All these others syntheses with multiple steps up the chances of weird toxic solvents or contaminants creeping in. I think it’s a contaminant issue that’s exacerbated by the drug use.
The government should just regulate it, control purity and production and let people access small amounts for recreation/performance. It’s not an evil drug per se - long history before it was criminalized. Plus that would neuter the cartels and protect people’s health more than pushing it underground.
Famously, the US spent about 15-20 years attempting this with opioids. They were widely available to people via a pseudo-medical process, or via secondhand dealing. Opioids were/are manufactured by regulated, publicly traded companies with inspectors who controlled purity and production. The result? A shattering drug addiction crisis that at its height killed more people annually than the entire Vietnam War.
(For people saying 'no, that was illegal heroin or fentanyl that did all that damage'- the Wiki page for the opioid crisis is quite clear that at least 50% of all deaths were due to perfectly legal, regulated opioids).
When you make drugs legal & easy to get, lots & lots of people do them- who develop life-shattering addictions and OD en masse. They also build tolerance and then move on to even harder stuff. AFAIK out of the 300ish countries on the globe, there is not 1 that has decriminalized hard drugs in the modern era. And no don't say Portugal, contrary to widespread myth they forced people under threat of jail to attend drug rehab, and anyways they've recently curtailed even that.
I realize this is not going to get a lot of upvotes on HN, but yes making it difficult to do hard drugs is a reasonable public policy goal. (Which again, is why literally every country on the planet does it). There's room to argue about the exact tactics, but the broad goal is perfectly legitimate
There is a world of difference between something like that and government dosed methadone, meth, etc.
The problem was not in fact opioids. It was the profit structure behind the distribution network. Remove that and the bulk of the problems go away too.
If the drug is socially stigmatized only true addicts will use it. Those are exactly the people you want to have access to it because they can be gradually tapered off on a controlled dosage, they can be targeted for interventions, and it keeps them from stabbing you and stealing your wallet to get more meth.
Its incredibly counterproductive to just outlaw a thing that people need on a level that they will do almost anything to get it.
Are you talking about this page?
https://en.wikipedia.org/wiki/Opioid_epidemic
Could you then be more clear where exactly your claim came from? I did not find it, but rather this:
"According to medical professionals, supervised injection sites are effective in reducing overdose deaths and the transmission of infectious diseases."
Theory: this is a socioeconomic problem rather than a public health problem. Our systems care too little for people. The easiest solution then is for people to self-medicate.
It's easier to deny people a harmful salve that they feel they need than to provide them the social supports that they deserve.
There is a pretty decent argument that this was still a result of pseudo-prohibition, which goes like this:
Opioids were easy to get a prescription for, but still required a prescription (and were covered by insurance), and were still highly restricted in who could manufacture them. That made the margins high, and consequently created a perverse incentive for the manufacturers to want patients taking the high margin insurance-funded opioids rather than a cheap commodity out-of-pocket NSAID or acetaminophen.
Because they still required a prescription, getting people taking them meant they had to capture the prescribing physicians, who now get their own perverse incentives. Not only marketing/kickbacks/incentives from the pharma companies, if something over the counter would work and that's what you recommend, the patients buy a bottle at Walmart for $5 whenever they need it and you never see them again, but prescribe something stronger and you get to bill their insurance again and again every time they need another appointment to re-up.
But "ask your doctor" was supposed to be the thing you do to get sound advice. Give the medical establishment a profit incentive to over-recommend the addictive thing and what do you expect?
Meanwhile if they were all available at the convenience store for the same price, nobody would have the incentive to push the addictive one, and then when you ask your doctor (or for that matter anyone else) what they recommend, they would generally tell you not to take opioids unless you really need them.
That depends on the drug. Both it's addictiveness and its destructiveness. It's likely true for meth. I doubt it's true for weed. It's demonstrably not true for many of the OTC drugs that have been easy to get for hundreds of years without the collapse of society
Like how about you have to do a short course which actually explains to you how a drug works, how to use it correctly, what are potential downsides, what are markers of overuse/wrong use.
And the other main issue with opioids and co: some people really have constant / chronic pain.
Do you know how exhaustive it is to constantly have pain? How annoying it is that you can't just go to bed and sleep?
But also we can't play devils advocate to say "you are not allowed to do drugs to num whatever issue you have" and also "but i don't want to take time and effort of helping you".
Oh i don't want you to kill yourself! But i don't want to spend time tomorrow afternoon either with you.
Our society is very hypcritical in this sense. Honestly i think people just don't want to see homeless people or fentapoeple. Its not about helping, its just about not being disturbed by them.
This is complete nonsense.
Opioids have never been made legal for recreational purpose. They were sold as painkillers by pharma corporations lying about their addictive effects and promoted through marketing campaign targeting doctors to prescribe them.
I has nothing to do with the topic of recreational drugs.
If the drugs are pure, and health problems that occur with abusing them (overdoses and addiction) are treated as health issues rather than criminal issues, then it's all a solvable problem.
Heroin being illegal didn't stop my brother from dying on it.
Because it's legal, people will try it. And because we live in a country where it is celebrated, encouraged, and every holiday seems to be an excuse for folks to get hammered, A LOT of people will try it. How many would never touch it if it were illegal? How many wouldn't drink and drive and kill themselves? How many innocent people in the other car, completely sober, would still be here? Because remember, booze, or drugs in general, impact more than just the user. Their families, friends, and other random people can be impacted. How many kids grow up with a drunk parent, unable to properly express or process emotions, might not have to grow up unable to maintain healthy friendships because they don't know what they look like, or won't be taken advantage of because they have a caretaker/fixer mentality because that's what they had to do as a kid.
We know making booze illegal doesn't work, and that's not what I'm suggesting here. I'm not even suggesting anything. I'm just saying, the blast radius of booze impacts a lot of people beyond the alcoholic, and statistically, a portion of those lives negatively impacted are the direct result of alcohol being legal. I can speak from firsthand experience the impact of an alcoholic single parent growing up, which would be the reason I look at this topic the way I do. Would I have been given a more healthy and "normal" childhood had booze been illegal? Idk. But some kid out there would have, which might be all that matters.
Except that you're wrong. The war-on-drugs kept drugs under control. It did not _eliminate_ them, but they also were not available on every street corner.
Once we stopped the war-on-drugs, the abuse rates skyrocketed. Not just opiods, but also meth. You can see it on the graphs in this article, the general wind-down of drug abuse policies started around 2008-2010.
The phrase “small amount” is doing a lot of heavy lifting in this statement.
The government does regulate and control amphetamine and methamphetamine (Desoxyn) as prescription drugs. The former is not all that hard to access. For a while it was as easy as signing up for a service through a TikTok ad and filling out a form, after which you were guaranteed a prescription. Those mills got shut down but it’s not hard to find a doctor willing to write a prescription in your area with some Internet searching (Side note: Lot of people get surprised when they get a prescription from some random doctor and discover that all of their other doctors know about it. Controlled substance prescriptions go to shared databases and it will be on that record for a while)
> It’s not an evil drug per se - long history before it was criminalized
Dose makes the poison, the recreational users aren’t going to be satisfied with your government regulated small amounts.
These discussions always end up with two parties talking past each other because one side wants to focus only on the ideal drug user who uses small amounts and has perfect education and self control, while ignoring that the meth users wouldn’t be stopped from seeking their larger quantities than a theoretical government regulated small amount program would allow.
I should also mention that methamphetamine appears to be quite neurotoxic at recreational doses. Maybe even smaller doses too.
We should also mention that the “long history” you speak of isn’t actually that long and was associated with small epidemics of overuse and addiction, too. It’s not like addiction is a modern phenomenon.
> These discussions always end up …
Before your comment i wouldn’t say anyone is lacking curiosity here. Tho your comment about fixing into a stereotype, seems the example of itself. I think it’s better to listen and discuss than assume the futures settle into a mischaracterization that you’ve already decided. That doesn’t seem very useful - except for ideology…
On the toxicity side, do you have any studies to cite? I wasn’t aware of toxicity, but it’s plausible.
Big picture tho, I’m not an expert in drug policy. It just sounds like a logical way to reduce harm overall. Reduce harm overall - worth repeating; on average, create a better society.
The conceivable parties who would lose out are: government funded agencies charged with fighting drug crime because their caseload and budgets would probably decrease; and on the other side the cartels and dealers. Although what seems to happen with the latter is once something is legalized, the supply chains morph into legitimate businesses somehow.
I still think it would work. I’m not convinced by what you said. Thank you tho
Something which has always grounded my beliefs is the comparison to alcohol.
Imagine we walked into bars and were presented with unmarked bottle of clear liquid, and had to order "1 alcohol, please!", where the alcohol % and quality of the drink was totally random. It'd be fucking chaos.
I think I've settled on the "drugs should be legal" but heeavvviillyyy regulated and marked. I wouldn't mind going to a bar and ordering a very weak MDMA drink, or going to a shisha cafe with weakened opium, weed, crack, etc.
Also, it seems the way drugs are punished criminally is totally wrong. Why not lock people up for false advertising rather than 'strength'? I.e if you're heavily cutting drugs, you should be strung up for manslaughter. It would put pressure on the manufacturers to label and regulate themselves.
Here is some of what the US has been doing ever since the "war on drugs" started:
- Ban the sale of such substances, forcing users to resort to the black market.
- Lock up anyone who uses or possesses such substances, training users that there is no help for them.
- Lock up anyone who helps or intends to help anyone else use or possess such substances, training users that there is no helping others.
- Censor information on how to reduce the risks of substance use, forcing users to put themselves in more danger. (Contrary to apparent popular belief, this does not dissuade users, only harm them.)
- Censor information on how to produce or obtain such substances, preventing the discovery of reliable sources.
- Engage in relentless fearmongering about how terrible and bad such substances are, encouraging users to entirely disregard all warnings about substance use.
In my opinion, here is what one should actually do:
- Regulate the production and sale of such substances. Don't force users to resort to the black market.
- Encourage harm reduction and responsibility towards substance use. Don't train users that there is no help for them.
- Warn only of the real risks and concerns about substance use. Don't train users to disregard very real dangers by flooding them with fake ones.
- Offer reliable sources for such substances. Don't force users to resort to dubious leads.
Recent research into psilocybin therapy, for instance, is very exciting. I've been using psychedelics at home for years, and I dream of a world where known quantities and potencies of such things can be reliably sourced over-the-counter for such use. I don't know if I'll live to see the day.
Also note that none of this prevents helping users who genuinely need it -- users with less self-control, for instance, or harmful dependency. But forcing them all into terrible shame, withdrawal and eventually an utterly preventable death, is the same kind of bullshit that looked at building more homes and then invented anti-homeless architecture instead.
The article addresses this:
> Second, the evidence we have is against the idea of contaminants in P2P meth. Almost all meth was produced using P2P since 2012, before most reports of schizophrenia. And P2P meth synthesis has changed several times in the interim, resulting in higher purity than ever before.
Not saying they're right, but the author at least believes this hypothesis is contradicted by the data.
It doesn’t necessarily follow that it’s impossible to have a legalized or decriminalized regime that works, but it is non-trivial to get right.
The world is obviously better of without drugs, but given that is not going to happen, the question to decide is: is the world better of with drugs from legal pharmacutical companies, or (somewhat) restricted access to drugs through an illegal system?
Decrimininalizing drug use is the worst of both worlds: you get more drug access, but it still happens through the illegal system and benefits narco terrorists.
If you don't want to put drug users in jail (you cannot reasonably fine homeless people), you can offer drug courts and diversionary programs.
You need the federal government to do what it did with Marijuana (which is still federally illegal), to be able to try the other choice.
I think the various pieces of evidence presented in the article basically all point against this. Is there a reason you think the evidence in the article is flawed?
The difference between most amphetamines and Desoxyn is that extra methyl group. That methyl group helps it cross the blood-brain barrier a little faster but the chemical that reaches the brain is the same in both cases.
I have multiple close family members who have struggled badly with drug and alcohol abuse. Good treatment is the way, not the government handing out drugs.
The thing is, drugs are addictive. ESPECIALLY meth. How would you prevent people from just getting as much as they want and then becoming drug zombies? Fentanyl is similar. Cartels perfected its production, so now it's pure and widely available.
It's even worse than meth in some regards. Once you start using fentanyl, you're going to become a hardened addict. And there will be almost no hope of recovery, the success rate of drug rehab treatments is in single-digit percentages.
I guess the idea is that people will just keep using "safer" drugs like cocaine instead? I'm not sure it's working, we legalized cannabis and it made zero difference.
A prime example is alcohol, where prohibition led to bad outcomes. This led to the regulated legalization model.
E.g. in some Nordic countries hard liquor is still only available in government stores and licensed restaurants, with exactly this logic. Not long ago bars could serve only one "unit" of alcohol at a time. Longer ago there were limits to how much alcohol one could buy in a week.
> I guess the idea is that people will just keep using "safer" drugs like cocaine instead? I'm not sure it's working, we legalized cannabis and it made zero difference.
Cannabis and cocaine are very different kinds of substances with very different uses and audiences. Expecting legalized cannabis to substantially reduce cocaine use is like expecting banning of coffee would substantially increase alcohol consumption. There can be some minor effects due to multiple illegal substances tending to have the same outlets, but this is likely a subtle at best.
Also how much more "safe" cocaine is from methamphetamine is not that clear. Probably the largest effect is from very different demographics of methamphetamine vs cocaine users.
Meth on the other hand really is quite nasty, it’s directly neurotoxic to dopamine neurons in a way that regular speed isn’t
If amphetamine isn't strong enough, you already have a serious problem.
I'm not saying that criminalization is the right way, just that I don't see a responsible recreational/performance use for methamphetamine. It's too strong and too toxic. The regulation should permit only use for addiction management imho.
Also, the long history is not exactly in its favor, given how the Nazis extensively used it and Hitler was probably a serious meth-junkie.
The main "advantage" is probably the smoking RoA of methamphetamine. The RoA difference is likely a larger factor in methamphetamine vs plain amphetamine effects than the pharmacology of the molecule.
The “super addict edge case” is a problem but the good of the many outweighs the good of the few. Don’t discard, but manage. I believe access to drugs should be psych/(genetic if reliable)/“allergy type”/behavior tested. I won’t give you salvia if you will flip out per tests, but if you’re okay, you’re green.
The advantage of state controlled access is that you can actually achieve that, in theory. Promoting the thing you’re against rn might actually help reduce the harm you want to remove.
The craziness of so many legal things being pretty bad for health is also something worth addressing (alcohol, cigarettes).
It certainly seems like prohibition is just making things worse and making it more lucrative for the least ethical of black market producers.
Similar situation with fentanyl when compared to previous opiates.
Phosphorus-ephedrine meth, aka shake-and-bake.
> It certainly seems like prohibition is just making things worse and making it more lucrative for the least ethical of black market producers.
I don't think P2P meth is any worse than what came before it. Prohibition is making things somewhat worse here for legal access to pseudoephedrine, though.
> Does this rule out the idea of contaminants? No. Even if it’s 97% pure d-meth, there could be something very nasty lurking in that last 3%. But I don’t see the need for such an explanation. We know there are many more heavy users, so there’s no need to go beyond the idea that quantity has a quality all its own.
It's fine if the author finds it an uninteresting problem because the probable answer is staring us in the face, but still, he only has a plausible hypothesis.
If Sam Quinones is correct in that there is a fundamental difference in meth then and now that is causing major issues for addicts, it would certainly be in society's interest to figure that out and rectify it.
Heavy disclaimer: I am neither a chemist nor a doctor, so this is speculation on my part.
Really? Seems to me that, in general, we suck at it.
1) meth is highly addictive and there is no pharmacological intervention for that addiction. there is no clinically effective therapeutic treatment for it either
2) meth is neurodegenerative. heavy users end up with a permanent disability
3) at some point around 2010 a bunch of cities decided it was totally cool if dealing and public use were normalized/decriminalized in areas their most vulnerable populations hang out.
(3) is an incredibly stupid and expensive policy given (1) and (2)
My wife and I live in the suburbs now but grew up in a very rural community. Last year we went to a wedding there. It was shocking how many people under the age of 50 were missing half their teeth.
What is this going to fix exactly?
Putting half the population in jail?
The main thing about Phenylacetone meth is that there's so much of it - https://news.ycombinator.com/item?id=29027284 - Oct 2021 (359 comments)
3 lines later..
>.. The Drug Enforcement Agency tests the meth they seize to see how it was made.
quick answer!
Another path to "knowing how it was made" is examining the manufacturing facilities. I think LE has some understanding of the flow of precursor into foreign manufacturing facilities, and this has become a common hot topic issue in international trade.
the new is just the old that came back. The old meth, "biker meth", was P2P. Then was ephedrine, and with a crackdown on ephedrine - back to P2P.
Another noticeable thing - the recent shortage of ADHD medication while supposedly illegal meth production has been growing. Demand is present in both cases while the capitalism model of responding with supply seems to work very well only in one.
Capitalism isn’t the problem at all with prescription medications. The annual production amounts are regulated by the government. There has been an explosion in demand for ADHD prescriptions between the way it’s trending on social media and the recent shifts in how easily prescriptions are handed out.
I don’t agree that inducing artificial supply shortages is the right way to regulate it, but there is no “capitalism bad” story here. If anything this is a good example of how central command and control of production doesn’t work.
I think the biggest takeaway for me is just how insanely ineffective banning pseudoephedrine over the counter was.
Price went down, usage went up overdose went up, seizures went up, the production just changed quickly and there wasn’t even a blip.
Billions of uses of bullshit decongestant products that didn’t work at all… and to get the good stuff you still need to buy it from behind the counter and give ID.
We could call the regions "states" and enshrine their right to self government in the constitution. You know, to make sure the federal government doesn't end up trampling on it at some point in the far future.
Pseudoephedrine restrictions drove the search for new chemistry and the new chemistry brought in the large scale labs.
All it takes is one party where your friends “molly” is not so pure and you’re high for 18 hours straight. “Let’s do that again next week” turns into “all weekend” turns into “all the time”
Precisely.
I was given some by prescription for ADHD, and when I first tried it, it completely destroyed me for some reason -- I could not seem to get myself out of bed to eat (or do much of anything), even when I was very hungry. I ended up having to sleep it off, because being awake for that was very distressing -- not only did it not help me, but it seemed it had caused me even greater executive dysfunction.
When I brought this up at my next appointment, I was prescribed pure d-amph to try next. This actually helped me a lot, and continues to help me to this day.
I can only guess that the l-amph was the problem with the adderall that day. While my body seems to also have issues with different brands of d-amph, they're more like heart issues rather than executive function issues.
Now I can't say that I led a P2P network anymore.
[0] https://improbable.com/wp-content/uploads/2025/02/Pseudoephe...
[1] https://www.science.org/content/blog-post/pseudephedrine-mad...
The real issue is actually measuring results. I think we have to design society to factor higher order effects in. That means a fundamentally new approach to things like voting and tracking accountability.
Is it even possible? Who knows. Sometimes I think our problems have outstripped individual life spans which makes them intractable.
In many states it wasn’t banned. It just moved behind the counter and you could only by a limited amount per month.
Which was actually fantastically good for those of us who actually need it, because this made it available again instead of the empty shelves.
Limiting pseudoephedrine need not have effect on overall quantity to have huge positive societal effects. More P2P in industrial laboratories means less DIY Birch reductions in a soda bottle.
I’m so glad these policies made it so meth isn’t super easy to find anymore.
Oh wait, meth is still dirt cheap fucking everywhere, but now I also can’t get effective cold medicine either. Can we please just admit this policy doesn’t have any effect on the meth supply curve and please put pseudoephedrine back in Dayquil?
Drugs are an alluring and easy avenue for people who have a difficult time fitting into their social expectations and dealing with pressures. Obviously this isn’t where it starts, but treatment is so difficult and the punitive effects are so harsh that it creates a system that’s incredibly difficult to get out of…so why would you?
This isn’t always the case, of course, but my own anecdote:
My best friend in high school got hooked on heroin - not sure exactly what started him on it or why, but I could tell that he knew he didn’t want to be in that place, and that he as genuinely trying to get clean but the resources were limited and often harsh.
He did get clean for a while and applied for a job at Walmart - this kid was stupid smart, we’d do EE and programming projects all the time and I always felt like he was miles ahead of my understanding of technology - but this was what he had available because of his history.
The Walmart drug test popped for the drugs he was using _to get clean_ and they denied his application. Went home, relapsed, got found dead by his mother. It’s awful.
1. US tobacco policy is far more liberal than the War on Drugs, yet which of the two is a successful case study in curbing harmful addiction?
2. The recent opioid epidemic is far more complex than "the government tried legalizing opioids and it failed". Whatever policies did exist weren't legalization of opioids, and didn't exist in a vacuum. You can't model that policy without factoring in the wide availability of contaminated street drugs and absence of safer OTC cannabis alternatives. More importantly, the drugs weren't merely available, but actively pushed in a way that should have been legally discouraged.
3. The above analysis completely ignores the most important point raised in the top-level comment: prohibition simply redirects capital from businesses that are regulated to those that are not. Say what you will about Big Pharma, but they usually don't go around hanging mutilated bodies from bridges.
4. Even if drug prohibition were the optimal policy for reducing addiction rates, at some point protecting people from their own choices ceases to be a valid excuse for harming the rest of us. We've punished countless marijuana users who mostly aren't addicts, inflicted terror and destabilization upon our neighbors to the south, and created what at least half of America believes to be an illegal immigration crisis.
5. The claim that drug prohibition even helps the people it's ostensibly supposed to help is extremely dubious. We're subjecting addicts to more dangerous substances than the ones they're actually seeking out, and locking up the ones who survive. Maybe there's a narrow slice of people who really want narcotics but lack the motivation to navigate black markets, but otherwise who is this all for? We're hurting everyone in our confusion just to enrich a cabal of warlords.
For instance, I could purchase psilocybin/mescaline/ibogaine treatment at a dispensary (obviously imagining a therapeutic commoditized future). I could also purchase mescaline/psilocybin/salvia recreationally. Some recreational access may be "psych tested", or at least "need to pass the monitored orientation session" using special assays to ensure people could handle a "solo flight".
For the chem in question, it really is a more basic case I think of purity/quality/amount/regulation. I could walk into a dispensary and do a 50mg (is that correct?) line instead of a hit of espresso. Would I do this? I'd like to try, at least. The fact that I could, and know it was high quality and safe would be very cool.
I'm probably a bit weird/sci-fi/psychedelic utopian but I love the idea of a menagerie of dispensaries dealing out all kinds of cool, useful and exploratory chemicals safely. There could even be a chain of PiHKaL/TIHKAL outlets. Perhaps affectionately named "Shulgin's Drug Store". lol :)
The problem is that addicts are not going to be satisfied. Canada tried "safe supply" programs, where addicts are provided with medical opiates. Some addicts ended up selling pills because they were too weak and buying stronger street drugs.
It also apparently failed to improve long-term outcomes, although it's a bit early to tell that for certain.
> Expecting legalized cannabis to substantially reduce cocaine use is like expecting banning of coffee would substantially increase alcohol consumption.
Well, it did not reduce opiate consumption either.
I have, and the argument that everyone addicted had some other issue going on is pretty pointless imho. Yes, they had some other issue, and now before fixing that issue they also have to deal with being a drug addict.
Some are. Your life could be better than it's ever been but if you've got a physiological dependence on a drug and don't have enough of it in your system you're going to have a very very bad time until you get more. Some drugs will even kill you if you fail to get more and you need to be carefully weaned off them before you can stop taking it.
The trend is for the unwanted L-isomer to be mostly eliminated. That doesn't really let you know the process. Other chemical markers are used for this:
"Reductive amination remains the preferred synthetic manufacturing route for methamphetamine with 98.4% of the MPP samples analyzed profiled as originating from a P2P precursor. Approximately 9% (n=62) of these P2P-based samples showed evidence of being synthesized to methamphetamine under Leuckart conditions. This process uses methylamine and formic acid or N-methylformamide as supporting chemicals. This percentage is a slight increase compared to CY 2022 seizures (~6%). In addition, the MPP has been monitoring the Mercury Amalgam sub-classification with approximately 2% of seizures (n=14) observed to have been synthesized under these conditions and an additional 1% (n=7) of sample profiles showing markers for both Leuckart and Mercury Amalgam reactions, indicating the mixing of finished products at some point during the postproduction process."
(from https://www.dea.gov/sites/default/files/2025-09/CY%202023%20...)
> Another path to "knowing how it was made" is examining the manufacturing facilities.
That's obviously not always possible. But the entire point of the discussion above is that law enforcement has a lot of samples and tests a lot of samples, so they are in a good position to understand what has changed.
Markers they found include formic acid and mercury. Neither of those would be particularly good for you to inhale.
They’ll be outside funeral homes, outside schools, offering free graduation crack. Ads on every bus, hot women handing it out in the street.
"From 1999 to 2020, nearly 841,000 people died from drug overdoses,[7] with prescription and illicit opioids responsible for 500,000 of those deaths"
Here's a chart showing overdose deaths from all drugs in the US- yes there's definitely a large spike from 'synthetic opioids' at the end there that's probably all illegal fentanyl. But notice the blue line for 'prescription drugs' was very very steady for the entire length of the chart. That's an enormous number of deaths from completely legal, regulated drugs!
https://upload.wikimedia.org/wikipedia/commons/f/fa/US_timel...
So... it's not saying 500K deaths are from prescription drugs, it's saying 500K deaths are from opioids (some of which were prescription)
Also, in the chart you mentioned, it's not clear if the opioid deaths were from legally produced prescription opioids. Certainly fentanyl is one of the biggest killers, and fentanyl is used in medical settings, but the fentanyl killing people is usually not from legal drug manufacturers.
In any case, drug dealers really don’t need to do any pushing, the drugs sell themselves. Have you ever taken an opioid? The idea that unfettered access would result in less addiction and death is a pretty remarkable POV
In this scenario the addictive product has the margins of a generic commodity and 75 competing suppliers. Getting the customer addicted has close to zero returns because the margins are thin and the customer's future purchases are more likely than not going to a random competitor rather than you. Notice how little advertising you see for things like flour or onions. If something is completely fungible and commoditized the incentive to push it on you is minimized.
And retailers have the opposite incentive, because making a $0.05 margin on a bottle of pills once a month is worth far less to them than not having someone who is a repeat customer lose their job to addiction or die of an overdose and then stop buying all of their other products.
> In any case, drug dealers really don’t need to do any pushing, the drugs sell themselves.
If the drug dealers don't need to do any pushing then why do they spend so much time and effort on pushing? It'd have to be because pushing gets results, and therefore blunting the incentive for pushing gets results the other way.
It's not that crazy, but it has to be coupled with accessible recovery programs. The classic tale (one that people in my life have gone through) is the prescribed opiates -> street heroin when the scrip runs out / when they change the oxy recipe so that it doesn't dissolve in water anymore so you can't shoot it.
This is obviously much more dangerous than getting oxy from your doctor, so the logic of "keep people from seeking heroin on the street" actually does make sense to me from a public health perspective.
I believe 1970 was also the year when amphetamine (Benzedrine) inhalers stopped being OTC.
Many countries, including the US, use methadone for maintenance. As I understand it it’s not as enjoyable as some people’s opioids of choice but it’s still an extremely powerful opioid depending on the dose (easily fatal).
So it’s not only the countries you mentioned that provide pharmaceutical opioids as maintenance treatment. The US does too, though the form is different.
What is this supposed to mean?
That’s a completely nonsense statement to make because you’ve provided no data on problem opioid use in Switzerland.
Is 1500 a lot? Not many? Average? Should all nine million be on the program?
Note that it is free, supervised and voluntary so ymmv in other countries. The conclusions of the original program with methadone in the 80s was that it resulted in hardly any reduction amongst heavy and problematic users and they were likely to go back to using heroine with all the associated problems, the heroine distribution program worked but needed some tweaking, thus the program was fully legalised and put into law resulting in supervised consumption (at the distribution point) with dosage control and medical checkups and far less issues.
Sure, you could demand injection on site to reduce this problem. But that just makes the program less appealing. You could also just hand out the users' drug of choice directly (heroin) rather than the less harmful substitute, but at some point that starts counting as physician-assisted suicide, really.
The result is that the illegal market dwarfs the legal market. The legal suppliers simply can't compete with efficient and untaxed illegal or grey market sellers.
Note that the consumers who choose the illegal market are not in general socially excluded, habitual criminals or broken down addicts. Weed is widespread in almost all parts of society and probably less prevalent along dirt poor, mentally unwell or homeless drug users, who favour fent or meth.
People with jobs and houses choose illegal weed because it's both cheaper and easier to get hold of.
> The result is that the illegal market dwarfs the legal market. The legal suppliers simply can't compete with efficient and untaxed illegal or grey market sellers.
Even with California taxes an 1/8th of flower is often less than half what I’d typically pay back in 2008 or so, even without adjusting for inflation.
Also, I suspect middle class buying preference in the last decade or so has heavily shifted to gummies/edibles and vape carts which are much sketchier in the black market vs relatively interchangeable flower.
The idea of smoking a literal bowl to get high wouldn’t even be in the first like 5 methods among the people I know. It’s not super appealing in your 30s-40s while living in apartments/not wanting to reek of weed in the office. So buying off the black market just isn’t attractive even if possible cheaper.
Which basically means the US hasn't really tried legalizing it at all.
(Not advocating for any position here, just commenting on the facts.)
However, this also highlights the primary difference between weed and meth, opiates: ease of manufacturing. The only other common drugs that come close are things like mushrooms and fermented beverages, and I'd argue both of those are still riskier.
Also out of curiosity why not go with one of the new peptides?
I'm scared of intestinal motility sides from GLPs.
Missing teeth may not be the worst, but in this case perhaps the most immediately recognizable.
If that offends anyone, I’m good with that.
Add to that that the routes of administration preferred by heaver users (smoking and injection) are also those that maximize the harms of mercury exposure.
https://www.dea.gov/sites/default/files/2025-09/CY%202023%20...
What America continues to ignore, intentionally or not, is the root cause of drug addiction which tends to be a more complicated and nuanced
Surrendering to the drugs was a mistake.
Yeah, we should have changed tactics. Zero-tolerance policies were terrible nonsense, long prison terms were not helpful, and we should have clamped on prescription pills way sooner.
> but ineffective or counterproductive at eliminating drugs
It was effective in _controlling_ their level. And alternative approaches are just not working.
Sure, marijuana is largely accepted at this point. Most other things you still buy from gangsters on a street corner or via the darknet and will still be arrested for having, frequently losing your job as a side effect.
To overdose deaths, those largely correlate to the Sacklers (ie medical professionals inappropriately pushing product with a veneer of legitimacy) and to fentanyl. The latter is particularly deadly due to the combination of accessibility to amateurs with the inherent difficulty of safely compounding such a potent chemical as part of a clandestine operation.
We're talking 48 thousand gun fatalities and 40 thousand traffic fatalities (98 thousand total) vs 80 thousand
At best it kept some amount of some drugs less visible in some suburbs and communities, while making it profitable for suppliers to cross those lines.
The main effect of the war on drugs was a level of incarceration outdoing almost any society in human history. The fact that the numbers jailed for victimless and quality of life 'crimes' kept going up is testament to the fact that there was hardly any effective deterrence.
A typical therapeutic dose of amphetamines is around 20mg, topping at around 60mg for serious narcolepsy. Recreational doses can go up to around 1000mg for long-term users with 360mg as the median: https://pubmed.ncbi.nlm.nih.gov/40385390/
That's the area of crazy toxic side effects just from vasoconstriction. Never mind direct effects on the brain.
If I could go to a regulated dispensary and do a line of methamphetamine I think I'd try it. I don't think it would be neurotoxic, but I'd be very interested to know data that supports that, obviously! If you have, please show.
The doses you are describing I think fall outside responsible recreational use and into other categories - that sound more like poisoning / overdose.
A problem of criminalization is that society seems to tend to bucket all illegal drugs into a single category of usage misrepresented by the worst doses. It is possible for people to use these substances responsibly. And with assistance on purity, and regulated access, I believe the chances are high.
The regime I am proposing should even make it easier to deal with the % of people who bucket into overdoese/poison territory.
I'm not sure how much 1 line contains, but to me it seems as if it would be 50mg?
You can, it's called getting an ADHD diagnosis through a telehealth provider, which gets you an adderal prescription. It's not literally meth, but for all intents and purposes it's equivalent.
After a fact dump about different types of meth, it's literally a collection of anecdotal evidence from meth users going "for the first 5 years of smoking weekly, I had a great time partying in a relaxed way with my best buds, now that I've lost my job, partner, family and home and smoke daily my mental health is fucked up".
And people working in drug care and enforcement saying "when a few rich hedonists would spend $60 for the next level high, it didn't cause schizophrenia. Now that we have thousands of former crack and opiate addicts living in tents injecting $10 bags three times a day it seems to be contaminated with something that causes detachment from reality."
The literal two most common and evergreen things in drug culture are users claiming that the old stuff was much better and would deliver a clean high without addiction for barely any money, and cops claiming that the old users were better, gentlemen fiends who did not sell their bodies or rob and exploit their own families, never bit or stabbed you when being arrested, and did not soil themselves or set fire to their own clothes while in custody.
The nancy ragean area levels , i would say yes. Rates are down. https://drugabusestatistics.org/drug-related-crime-statistic...
However, it certainly hasn't gone to 0 and is still quite high.
> suggestion that the war on drugs in the US ever ended.
It has not happened evenly across the country, but it happened on the Pacific coast. Drug use stopped being punished, with people openly consuming drugs in front of the police. Oregon even made that official.
This is an important point. Drug enforcement operations did not stop, because no large-scale bureaucratic system can stop at once. But they became a futile theater.
Curtailing cocaine/opium traffic was hard, but not impossible. Cocaine had to flow from growers high up in the mountains, through multiple countries and transportation modes. Each step increased the price for the end-consumers. And cocaine/opiates are relatively bulky, so smugglers couldn't just do one high-risk operation, they had to build a robust supply chain.
Fentanyl upended that. It can be cooked in a lab in Mexico just outside of the US border. The precursors aren't particularly expensive either. It's also highly potent, so that one milk jug of pure fentanyl powder can supply a large-ish state in the US for a year. So high-risk high-reward one-off smuggling operations are much more feasible.
That’s why I think the psychoactive legislation that’s introduced recently about psychedelics is so important because those things can rapidly accelerate processing and healing psychological trauma.
My view, is if this was done 20 - 30 years ago there wouldn’t be such a large demand for opiates. I take it further and say that probably some in the drug companies understand this already and were lobbying against the introduction of more curative psychedelic treatments so that they could sell subscriptions to painkillers.
Yes but that's different from 'every random person can buy some meth at 7-11 or the government store' though. I'm fine with a controlled program for registered, hardcore addicts- the 2% who do 50% of the drugs or what have you.
>The problem was not in fact opioids. It was the profit structure behind the distribution network. Remove that and the bulk of the problems go away too
I mean, states & countries that have completely state-run liquor stores still have alcoholism and serious alcohol problems though? If 'removing the profit structure' worked magically, more countries would do it. AFAIK rates of alcoholism aren't even different between state-run and private sector models
A better comparison is probably countries where prescription drugs can’t be advertised to the general public. But, then you’re dealing with a lot of differences in other government policies.
They have less of it. Reducing access and increasing price reduces consumption, as any economist would expect.
The main problem with government monopolies of this sort is that they usually lack democratic legitimacy (i.e. would be voted away in a single issue vote) are under constant PR attack from people who profit from the regulated product. Leading to concessions such as the Norwegian monopoly being run as a for-profit corporation.
> If 'removing the profit structure' worked magically, more countries would do it.
No they wouldn't, for the obvious reason: those who profit from it have a voice, and are better organized than the ones who suffer from it (many who are addicts and want easy access anyway).
Instead the pressure to consume alcohol comes at a grassroots level. Social alcohol consumption is deeply rooted in human culture, and it's generally the people around you who will push you to consume. This pressure is independent of any profit motive, so removing the profit motive does nothing to affect it.
> AFAIK rates of alcoholism aren't even different between state-run and private sector models
Looking at some 2016 WHO statistics, the US seems to have ~3x the rate of alcholism as Iceland, but I recognise these are cherrypicked examples and I'm not interested enough to do a deep dive aggregating countries. Still, it seems plausible that government intervention can reduce alcholism rates. The fact that it's not 0% means nothing; nothing in the world is 0%, outlawing murder doesn't mean murder doesn't happen, but you can strive to reduce it as much as reasonably possible.
I expect any comparison of alcoholism rates will need to account for social (particularly religion) and socioeconomic factors. An awful lot of addicts are engaging in escapism.
Lately the trend seems to be slightly decreasing, see : https://ourworldindata.org/grapher/per-capita-alcohol-1890 (of course heavy dependent on the country and the timescale selected)
> Social alcohol consumption is deeply rooted in human culture
This is actually dependent on the culture and not all are the same, interesting paper on the topic (in cultures with higher agricultural interdependency alchool was not used as a tool for social cohesion): https://www.researchgate.net/publication/404116345_On_the_Fu...
>Opioids were/are manufactured by regulated, publicly traded companies with inspectors who controlled purity and production. The result? A shattering drug addiction crisis
>They were marketed and sold to consumers as safe, much more effective, and dramatically less addictive than it actually was. An industrial addiction machine ignored regulatory safeguards, built a 'pay for play' rewards structure to incentivize prescriptions, and a zillion other cartoonishly evil things
>I mean, states & countries that have completely state-run liquor stores still have alcoholism and serious alcohol problems though?
I tried to draw upon the main central point of each comment to this point. This discussion felt reasonably solid until this point where I feel like you failed to refute their main point. Your counter-example is still apples and oranges. State run liquor stores don't have the strong financial incentives to push alcohol and they don't downplay the addictive potential of their wares using fake science and they don't have authority figures give their patients official recommendations to take alcohol as a treatment with that fake science and financial motivation. Obviously people can and do still get addicted to all kinds of things without that scheme in place but I feel your initial example is pretty uniquely evil and not something we can learn generalizable lessons from, other than "don't do super evil stuff". Surely if your initial point is strong enough you can still make your case using other more generalizable examples.
It is disingenuous to claim that something doesn't work if it doesn't eliminate it completely. It is pretty well recognized that tight regulation of alcohol sales and marketing together with taxation helps reduce overall consumption. Alcohol consumption was also not eliminated during the prohibition in the US.
It's also important to recognize that making a drug legal is not the same as regulating it properly, and just making it legal can very well bring more harms than keeping it prohibited if no regulation of its sale and marketing is introduced.
I live in Spain. Alcohol is not tighty regulated here, and is cheap if we compare with nordic countries. But we, overall, have a culture of knowing how to drink, low proof drinks and in low quantities. The worst drinkers here are tourists from northern countries that binge on high grade alcohol because it is cheap. I had never seen someone chugging a liter of beer like it is water, or do that thing with a can of beer where you force the whole can, or that other thing with the funnel and a tube, like you were in a hurry to get drunk. You just drink a beer whenever you want, at slow pace. Spain, overall, consumes a lot of alcohol, but the consumption is so spread among the population that you rarely see adults drunk.
Our neighbor in the south, Morocco, allows for marihuana consumption and selling, and they have way less problems with it than any european country. But they have alcohol tightly forbidden, and it is a big problem there.
I went to Finland, and there were ships going from Finland to Estonia, carrying people just to buy cheaper alcohol there. They went back to Helsinki with shopping bags full of vodka. Makes you wonder how does it look Tallin in drinking statistics. I bet something similar is going on between Sweden and Denmark or Germany, whatever trip is shorter and cheaper.
The point is that a culture of taking drugs needs time to develop.
https://en.wikipedia.org/wiki/CIA_involvement_in_Contra_coca...
I’m not convinced either, the book looks interesting though. I might watch the hbo adaptation whenever that comes out ¯\_(ツ)_/¯
https://www.rollingstone.com/culture/culture-features/fort-b...
You slip such a confident assertion in there seemingly without justification. Do you think (for example) that the world would be better off without alcohol? I certainly don't. Everything has downsides; that doesn't on its own justify eliminating it. It's analogous to the adage that the most secure computer is the one encased in a block of cement so as to render it entirely unusable.
The only real benefits are not being the one outside the group, and the downsides include liver damage, social damage, massively higher risk for falling, drunk driving,...
More to the point, alcohol would never be permitted if it was invented today. Marijuana might.
> More to the point, alcohol would never be permitted if it was invented today. Marijuana might.
Isn't that circular reasoning? We know the world is better off without it because it would run afoul of the current regulatory regime. It would run afoul of the current regulatory regime because we know the world is better off without things like that.
I can understand why methadone is ineffective as a treatment.
I had to call an ambulance for one friend cos he stopped breathing in front of me.
I woke up on my kitchen floor 45 minutes after a shot. I had time to cap the needle before I passed out and had no idea I was about to go down.
Another mate died because she used at home alone while her partner was at work.
Other than that, it’s a pretty nice high :)
I get why you’d take it the other way tho
https://pubchem.ncbi.nlm.nih.gov/compound/Pyrovalerone
"Pyrovalerone is a DEA Schedule V controlled substance. Substances in the DEA Schedule V have a low potential for abuse relative to substances listed in Schedule IV and consist primarily of preparations containing limited quantities of certain narcotics."
I suspect higher purity & potency of street drugs has much more to do with more sophisticated operators operating outside of the US than strict prohibition. Same with fentanyl.
I believe this explanation is too simplistic...
"the harder the enforcement, the harder the drugs."
Interestingly, in both cases the semantic shift seems to have been caused by the enactment of laws to control drugs. The legal term these days is probably "controlled substance" in English, but "narcotic" now definitely refers to many drugs that are not medically narcotic.
They just need to exclude the shops in a 150 m radius from Terminal D in the Tallinn harbor to get accurate statistics, the Finns rarely go beyond that ;)
There has also been a movement to change the culture of drinking in Denmark, and the consumption has generally been going down, although it still remains high among youth. This also goes to show that there are many complex factors at play and that legal status alone cannot explain consumption patterns.
I do believe that prohibition makes it a lot harder to influence the culture around consumption compared to a legalized and regulated market.
Perhaps you’d be able to cope with life better if you weren’t so dependant on self medicating with harmful intoxicants and threatened by any statements against them.
Coincidentally, aside from official prescriptions recreational social interactions are also the primary method of introduction to drugs of all sorts.
(This is a serious article by a serious researcher. There exists good work on Frontiers in….)
The 5-HT2A receptor is profoundly immunomodulatory. (Acid is arguably a more potent immunomodulator – an antiinflammatory one – than it is psychoactive.) Local inflammation is a thing in injury, "global" inflammation as well – there is strong interplay between cytokines and metabolic/anabolic/catabolic process; Interleukin-6 stimulates osteoclasts which actively break down joint tissue – and neuroinflammation also affects physiology. Muscle tone, blood flow, pulmonary function, and so on.
Ego death happens to be a phenomenon or qualia when you boop that receptor hard. I'm not sure ego death necessary for anything. It might be. Ego death is very intimately related to the individual neuronal state and memory, and inflammation is quite enmeshed with that. (Cf. cortisol.)
Like, psychedelics? I'm not a hippie. I'm not into psychedelics. I'm into neuroinflammation, haha
I have heard psychedelics be described as the most effective placebo of all placebos.
I don't have a citation to hand and it's really old but there was academic research supporting that at some point. IIRC they used some clever request to get people to move their facial muscles in various ways without tipping them off about what was really going on and then asked them lots of questions that touch on emotional state.