the problems with the meth epidemic are 3 fold. two problems are intrinsic to meth and one is a matter of public policy.
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)
The ephedrine (or pseudoephedrine) synthesis is a one step using phosphorus/iodine reduction directly to methamphetamine. It’s simple and clean in that only an acid base extraction is required, and only one set of NP solvents.
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.
>The government should just regulate it, control purity and production and let people access small amounts for recreation/performance
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
I think a astronomically better example would be programs in the Netherlands, Denmark or Switzerland, where people heavily addicted to heroine can get into programs that will provide them with pharmaceutical heroine.
Still prescribed by doctors (although specialized ones), but not just for pulling a wisdom tooth with huge margins for the Sacklers...
A problem LAR programs have had since the start is that although methadone is less attractive as a drug than heroin, it's still attractive, and basically the only way to figure out how much a heroin addict needs is to ask them. Leading to users asking for extra, selling the excess (to users who were not in the LAR program) and buying other drugs with the profits. For some years, more people died from methadone overdose in Norway than heroin.
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.
Your opioid comparison is wildly apples to oranges. 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 .
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.
I think another under-discussed factor in the opioid crisis is that opioids are cheap, but (American) healthcare to treat underlying pain is not. You might not be able to afford six weeks of physical therapy, surgery, etc., but you can probably afford $11.23 a month for a generic prescription.
My view of a lot of the opioid crisis stuff aside from physical pain is psychological trauma - people self medicating as an alternative to doing the work.
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.
Chronic Back pain is correlated with emotional trauma. The physical body is a mere projection of the energetic and spiritual being. This is wahy meditative spiritual practices such as yoga and taiji are good for chronic pain, as the physical pain is a mere projection of a deeper trauma that needs released.
Ignoring the spiritual part, emotional state does have a well-known feedback loop with physical state. There’s a (largely incorrect) idea in pop psychology that just as happiness leads to smiling, smiling leads to happiness. It’s not nearly that simple, but there are some more straightforward examples: lots of tense emotional states (anger, anxiety) lead to tense muscles (jaw being the classic example). Relaxing your jaw can lead to a (temporary) relaxation of your emotional tenseness. I’ve never heard of a similar result for the lower back, but it’s not hard to imagine. If nothing else, they must be correlated through sedentary lifestyle.
Setting the woo aside, there is a lot of data on disorders like central sensitization syndrome that show our psychological state has a very strong modulating effect on our perception of pain.
>Those are exactly the people you want to have access to it
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
> I mean, states & countries that have completely state-run liquor stores still have alcoholism and serious alcohol problems though
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).
That's a bit of an apples and oranges comparison. The thing about for-profit prescriptions is that they incentivize doctors to prescribe opiates for people who don't need them, people who may not have even been interested in them. A for-profit retailer selling alcohol doesn't have that aspect at play at all; at most the for-profit aspect encourages flashy advertising and displaying alcohol more prominently, but nothing to the level of having a trusted expert in a one-on-one setting personally pushing for you to consume.
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.
State run liquor stores in the US don’t prevent companies advertising alcohol on TV. The US is really bad at allowing drugs without then also allowing drug promotion.
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.
All Scandinavian countries except Denmark have some form of state-run monopoly on the sale of harder alcohol, and of these countries, Denmark is the country where people drink the most, in particular among the youth.
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.
> A shattering drug addiction crisis that at its height killed more people annually than the entire Vietnam War.
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.
I personally consider the war on drugs to be a colossal failure and there tends to be widespread agreement that the War on Drugs was somewhat effective at enabling enforcement, but ineffective or counterproductive at eliminating drugs or reducing long-term harm.
What America continues to ignore, intentionally or not, is the root cause of drug addiction which tends to be a more complicated and nuanced
Well, now the war on drug is over and we see that the harms from _not_ doing it are worse. In 2023, overdoses overtook gun and traffic deaths _combined_.
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.
> The government should just regulate it, control purity and production and let people access small amounts for recreation/performance.
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.
No, policy wise I appreciate you getting into the nuance, but I feel like you take the argument to polar extremes (with an attitude of confident, final certainty), when the expected outcome is across the middle. This smells more like ideology than practicality.
> 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
> On the toxicity side, do you have any studies to cite? I wasn’t aware of toxicity, but it’s plausible.
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.
Oregon decriminalized drugs in 2020 and the experiment is widely viewed as a failure by both sides of the political spectrum. The Democratic legislature rolled it back four years later.
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.
Its meaningless to decriminalize using it, since it does not give big benefit of replacing narco terrorists producers with pure, controlled stuff from legal pharma companies.
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.
> 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 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.
> I think it’s a contaminant issue that’s exacerbated by the drug use.
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?
I don’t take the article as authoritative. It’s argument against contamination is not strong. It doesn’t present any real evidence for it. You can elaborate if you like
Government does sorta regulate it. Desoxyn is (rarely) prescribed for ADHD when other meds aren't effective enough.
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.
> The government should just regulate it, control purity and production and let people access small amounts for recreation/performance.
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.
Except that you fail to mention that amphetamine abuse is strongly associated with Parkinson's and other neurological diseases, which are serious public health burdens, and likely contribute to the phenomena of high personal tax regions like the EU.
Check out the book “The Fort Bragg Cartel” if you’re wondering why drugs are illegal even if legalization makes more sense from a harm reduction standpoint. The highest levels of the military are involved in drug trafficking. Use of drugs by clandestine colonial states goes all the way back to the opium wars. US is nothing new. The deep state funds off the books operations with drug money and possibly human trafficking as well.
And I thought for a second they were talking about peer to peer meth but no that's what the DEA shut down by tightly controlling pseudoephedrine, where before meth using meth makers were making meth and distributing it.
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.
> that's what the DEA shut down by tightly controlling pseudoephedrine, where before meth using meth makers were making meth and distributing it.
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.
Ephedrine isn't banned, not even behind a prescription, there's just rather strict limits on how much you can buy a month. I take a Bronkaid every morning with my coffee.
I was thinking the same thing, though I couldn't remember the timeline. Makes me wonder if there was something already in the zeitgeist, or if it was fueled by the obsession with purity in the series. I could totally see Breaking Bad causing chemists to want to up their game, or causing chemists to get clowned for having low purity.
yes, while the show probably popularized the idea of purity for meth, in general strict prohibition leads to increase in purity and potency. We've recently seen that with heroin/fentanyl. There is probably still no "fentanyl of meth", and thus so far only purity increase. Once a more potent, fentanyl-like, meth appears, it will probably similarly get into and displace a lot of classic meth trade.
What? Prohibition historically showed the exact opposite.
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 OP wanted to make the point that one of the most important things for people profiting from the illegal sale of drugs (meth or heroin/opiates) is to minimize the amount that has to be trafficked (1kg of 10% meth vs 100g of pure meth or 1kg of heroin vs 10g of fentanyl).
The production case for a stronger stimulant is weaker. Heroin is a really complicated molecule. It is only made from a natural precursor. Meth can be made by two major pathways, and P2P can be made by at least four off the top of my head. It was the fentanyl equivalent for cocaine. For anything else, you balance the increased complexity of synthesis with any increase in potency.
It's not insane, and it's the other way around. The writers consulted directly with DEA agents, they were being told how the meth trade was changing and wrote reality into their show.
Pseudoephedrine restrictions drove the search for new chemistry and the new chemistry brought in the large scale labs.
The article was doing so well until the conclusion.
> 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.
The author points out a synthesis route that includes lead in a reducing agent, and I think that other routes also depend on reducing agents that contain mercury (aluminum amalgam). Heavy metal exposure is cumulative, so even small amounts over a long time could be significant. They also disrupt the same dopaminergic system that heavy doses of stimulants disrupt, so the effects could be hard to find if we only look at the population that uses illicit stimulants.
Heavy disclaimer: I am neither a chemist nor a doctor, so this is speculation on my part.
Indeed, and for a layman like me it even sounds quite plausible that this could be what is making people go "mad as a hatter": https://en.wikipedia.org/wiki/Erethism
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.
>He points out that “old” meth was made from ephedrine and that “new” meth is made from a chemical called Phenylacetone or P2P
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.
In the former case, you have government artificially suppressing supply and acting to dissuade pharmacies from keeping almost any extra stock, which is unfortunate.
> 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.
Throwback to A Simple and Convenient Synthesis of Pseudoephedrine From N-Methylamphetamine [0] [1], a 2012 paper describing how to synthesize Sudafed from meth lol
I don't think its innate though - most people I've met can think of higher order consequences or at least understand them.
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.
The other day I needed pseudoephedrine, so I asked for one box of instant tablets and one box of extended release capsules. The store said they’re only allowed to sell me one box so I had to choose.
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?
Tried clicking the fivethirtyeight link halfway down the article, and was immediately reminded of what abc decided to start doing today. What an asshole move.
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)
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
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.
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.
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.
I have heard psychedelics be described as the most effective placebo of all placebos.
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
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
The craziness of so many legal things being pretty bad for health is also something worth addressing (alcohol, cigarettes).
https://en.wikipedia.org/wiki/CIA_involvement_in_Contra_coca...
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.
3 lines later..
>.. The Drug Enforcement Agency tests the meth they seize to see how it was made.
quick answer!
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)
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."
Pseudoephedrine restrictions drove the search for new chemistry and the new chemistry brought in the large scale labs.
> 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.
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.
Really? Seems to me that, in general, we suck at it.
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.
[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.
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?
Now I can't say that I led a P2P network anymore.