Legalizing opiates is silly. It only takes a handful of times to get hooked and people currently use alcohol for months on end to get through hard times. Anyone with even a slight propensity for substance abuse would be an addict within a year. Contrary to the popular narrative it’s not super simple to get opiates and honestly it’s not on most people’s radars to even seek it out.
A lot of people are taking fentanyl thinking it's something else. It's pervasive in the drug supply. Kids who are being served ads for ketamine on social media are buying street K (obviously with a confidence boost from the advertising big tech allows) and boom, fentanyl. People who have been prescribed xanax, and got a little addicted and then buy it on the street because the pharmacist and doctor are onto their misues... It's not as simple as calling it an opiate thing, and even then, opiate addicts in my book deserve to like live. We have to rethink our approach to drugs, because this isn't the same game as even a decade ago. I think legalizing and deshaming to the point of exhaustion makes sense, but I'm not sure my thought is right.
The US effectively had legalized opiates during the Oxycontin era. Many people were addicted to these drugs under order of their doctor. Then their supply was cutoff and they started seeing illicit sources. Enter: Fentanyl.
Both! Sure: little risk when there are few or no drugs in a specific social setting, and no peers are using drugs. So it is true that social setting can be determinative in extreme cases. But if drugs are available and some peers are users then genetic variation definitely modulates risk of addiction to drugs that greatly degrade function and even mortality risk. I am sure you know last year’s excess death attributable to opiates and ilk—-now well over 100,000 in 2023— four-fold higher than in 1990. Team Sackler/Purdue Pharma, lax regulation, and greed all around, get lots of opprobrium but no jail time.
And just to admit:
Alcohol and tobacco both have much higher burdens in terms of disability-adjusted life years.
