it's now admitted that many long-time SSRI users who wish to get off of them require a slow tapering off period of a year or more.
You sound like the White Queen, from Alice In Wonderland: the only thing a government can possibly accomplish is "OFF WITH THEIR HEADS!!!"
Like, you know, Duterte in the Philippines: https://www.reuters.com/investigates/section/philippines-drugs/
https://www.msn.com/en-us/news/world/philippine-court-acquits-top-critic-of-ex-president-dutertes-war-on-drugs/ar-AA1b8LHe
So, how did the "simple" approach work out there?
But, well, you have a link to pictures of some bootleg meth users who were criminalized, pushed into a corner and poked with sticks, after consuming unregulated and poisonous products made with a witches brew of bootleg chemicals like hydriotic acid, muriatic acid, iodine, mercury chrloride, P-2-P, and lye. So, case closed, according to that weighty logic:
"I really do not think something that does this should be legal."
On that we're agreed: I don't think that poisonous bootleg meth should be legal, either. Fortunately the methamphetamine sold in American pharmacies doesn't have those problems. Because its manufacture is regulated by the FDA, as an approved Schedule II drug that's legal by prescription. A fact that I've already mentioned, that you've evidently overlooked.
"Singapore vs. the DPRK"
fine to stop discussing. your equivalence talk just makes me think your deranged and ideological. please talk to some people from both places.
"You want a ban on that?"
I don't think Oxycontin ever should have been sold to people that weren't chemo patients or had back surgery. The Sackler's convinced everyone that "pain" was under diagnosed and under treated, and they were able to convince people because it just happened that everyone's incentives were to do so. Doctor's were given "discretion" to determine what people needed outside of those clear cases, and it turned out they needed whatever made the doctors money. Insurance was bought off with manufacturer rebates. Patients obviously liked how it made them feel.
I could say a lot of the same about SSRIs. Way more people are allowed on them in the first place than should be. All the financial incentives are the same.
The basic problem is that these medicines should only be used in extreme medical cases, but it was decided everyone with an achy shoulder or a bad thought should get whatever they want. We gave doctors "discretion" and they always exercise discretion in the direction of their pocketbook.
That's what I think will happen with any drug that makes people feel good. The patients will want it. The doctors, manufacturers, and insurance companies can be bought off with government insurance money. In general I think the entire incentive structure that makes it profitable for all these parties to engage in this needs to be attacked. As long as people make money there will only be pushback against "discretion" after the bodies pile up.
"I don't think that poisonous bootleg meth should be legal, either"
So you're a PROHIBITIONIST. Bootleg meth has willing suppliers and willing buyers. And you're off prohibiting it, you puritan. Don't you know that if you make things people want illegal they will turn to crime and gang wars.
Once you've decided that it's GOOD to make certain drugs illegal we are just arguing over what those drugs are and what the regulations should be. And unless your answer is "everything legal and no regulations" then there is going to be an incentive for an illegal drug trade of some kind. The question is what to do about it.
"I don't think Oxycontin ever should have been sold to people that weren't chemo patients or had back surgery."
Chemically, Oxycontin is merely time-released oxycodone- which was prescribed for decades for acute pain relief as Percodan, typically in 5mg amounts. It's only marginally more powerful than hydrocodone- 20%-50% more powerful. Hydrocodone is Vicodin- the more common mainstay for acute pain problems like wisdom tooth extraction, back sprain, and shingles outbreak. As with Percodan, 5-10mg is typically all most people require for those pain conditions.
The problem that launched the Oxy epidemic was not related to any sinister property of oxycodone, per se. It's due to the fact that it was compounded for extended release, often in amounts as large as 40mg, 80mg, or even 120mg. And all users had to do to get the instant release was to chew them!
5-10mg of oxy makes for a good pain reliever. When chewed for fast release, 40mg of oxy compares favorably with a bag of street heroin.
"The Sackler's convinced everyone that "pain" was under diagnosed and under treated, and they were able to convince people because it just happened that everyone's incentives were to do so."
Not "everyone's incentives." The real problem there isn't any particular drug- it's the "marketing innovations" of the Sacklers, which go back to the 1950s, when old man Sackler got the brainstorm that prescription pharmaceuticals could be marketed just like soda pop, by using full-page ads in magazines and commission-sales pitches to physicians. I think this was an idea gone horribly wrong. But the answer is not to ban the drugs- it's to ban the commercialization, advertising, and commission sales pitch techniques. And the doctors need to get a lot more education about medications- particularly about pain and addiction medicine.
"Doctor's were given "discretion" to determine what people needed outside of those clear cases, and it turned out they needed whatever made the doctors money."
Many of the doctors were sincerely misled- they trusted the sales people, and the threadbare, slipshod studies that provided the basis of the sales hype for Oxy. The doctors should have had more skepticism, simply due to the amounts of opiods compounded in each pill. But pain, addiction, and pharmaceutical side effects have been given such short shrift in the curricula of medical schools that the doctors were naifs. (Except for the unethical ones.)
There are no direct kickbacks to physicians from every prescription that they write. But pharma companies have been known to reward physicians who prescribe brand-name products beyond a given level with bonuses all the time. That's another practice that needs to be banned. But it isn't the fault of any particular drug.
Scrip docs make their money as private practitioners catering to one particular clientele (like "pain patients") with cash visits, in and out, as fast as possible, like an assembly line. It's an unethical practice that would have easily been detected if a nationwide database of accountability had been in place in the 1990s and 2000s. The fact that it wasn't is not a failure of regulation- it's a failure of un-regulation. A bug in the regulatory scheme, not a feature. And overcompensating by choking off supplies after the damage has been done is not an evidence-based response; it's political posturing.
"Insurance was bought off with manufacturer rebates."
This is more like a problem of the US health care system in general. Notwithstanding my support for private markets for consumer products, pharma is different: I'm not averse to the notion of nationalizing pharmaceutical manufacture. Drugs are not soda pop, or televisions, or shampoo. They're generic chemicals, identical except for occasional minor changes in compounding. We should consider a public option for their manufacture. We definitely don't need ads for them on TV.
"Patients obviously liked how it made them feel."
Yes, but that sometimes came as a surprise; the way Oxy (and fentanyl) got marketed in the 1990s is approximately as deceptive as the way opioid-based patent medicines were marketed, prior to the 1906 Pure Food and Drug Act. Read the book Dopesick. I've read hundreds of books on drugs, but that book had me staring at the ceiling all night after I read it. Read the book Dreamland, too- it isn't quite as harrowing, but it's a telling account of what happens when powerful substances with supplies that are supposed to be controlled and accountable slip the leash, due to a complete failure to effectively implement a regulatory system.
In my opinion, the subtext for that failure was Respectability and Prestige Power (including campaign donations.) Congress failed to take the DEA seriously, because they couldn't quite comprehend the notion that opioids manufactured and sold by their Big Pharma donors and lobbyist buddies could actually be as harmful as the opioids sold by "the gangs" on the illicit street market.
After all, like Peter Schweizer says, the real corruption in Washington isn't what's illegal- it's about what IS legal. Surely you've read Roger Morris' 1996 book Partners In Power...remember the three chapters entitled "Washington I/II/III"? Here- refresh your memory with this free download: https://archive.org/details/partnersinpowerc0000morr_c3r1
The Oxy epidemic- and its aftermath- isn't the fault of any particular chemical compound. Opiods- including fentanyl and oxycodone- continue to be the legitimate mainstay of pain management medicine. Because they're the most effective class of compounds, for many pain sufferers.
"And all users had to do to get the instant release was to chew them!"
Sounds like a pretty easy thing to get around, and people did.
"it's to ban the commercialization, advertising, and commission sales pitch techniques."
"That's another practice that needs to be banned."
I don't have a particular problem with this line, but the fact that all this stuff is still around is an indication of its staying power.
Here are the parties that can prevent a drug from getting dispensed.
1) The patient
2) The doctor
3) The insurance company
4) The government
When the drug is pleasant and addictive, the member doesn't stop it from getting dispensed. That is by far the #1 line of defense, when patients want something they tend to find ways. Its easier to control abuse when its not a drug the patient would enjoy.
The doctor and the insurance company can get paid off. Ultimately, this money comes from the government. Yes, manufacturers give rebates, but rebates are only effective because
A) The government allows them &
B) the government has designed its insurance programs in such a way that rebates can be abused.
The government does this because they don't give a shit. Trust me, I know these people, they don't give a shit. Sometimes it's even the point (they want to backdoor subsidize Pharma because key constituencies want cheaper drugs.
The government only cares when it causes a political problem. Opioids caused enough bodies to show up that congress couldn't ignore it anymore. Then they made the agencies do something because there was a political advantage to do so. This is the sort of thing that will only be done AFTER THE FACT, and usually only in high profile cases with lots of dead bodies.
I think it would be better to have a baseline skepticism of drug classes where usefulness is hard to prove and patients have bad incentives. Relying on doctors/insurance/government to nuance things in those cases is probably going to have a bad track record.
"Yes, I'm in favor of prohibiting some substances. And tightly regulating others"
So you've agreed with my the whole time.
"However, I think that civil confiscation of unsafe products is typically a more practical solution than getting the criminal courts involved."
If you mean possession, yes. I'd be fine with decriminalizing small possession.
If you mean manufacture and sale, I think that's criminal.
A lot of people in on possession charges are really plea bargains down from bigger crimes. I don't think it will impact incarceration much to decriminalize possession, cops will find something else if they think it's a real criminal.
"No one would buy the bootleg garbage if they could get a pure supply"
It seems to me that people will buy almost anything. You can't just decide that people can make a drug whose purpose is addiction.
"The basis of my drug policy positions is that I follow the evidence."
We all do.
It seems to me we have a few differences:
1) I think that we should take a skeptical look at drugs whose benefits are unclear and whose harms are addictive. We should generally assume that in cases were the patient will have bad incentives it's hard to get the other players to reign things in.
2) I don't think drugs drive crime to the same degree most "legalize drugs" people do. I think that crime is mostly dumb low IQ young men that want to participate in a violent tournament and drugs is just an excuse. If you made one drug legal they would find another. If you made all drugs illegal they would fight over something else.
I think the "solve crime by legalizing drugs" crowd is distracting from the real issues with crime (clearance rates and punishment). I think crime gets solved by solving crime, and that various "root causes" have more excuse to them than truth value.
3) I think that a lot of drug addiction can be incented. That is street dealers, manufacturers, and doctors can find ways to create new addicts if they've got an addictive substance they can use. If they can't use one, I think they will just move on to another, until we get one even you balk at. Hence, this will always be a problem.
"Sounds like a pretty easy thing to get around, and people did."
15 years too late, Purdue eventually reformulated the pills with some gummy substance that makes the pills impossible to snort or shoot. It's undoubtedly still possible to dissolve the active ingredient by leaving it in a glass of water overnight, or something like that.
"When the drug is pleasant and addictive, the member doesn't stop it from getting dispensed. That is by far the #1 line of defense, when patients want something they tend to find ways. Its easier to control abuse when its not a drug the patient would enjoy."
So what's your obsession with defining and controlling other people, simply on the basis that they find a substance pleasurable? Coffee is pleasurable- and addictive, too. If someone isn't broken- giving pronounced evidence of a problem for public health and safety- what's with your insistence on forcibly fixing them? You must be familiar with the term "iatrogenic problem." You don't seem to know how to apply it to evidence right in front of your face, though.
People who became addicted to opioids due to the massive over-prescription by their doctors often eventually lose all perspective on any pleasure they might obtain from them, incidentally. They aren't primarily driven by the situation that you're so het up about- chemically derived feelings of euphoria. Opioid addicts perceive a need for the substance the way that thirsty people in the desert perceive a need for water. And I really wish that the APA hadn't gone off into arcane jargon neologism land, by redefining the term "addiction" as something less than what it means for opioid addicts. Because the new rules make it seem like everything enjoyable is addictive. For people with authentically serious drug dependencies, addiction feels like life or death. Not the same thing as being "addicted" to a smartphone.
Speaking for myself, I'm wary of opioids. I've gotten them for acute pain, and I take the minimum. But few people heed even accurate information from officialdom, given that officialdom is on a hypocritical crusade to terrorize the citizenry into modifying their personal behaviors. I mean, so much for education. And that goes for illicit-drug naive people, too- there's such a cult of Expertise in the US that most people are conditioned to do anything a licensed physician says, and take anything the doctor orders, without doing so much as a single keyword search on the possible hazards on what they've just been told to swallow.
So yes, I agree that it really is ultimately the patient's lookout. But you can't inject an overhaul of societal attitudes into people like a vaccine. That leaves it to the doctors to act responsibly in their prescribing- neither too punitively or too recklessly. And yes, addiction medicine with prescription maintenance ought to be an approved practice, with care available to the public at large, not just the wealthy addict population.
"Government only cares when it causes a political problem."
"The government" has spent over a trillion dollars on the Drug War in the past 50 years. Presidential administrations have gone out of their way to avoid the related "political problems" by pandering to the ignorance of the citizenry and indulging in chicanery and hypocrisy to cultivate mass public cognitive dissonance on these topics. That is not the fault of the movement to reform the drug laws.
You just sound ridiculous at this point. Don't take it personally: the position you're arguing for in this case is so weak as to be indefensible. You might actually be capable of making valid points in a critique of, say, single-payer health insurance. But you're twisting yourself into knots with hypothetical arguments and unsupported fantasy conjectures in order to justify the status quo of drug criminalization and cannabis prohibition.
"eventually lose all perspective on any pleasure they might obtain from them"
Yes, that is how drug addiction works. People start it because it feels good, they need more and more, and it fries them up. That's why dealers (legal and illegal) often give the first dose free. They know how addiction works. They create their own demand.
"So what's your obsession with defining and controlling other people"
When people become drug addicts they become a menace to themselves and society. I care about how addiction makes live worse for everyone. They become criminal and dependent. They cost the government a lot of money.
"If someone isn't broken- giving pronounced evidence of a problem for public health and safety- what's with your insistence on forcibly fixing them?"
Coffee doesn't predictably turn people into criminal street addicts with probability X% that is above the threshold at which the substance should be allowed. Meth and other drugs do. I'm not going to give people meth, wait until they destroy themselves and become a burden and danger to society, and then start worrying. If a substance has little benefit a predictable high cost then it shouldn't be allowed. If it has strong benefits in rare contexts (pain killers and back surgery) then they should be tightly controlled and only allowed in those narrow lanes (most hard street drugs don't have benefit in any context).
The same way we don't allow all sorts of things we know lead to trouble. We don't even allow people to drink alcohol after the 7th inning because we know it leads to more drunk driving on the way home from the game.
"has spent over a trillion dollars on the Drug War in the past 50 years"
A trillion dollars over 50 years is not a whole lot. That's why they've got to add it up over 50 years to make it look big. And if you're using the article I googled, they are counting a lot of costs which are dubious to be part of the war on drugs. Is the incarceration costs of everyone with a drug charge in prison a cost of the war on drugs? None of those people would be in prison anyway? When marijuana was legalized it didn't put a dent in incarceration, because people on drug charges are usually violent criminals too.
But let's say the government was spending a lot of money. Would that prove that the government "cares"? The government spends a lot of money on a lot of things and doesn't give a flying fuck about the results. The spending is the point, interest groups are getting paid, not whether it works.
Singapore "cares" about its War on Drugs. That's why it won its war on drugs. I suspect they spend less on their War on Drugs than we do.
The bottom line is simple. Nobody has the "freedom" to destroy themselves.
When they do they inevitably become a problem for themselves, others, and society. Some substances statistically lead to self destruction at unacceptable rates relative to the benefits and thus shouldn't be allowed.
You understand this is a problem, but you can't quite get around this "freedom" hang up. It's why you fly off the handle and call places like Singapore as being like North Korea, or call anyone wanting to stop people from becoming meth addicts of wanting to ban coffee. Freedom to engage in behavior likely to lead to self destruction is just something you think Makes America Great. It's regrettable, maybe something should be done, but we should always air on the side of allowing self destruction and not be judgmental.
I don't. I don't see any freedom in being and addict. I don't see any freedom being victimized by an addict. I don't see any freedom in paying for an addicts public benefits.
I believe in freedom because I want to be my best self, not my worst self.
"So you're a PROHIBITIONIST."
Yes, I'm in favor of prohibiting some substances. And tightly regulating others- that process that you seem to regard as a corrupt feature of government, rather than a process with some bugs. However, I think that civil confiscation of unsafe products is typically a more practical solution than getting the criminal courts involved.
"Bootleg meth has willing suppliers and willing buyers."
I've already told you twice: amphetamines- including methampetamines- are LEGALLY REGULATED. No one would buy the bootleg garbage if they could get a pure supply. Come on, this is basic. But we're dealing with a medical-legal regime that won't even attempt to experiment with amphetamine maintenance for meth addicts- not even a program like methadone maintenance, where users would show up for a daily dose of oral medication. Many of those folks have undiagnosed ADD (which is a real ailment, fwiw.) But if someone is criminalized prior to diagnosis, they're sunk. They're "meth freaks."
I'd be a lot more dubious about Schedule II amphetamine prescription- something like 13 million Americans have an amphetamine or methylphenidate script- if it was driving large numbers of people on to the street to bang 100mg loads of crystal ten times a day. But it isn't a problem the way over-prescribed Oxy was. Because it isn't the same substance. Dependency and ill health effects from amphetamine pills are a personal liability- the warning signs of overuse need to be heeded. But it isn't a public health menace. Whether over-prescribed or not, people aren't dropping dead left and right from their Adderall prescriptions. There isn't an epidemic of doctor shopping and wholesale diversion of industrial quantities to the street market so that people can gobble/snort/shoot mass quantities of amphetamine pills to cope with an escalating tolerance and an intensifying addiction.
The basis of my drug policy positions is that I follow the evidence.
"Once you've decided that it's GOOD to make certain drugs illegal we are just arguing over what those drugs are and what the regulations should be."
Well, yeah. But unlike myself, you've just spent half of your post content arguing that regulatory controls are corrupt and ineffective, and that the only answer should be "simple laws, with no loopholes" to work as blanket prohibitions over a wide array of substances, including marijuana, a nontoxic herb that's less poisonous than many of the products in stock on a kitchen spice rack.
Which is to say, you're all over the place on this.
So am I- but I'm basing the differences in my policies on rational assessment of harm to public health and safety. Whereas you're still thrashing around like the White Queen from Alice In Wonderland.
Hopefully, my last post cleared up your confusion in regard to my position on the proper regime for controlling opioid prescription.
Now, on to another point:
"If you think legal opioids were a mess I don't see how legal meth is going to go down any easier for you. The same dynamic will go down."
Meth (aka methamphetamine aka Desoxyn) is already legal. Schedule II*. What, nobody told you? The statistics on how many legal meth prescriptions are written annually have proved resistant to my inquiries. But it's well-known that as a class, the amounts of prescribed amphetamines are in the hundreds of millions annually- they're almost as common as they were in the 1950s and 1960s. Fortunately, there's little evidence of a public health problem resulting from that situation. Notwithstanding the fact that amphetamine pills aren't exactly free of harm or addiction liability, their widespread prescription in recent decades hasn't led to the disastrous effects of the Oxycontin epidemic. However, if the Drug Warriors want another illicit street drug disaster on their hands, they'd get one soon enough if they were to decide to choke off the prescription of amphetamines the way they did prescription opioids.
It's worth noting that the last time the Federal government took measures to drastically limit the prescription of amphetamines in the early 1970s, the user demand swiftly shifted over to another product that was coincidentally just arriving on the heels of the burgeoning nationwide retail marijuana market: cocaine. This time around, the illicitly sourced methamphetamine market is much more mature. So I'd anticipate that the two commodities would have to fight it out for the newly expanded street demand. The increase in the consumer base resulting from a crackdown on amphetamine prescriptions would almost certainly be massive, however.
Meanwhile, the current medical-legal regime in the US is even more rigidly opposed to providing a daily regime of oral amphetamine maintenance for people with meth problems than it is to providing controlled amounts of opiods to opioid addicts. Go figure.
[ *Cocaine and fentanyl are also DEA Schedule II controlled substances, fwiw. ]