Drugs like analgesics are especially dangerous though. There will always be people who turn to analgesics to relieve the pain of everyday life. People will turn to heroin or oxycodone to escape from the sorrow following the loss of a loved one, and it will work --- at first. Then they develop an addiction, and a tolerance, until they get to a point where the drug no longer relieves the pain of everyday life, only the pain of not having the drug.

In order for legalization to be effective, the legal drugs have to be equally potent, equally priced, and easily accessible. The fear of associating with a toxic culture, and of being arrested is part of what prevents more people suffering loss and other stress from turning to analgesics, I fear that the legalization of such drugs would result in more people addicted, albeit with a somewhat more manageable addiction.

I think I still support full legalization, but it's much easier to legalize low addiction substances than the "bad drugs".

What's wrong with being "addicted"? You talk as if there was zero benefit to the user of opiates after they reach a certain point. Apart from the stigmatization of addiction as an intrinsically bad thing, where's the harm? Outside of legal and financial issues, which society has self-inflicted? Where's the evidence that users derive no more value once addicted? Users can " stay well " with less euphoric opiates, yet choose not to. If all they're taking the drug for is to clear the pain of withdrawal, why not prefer simpler, longer-lasting opiates?

People are treated with terrible shit like Haldol, lithium, and Zoloft, but we don't mock those users, calling the medication a toxic addiction and an escape. Even when those medications are very damaging to the body (lithium requiring regular checkups to make sure it hasn't actually accumulated to toxic levels). Those users don't get stigmatized beyond being mentally ill in the first place. In fact, the opposite is heard, with "he's off his meds again", or stories of responsible users that reliably take their medication.

Because physical addiction comes with tolerance. Opiates also have a high overdose potential, and when you combine tolerance-forming with high toxicity, people die. Yes, addicts can continue to get positive effects from the drug, but only by increasing dosage. And dosage can only be increased so many times before they die of overdose.

High-purity opiates are necessarily expensive. The street price is inflated because they're illegal, and pharmaceutical companies have to jump through some hoops to avoid legal issues, and because of patents, but an addiction will always be expensive.

Some addicts can continue to function as a part of society, but others can't. Many of them only become addicts after they are already unable to function, either due to mental health issues or overwhelming stress. I don't mean to imply that these people are morally lesser because of their inability to perform as society expects them to, just that it's a tragedy.

The drugs prescribed for mental health problems are scary, and probably over-prescribed, but they can also help. Lithium can be toxic, and it often quells the patient's personality, but when used correctly it can improve the patient's quality of life.

We might find that one day we prescribe opiates for short-term emotional pain, but they will never be appropriate for chronic issues. Even well-trained doctors make the mistake of prescribing analgesics for chronic pain like arthritis. If that's the case then how can we expect untrained individuals suffering emotional pain and probably some mental health issues to make a good decision about buying opiates from a dispensary. And if it's any harder for them than just going to a corner store and picking up the drugs, the illegal market will still thrive.

[1]: Really, it's inappropriate to mock anyone for substance use, but I take by the tone of your comment that you agree with that.

> dosage can only be increased so many times before they die of overdose.

Citation? In palliative care, dosages can become incredibly high. The bit of info I've read has not talked about a maximum dose, nor have I heard stories about reaching such a level. (There probably is such a dose, just as there is for water, but I'm not sure it's been much of a hindrance to actual patients.)

An addiction has no reason to be expensive. Without being rude, I think you're just making that up. Using GoodRX, I've found that methadone is under half a cent per mg. So for a one-gram-a-day morphine equivalent (120mg methadone) that's a grand total of $18 a month. As comparison, 30mg methadone could (would?) kill a non tolerant user. If that's the current pricing, under all the extra regulatory work and reduced production due to legal limits, we'd expect it to drop. And spending just $200 a month, or 10x of the current price for 1G MED a day, seems not that bad, really.

You go from saying a dangerous, toxic, element such as lithium is OK because it improves the patient's life... to opiate treatment is bad because of addiction. That's it?

The US and Europe alone use about 100 tons of oxycodone, annually. Where is that all going? Yeah yeah, diversion is a "big deal", but even if it's massive, like 50%, most of it is going to the intended target. I'm not sure how production tonnage converts to personal usage, but at 40mg/day, that's about 6 million users. Total annual US prescriptions for opiates is in the quarter billion range (divide by 12 to get a rough estimate of users?) Yet oxycodone only created 175K hospital visits in a year. So we're at a hospitalization rate of only ~3% ? I think that destroys the idea that most users suffer tremendous damage from it. So what about the other 97%? The guy that did your taxes. The person who wrote the backbend of the next app you use? The old friend that just sits around in bliss? We should tell them to sod off because, hey, not all y'all is productive enough, and I don't like your living in an escape?

That 97% could be misleading. Massive over a 3 year usage cycle it's a different 3%, so perhaps 10% of users end up with a hospital event.

I knew people that died from OD. Perhaps because they couldn't get things together, and opiates were too big a call. Or maybe because they bought random quality shit and had no way to properly dose, plus their tolerance wasn't a nice chart due to constant pressure and stigmatization of their usage forcing them into period "rehab". Scenarios that would mostly disappear with proper production and social acceptance.

I also know many more people that have been opiate addicts for presumably a long time. Otherwise fine citizens, you might thing. Most people aren't willing to talk about their usage. But keep your eyes opened in meetings; look for the people with pinned eyes. Opiate addicts are everywhere. (6 million+ oxy users alone would be 2% of the US population.)

1: http://www.drugabuse.gov/publications/drugfacts/drug-related...

> The US and Europe alone use about 100 tons of oxycodone, annually. Where is that all going?

Use, or dispense?

I've had two Achilles tendon surgeries, and for each surgery I was prescribed a fair-sized bottle (30?) of oxycodone. So that's about 60 tablets that were dispensed to me. I've taken probably less than five. Why not just dispense five? Because it's a bureaucratic rigamarole to dispense oxycodone, so they just dispense more than you require and let it go at that.