My experience of losing a friend to heroin (2020)

Don't get me wrong: I am absolutely in favor of decriminalization, as well as other radical changes in our society's relationships with drugs, mental health, and addiction. But it would be catastrophically naive to suggest that legalized/decriminalized opiates are some kind of panacea.

If heroin didn't exist, these people would probably plain old alcoholics. The damage caused by an alcoholic is pretty similar to the wake of a heroin addict... It's not identical, but the overlap in causes & effects of abuse is pretty similar between the two drugs.

Ultimately, the problem is that some people reach young adulthood without having developed a robust set of emotional coping mechanisms for handling the stresses of their lives. These folks are a LOT more likely to fall into the larger patterns of self-destructive behavior that drive them back toward drugs, over and over again.

I'm a strong proponent of the US taking the approach the Swiss took to combat their opiate epidemic in the late 80s and early 90s. Anyone that is addicted to drugs can get the drugs they want, they just have to already be addicted first, and accept the drugs in a safe environment. It would be extraordinarily expensive, but cases like Jacks are already costing us much more than just giving him drugs, keeping him alive, then having healthcare professionals be there at exactly the moment he decides he's had enough. The effect on new users would be profound as well: as all the current users naturally age out of wanting to use hard drugs, the majority of drug dealers (other users themselves), won't have the capability to introduce new people to hard drugs.

However, we seem to have this huge moral hang up in the US about giving addicts drugs, even though we know that will save lives and money by reducing crime and lowering overall healthcare costs. For all the money Jack's parents spent on rehab, and hours spent watching him, none of it could prevent them burying their son the day he got a bad bag of heroin. For a case like Jacks, only safe drugs and injection sites would keep him and the millions of people stable before they are ready to move on.

The US is just not prepared to do what it takes to solve the opiate epidemic, and it's so frustrating to what tens of thousands of people die while we aren't anywhere near getting our act together. It's a Vietnam war in OD deaths, every year, and the Sacklers just walked with no criminal liability. Unless we do something drastic to reach these people, the opiate crisis is never going to go away.

Recently heard this podcast with Lex Fridman and Carl Hart (author of Drug Use for Grown-Ups) and talk about this

I'm not taking about weekend poker players, here... I mean people who've lost their wife, kids, house, and job to a gambling habit. They have zero savings, mountains of debt, and if you lend them $20 to get groceries, they'll go hungry after gambling it away?

Modern video games are designed by highly paid, PHd-level behavioral scientists to be as habit-forming as possible. If you're vulnerable to it, you're going to have the same kind of struggles getting away from video games as a heroin addict would from junk.

The lack of immediately lethal consequences is only part of the problem... Addicts can ruin their lives, and take their families and friends to the point of no return, even without the possibility of something as serious as an overdose.