Sure, addiction per se won't. But in my observation, the correlation with death is troublingly high! Though I suppose it's totally possible there are many, many more stealth addicts than I'd think.
We should make the distinction between "addiction" and "physical dependence". They can go hand in hand, but one can be present without the other. Plenty of people are dependent on everything from alcohol to benzodiazepines to their SSRIs - which will likely cause fairly grave health outcomes regardless of how compulsive their use is, or if their routine use causes harm on its own. If you go cold turkey off a routinely prescribed benzodiazepine regimen you are very likely to have your seizure threshold lowered so that you can seize without any history of epilepsy or other conditions that cause seizures, and that, of course, kills quite a few people every year. Alcohol frequently works the same way.
Addiction itself, or as how the DSM-V prefers to call it, "substance use disorder", is problematic since its pathology is by definition partly subjective. Whether someone's compulsive use is harmful or even considered compulsive is, well, subjective. I don't have to go to work, so my boss, if I have one, can never fire me for being high. If my work is better when I'm high, I wouldn't want to quit. It's rational to stay on whatever that makes me productive and I can afford. If social opprobrium, which is also subjective (see: Qat and its role in Yemeni society, for example), then addiction is, well, in a sense meaningless as a universal concept. It only appears so because America's foreign policy is coercive and paternalistic and that happens to align with the goals of governments either seeking to advance their particular narrative - the Communist Party of China needs the Opium Wars to be actually about opium, not because its ultra-protectionist authoritarianism ran against supply, demand, and human behavior. South American countries needed foreign aid and so sold part of its domestic policy to the US in a decades long futile war against their own interests. Bootleggers and baptists, Communist Party's raison d'etre and the American pastime of fear mongering and oppression. The story is ancient, but the alignment of interests happen, whether in 1839 or in 2025.
People die from overdoses, sure. But that's not unique to those we placed on the schedules of the Controlled Substance Act. Far from it, in fact. Some, or, since the precise outer boundaries of the Analogue Act is nebulous at best, it's extremely likely that what a court will find to be an "illicit substance" have never killed anyone and may not have even been synthesized at all. The DEA scheduled an analogue of a Schedule IV benzodiazepine, Etizolam, based on four unconfirmed reports in Norway that it was detected in hospital visits of patients who went to the hospital not for the effects of the substance the commissioner placed into schedule I on an emergency basis and then laundered in as final during COVID. Why Norway? Because there literally were zero cases involving the substance causing anyone injury in the US at the ime, or really, as far as we know, since, but we can't, because being put on Schedule I makes any research into it effectively impossible. What you don't know can't affect you, right? Well, when you have moralistic ideologues in charge of medicine, knowledge, process, and even reality takes a backseat to the outcome, which tends to be self-serving. Why have a DEA when you don't actually need it? Why have an ATF when all three things they purport to regulate (before they added explosives into the name but not the acronym in this century) are things that the states can and have regulated, in their own way, since the founding? Well, the outcome is that the DEA ensures that there is an "illicit drug problem" by laundering money for the cartels and coupled by harsh laws on possession that frequently have no intent requirement, creates a circular criminalization hamster wheel against the forces of the market. It's not about addiction, it's about making sure that those given power and money holding onto just that. Since the shutdown also made what's left of the OIG's site inaccessible, that particular minor scandal is generally outlined, with redactions, here: https://archive.org/details/a-20071-1. The ATF's own pernicious scandal to create crime that justifies its existence is well documented in investigative journalism at places like https://6abc.com/post/feds-accused-of-targeting-minorities-in-stash-house-stings/55463/ and https://www.usatoday.com/story/news/nation/2014/05/29/atf-stash-house-sting-backlash/9719403/. Caveat is that due to poor record keeping, the 1,000 created cases of criminal conduct is certainly a dramatic undercount. but the DEA's own OIG decided a 5 decimal place error in cocaine seizure reported as a valid typo says a lot on its own.
The kind of overdoses one think of - doing too much the first few times someone uses a drug, is not what most overdoses are like, and even those are really created by the fact that prohibition does not actually magically makes supply and demand disappear, but instead introduces artificially inflated prices for products produced by those without necessarily having the same sort of expertise and equipment to ensure product quality, and also, a need to produce the most potent and smallest in physical size version that can still be sold for a profit. Methanol to ethanol, fentanyl to heroin. The rehab industry, which is, well, frankly, modern quackery in the most visible of its forms, operate with reckless disregard for the fact that they do nothing to alter behavior but creates a situation where upon exiting the program, users no longer are able to gauge either the quality of the merchandise on the street or where their tolerance is at. That's how addiction kills - circuitously, and from policy that ensures that it kills. Nobody actually believes that the opioid crisis started in the 90s, right? Purdue is not too big to fail, but Pfizer, Teva, etc are.
I worked at a public defender's office in what used to be part of the "meth belt" but at this point little true distinction remains, and this sort of doublespeak from the state becomes numbingly routine. Since 2008, around 40 of my friends and acquaintances have died from the escalation of the opioid crisis prompted by the enforcement agency, whose decisions are rubber stamped by the FDA, although they would override FDA's findings regardless if they saw fit. The DEA is not staffed primarily by doctors, or lawyers, or professionals with a post-secondary education by large. They are cops, and they dictate how medicine is practiced. Pure and simple. They do not care about patients and their well being. It's stated in the federal register: "The processes and procedures associated with dispensing a controlled substance are not relevant factors to the determination of whether a substance should be controlled or under what schedule a substance should be placed if it is controlled." But it's at the very least disingenuous to say that "the DEA believes that when a practitioner makes a medical determination that a particular controlled substance is appropriate to treat a patient's medical condition, the practitioner will prescribe the appropriate controlled substance, regardless of the substance's schedule" when the policy of the DEA is also to specifically prevent that very decisionmaking they suggest. https://www.nbcnews.com/politics/supreme-court/supreme-court-sides-doctors-convicted-pain-pill-schemes-rcna35514
There's a whole out-right openly racist origin to this whole enforcement regime but, at this point, it almost doesn't matter that our drug policy is a prolonged act of race baiting that became the de facto welfare system for a certain favored demographic. It matters more that the medical aspects does not matter even if it made sense. It's policy, not science, that's driving this train. And policymakers assign blame to all but themselves.
Thanks for good observations, I do not knew that one of my classmates was an fentanyl addict until he died, he when he was visiting home town always tried to score some xanax. Thats my observation. And I basically put benzodiazepines as a drug of same potency of abuse as heroin.
Heroin overdoses can be lethal, but if you can afford it, addiction won't kill you. My sister, a nurse, has relayed to me that distinction
Sure, addiction per se won't. But in my observation, the correlation with death is troublingly high! Though I suppose it's totally possible there are many, many more stealth addicts than I'd think.
We should make the distinction between "addiction" and "physical dependence". They can go hand in hand, but one can be present without the other. Plenty of people are dependent on everything from alcohol to benzodiazepines to their SSRIs - which will likely cause fairly grave health outcomes regardless of how compulsive their use is, or if their routine use causes harm on its own. If you go cold turkey off a routinely prescribed benzodiazepine regimen you are very likely to have your seizure threshold lowered so that you can seize without any history of epilepsy or other conditions that cause seizures, and that, of course, kills quite a few people every year. Alcohol frequently works the same way.
Addiction itself, or as how the DSM-V prefers to call it, "substance use disorder", is problematic since its pathology is by definition partly subjective. Whether someone's compulsive use is harmful or even considered compulsive is, well, subjective. I don't have to go to work, so my boss, if I have one, can never fire me for being high. If my work is better when I'm high, I wouldn't want to quit. It's rational to stay on whatever that makes me productive and I can afford. If social opprobrium, which is also subjective (see: Qat and its role in Yemeni society, for example), then addiction is, well, in a sense meaningless as a universal concept. It only appears so because America's foreign policy is coercive and paternalistic and that happens to align with the goals of governments either seeking to advance their particular narrative - the Communist Party of China needs the Opium Wars to be actually about opium, not because its ultra-protectionist authoritarianism ran against supply, demand, and human behavior. South American countries needed foreign aid and so sold part of its domestic policy to the US in a decades long futile war against their own interests. Bootleggers and baptists, Communist Party's raison d'etre and the American pastime of fear mongering and oppression. The story is ancient, but the alignment of interests happen, whether in 1839 or in 2025.
People die from overdoses, sure. But that's not unique to those we placed on the schedules of the Controlled Substance Act. Far from it, in fact. Some, or, since the precise outer boundaries of the Analogue Act is nebulous at best, it's extremely likely that what a court will find to be an "illicit substance" have never killed anyone and may not have even been synthesized at all. The DEA scheduled an analogue of a Schedule IV benzodiazepine, Etizolam, based on four unconfirmed reports in Norway that it was detected in hospital visits of patients who went to the hospital not for the effects of the substance the commissioner placed into schedule I on an emergency basis and then laundered in as final during COVID. Why Norway? Because there literally were zero cases involving the substance causing anyone injury in the US at the ime, or really, as far as we know, since, but we can't, because being put on Schedule I makes any research into it effectively impossible. What you don't know can't affect you, right? Well, when you have moralistic ideologues in charge of medicine, knowledge, process, and even reality takes a backseat to the outcome, which tends to be self-serving. Why have a DEA when you don't actually need it? Why have an ATF when all three things they purport to regulate (before they added explosives into the name but not the acronym in this century) are things that the states can and have regulated, in their own way, since the founding? Well, the outcome is that the DEA ensures that there is an "illicit drug problem" by laundering money for the cartels and coupled by harsh laws on possession that frequently have no intent requirement, creates a circular criminalization hamster wheel against the forces of the market. It's not about addiction, it's about making sure that those given power and money holding onto just that. Since the shutdown also made what's left of the OIG's site inaccessible, that particular minor scandal is generally outlined, with redactions, here: https://archive.org/details/a-20071-1. The ATF's own pernicious scandal to create crime that justifies its existence is well documented in investigative journalism at places like https://6abc.com/post/feds-accused-of-targeting-minorities-in-stash-house-stings/55463/ and https://www.usatoday.com/story/news/nation/2014/05/29/atf-stash-house-sting-backlash/9719403/. Caveat is that due to poor record keeping, the 1,000 created cases of criminal conduct is certainly a dramatic undercount. but the DEA's own OIG decided a 5 decimal place error in cocaine seizure reported as a valid typo says a lot on its own.
The kind of overdoses one think of - doing too much the first few times someone uses a drug, is not what most overdoses are like, and even those are really created by the fact that prohibition does not actually magically makes supply and demand disappear, but instead introduces artificially inflated prices for products produced by those without necessarily having the same sort of expertise and equipment to ensure product quality, and also, a need to produce the most potent and smallest in physical size version that can still be sold for a profit. Methanol to ethanol, fentanyl to heroin. The rehab industry, which is, well, frankly, modern quackery in the most visible of its forms, operate with reckless disregard for the fact that they do nothing to alter behavior but creates a situation where upon exiting the program, users no longer are able to gauge either the quality of the merchandise on the street or where their tolerance is at. That's how addiction kills - circuitously, and from policy that ensures that it kills. Nobody actually believes that the opioid crisis started in the 90s, right? Purdue is not too big to fail, but Pfizer, Teva, etc are.
I worked at a public defender's office in what used to be part of the "meth belt" but at this point little true distinction remains, and this sort of doublespeak from the state becomes numbingly routine. Since 2008, around 40 of my friends and acquaintances have died from the escalation of the opioid crisis prompted by the enforcement agency, whose decisions are rubber stamped by the FDA, although they would override FDA's findings regardless if they saw fit. The DEA is not staffed primarily by doctors, or lawyers, or professionals with a post-secondary education by large. They are cops, and they dictate how medicine is practiced. Pure and simple. They do not care about patients and their well being. It's stated in the federal register: "The processes and procedures associated with dispensing a controlled substance are not relevant factors to the determination of whether a substance should be controlled or under what schedule a substance should be placed if it is controlled." But it's at the very least disingenuous to say that "the DEA believes that when a practitioner makes a medical determination that a particular controlled substance is appropriate to treat a patient's medical condition, the practitioner will prescribe the appropriate controlled substance, regardless of the substance's schedule" when the policy of the DEA is also to specifically prevent that very decisionmaking they suggest. https://www.nbcnews.com/politics/supreme-court/supreme-court-sides-doctors-convicted-pain-pill-schemes-rcna35514
There's a whole out-right openly racist origin to this whole enforcement regime but, at this point, it almost doesn't matter that our drug policy is a prolonged act of race baiting that became the de facto welfare system for a certain favored demographic. It matters more that the medical aspects does not matter even if it made sense. It's policy, not science, that's driving this train. And policymakers assign blame to all but themselves.
👏🏻
Wow. This is stung in all the right places.
Thanks for good observations, I do not knew that one of my classmates was an fentanyl addict until he died, he when he was visiting home town always tried to score some xanax. Thats my observation. And I basically put benzodiazepines as a drug of same potency of abuse as heroin.