Alcohol and tobacco kill far more people than opioids

https://www.vox.com/policy-and-politics/2017/10/27/16557550/alcohol-tobacco-opioids-epidemic-emergency

50 44 9 years ago

Overeating also kills. Lack of exercise kills and so on.

Opiods are different, IMO, because they are generally issued by doctors, and they can kill you pretty quickly. Alcohol and tobacco, while dangerous, do give quite a bit of time to change and be saved.

Obviously the govt should do anti-smoking campaigns, but opiods are different.

Alex3917• 9 years ago

Alcohol and tobacco, while dangerous, do give quite a bit of time to change and be saved.

The typical tobacco death is someone in their 70s, whereas the typical alcohol death is someone in their 30s. (The majority of alcohol-related deaths are from suicide, car crashes, and slip-and-fall type injuries.) I doubt the types of deaths we're seeing from heroin are that much different than with alcohol.

jrs95• 9 years ago

True, but alcohol deaths are a much lower percentage of the drinking population than opioid deaths are to opioid users. That makes it more difficult to reduce imo. Alcohol kills indirectly in such a way that aside from efforts to curb drunk driving or drinking altogether there's not much that can be done. Personally I think mandatory breathalyzer ignition locks are probably the best you could do to quickly cut down on alcohol related deaths.

aaronblohowiak• 9 years ago

I fear that we will overcorrect and make painkillers hard to get for people that are suffering. In some countries, the chronically ill are unable to get access to powerful painkillers and that is a damn shame.

I also think that we need more research into pain-fighting interventions to develop non-opioid painkillers.

GordonS4• 9 years ago

If you take a look at /r/ChronicPain, it's evident that this is already impacting on a lot of people.

We don't need to demonise opioids, we need to carefully control their use.

simonh• 9 years ago

I don’t think they are, honestly. They are all dangerous substances that should be controlled or banned. However there’s no appetite to ban tobacco or alcohol. The latter was actually tried in the US and failed miserably. Persecuting opioid users has also been tried and failed miserably for exactly the same reasons.

The question is what lessons do we learn from this? Tobacco and alcohol use are treated as public health issues. That should continue and be extended. This has been shown to work where outright criminalizatuon has been shown to fail.

The same lesson should be applied to opioids. I don’t believe they should be legalised. As in Portugal, non medical sales should still be illegal and treated as just as serious a crime as now, but use should not. Possession of small amounts should be no more criminal that having a few too many cigarettes in your airline baggage, it should be an administrative offence. Doctors should be able to treat, help and support opioid addicts just as much as they help alcoholics without risking being treated as accessories to a crime. Providing clean needles should not be treated as a crime aiding and abetting drug use. Hundreds of thousands of users with no history of violent crime and convicted solely on the grounds of possession should be at home with their families and no more persecuted that smokers or drinkers. Crack down on the dealers and support the users to get them back into society, turn users into allies against the trade by treating them as victims. It’s been shown to work.

crimsonalucard• 9 years ago

What about the percentage of users vs deaths? The numbers speak of something, but it would be unwise to use the numbers as a metric to say that opioids are safer than tobacco and alcohol.

GordonS4• 9 years ago

I think it's tricky to quantify; a lot of opioid use is illegal, and that aspect undoubtedly alters things.

jmh5303• 9 years ago

We tried banning alcohol once already...

ghostbrainalpha• 9 years ago

And besides the whole rise of organized crime thing, it was a fabulous success!

Did you know that the customer warranty didn't exist before prohibition? People were generally so drunk that it wasn't considered a viable option to warranty your products because people would break them in their drunkenness.

leroy_masochist• 9 years ago

The author seems to be striving to miss the point.

There's a big difference between dying of cirrhosis, heart disease, diabetes, lung cancer, emphysema, etc in middle age and a 19-year-old kid OD'ing a couple of weeks or months after falling down the addiction spiral.

It's not just the number of deaths, it's the impact to society. Line cooks don't steal kitchen equipment to buy booze and smokes. Opiate addiction upends lives in a way that alcohol and tobacco simply do not.

jmh5303• 9 years ago

One cause (some say a or the major cause) of the agricultural revolution was a desire to make alcohol more efficiently. Can we count all the people who are alive because the agricultural revolution on the side of alcohol?

ssijak• 9 years ago

Booze addicts do steal stuff and are as bad for society as opiate addicts

24gttghh2• 9 years ago

The CDC would point out that yes, Alcohol has a huge impact on society; in this context, via drunk driving:

https://www.cdc.gov/motorvehiclesafety/impaired_driving/impa...

Every day, 28 people in the United States die in motor vehicle crashes that involve an alcohol-impaired driver. This is one death every 51 minutes. The annual cost of alcohol-related crashes totals more than $44 billion.

oxide3• 9 years ago

most people don't start with heroin.

Keep in mind any solution, including painkiller cutbacks, is proven to result in increased heroin usage (see: oxycontin reformulation in the early 2000's. By the end if the decade all abusable oxycontin would be gone.)

People are dying because heroin is illegal. Full stop. Fentanyl cut in heroin is a result of a broken approach.

anigbrowl• 9 years ago

Yeah, it's pure clickbait.

mnm1• 9 years ago

That difference is mainly legal status. Make alcohol and tobacco illegal and you'll see line cooks stealing to buy booze and smokes, organized crime around the industry, and everything we currently have with other illegal drugs. Hell, you don't even have to run this thought experiment yourself, but just read books about prohibition.

Also, what's the difference between a 19-year-old kid OD'ing a couple of weeks or months after falling down the addiction spiral and a 19-year-old kid dying in a car crash from drinking and driving a couple of weeks or months after falling down the addiction spiral (of alcohol)?

jmh5303• 9 years ago

The subtitle is "Should they be considered an “epidemic”" and it says in the article "We don’t often call alcohol or tobacco “epidemics,” even as we regularly use that same language for opioids that are linked to a fraction of the deaths from alcohol or tobacco.".

They are basically proposing to re-define epidemic. Traditionally, an epidemic is the rapid spread of something, usually a disease but not necessarily. Alcohol and tobacco have already rapidly spread. There's nowhere else for them to spread.

24gttghh2• 9 years ago

Feels like people are forgetting that Endemic is the perfect word for this sort of thing...They don't need to redefine epidemic; they need to use a more accurate word.

oxide3• 9 years ago

Im pretty sure it's criticism about the knee-jerk "emergency" declaration that has been nothing more than symbolic.

jjkk0101• 9 years ago

It boggles me that we still are faced with aggregated statistics to deny there is opioid crisis going on. If nothing else, alcohol and tobacco are also prone to addiction and should be curbed as well.

crankylinuxuser3• 9 years ago

I've never been a fan of these kinds of articles. They beg the question "Why arent we doing X?". There's a similar article about "Why aren't we stopping gamblers from addictive behavior?" on HN's front page. They seem to share a trend:

They look for legalistic controls over an individuals actions. And both attempt to say that their actions are addictive, therefore we cannot trust their actions, so we have to decide for them. I'm not comfortable with that logic. Nor am I for shoving more drugs underground. Cause that's that high taxation and controls do.

I tend to go on the side of freedom, even if it's "free to be dumb". And people will do destructive things. I don't particularly like this notion of nanny state.

oxide3• 9 years ago

People ought to get used to erring on the side of freedom.

Heroin is being cut with fentanyl because heroin is super fucking illegal for nothing more than political leverage over 1960's blacks in the US.

Err on the side of freedom today, save 500 million in price gouged narcan tomorrow.

You can ban everything you want, lock up dealers and distributors, sue doctors, burn poppies etc all day long. You'll just step on more used syringes until each one of us has some tough fucking conversations with each other in these United States of America.

rmetzler• 9 years ago

These articles are written by lobbyists. They just want to open up new fronts in the discussion to hinder any change that might threaten the status quo. It's the same with NRA lobbyists, big tobacco in Africa and Asia, big oil companies and soda companies who use high fructose corn syrup.

abhi32• 9 years ago

I tend to go on the side of freedom, even if it's "free to be dumb"

The issue is not as simple as you characterize it. Should 'freedom to be dumb' include freedom to drive drunk/while texting?

And both attempt to say that their actions are addictive, therefore we cannot trust their actions, so we have to decide for them.

You seem to think that these controls exist for the protection of the addicts. They don't. They exist to protect the society and economy from a downward spiral caused by widespread drug addiction - which is what will happen if you remove all controls.

lowmagnet• 9 years ago

DWI is a broad limitation on the use of any substance that impairs its user while driving. Texting is called "distracted driving" in some states/countries.

The drugs can be made legal, the consequences would still be the same. Except in cases where someone smoked cannabis last week and it still shows up a week later as metabolites, which is only a problem because the substance is illegal in most states still.

crankylinuxuser3• 9 years ago

The issue is not as simple as you characterize it. Should 'freedom to be dumb' include freedom to drive drunk/while texting?

But, it is. No law stops drunk driving. It is "illegal", but that's only a threat after the fact. And bringing cell phones is only a recent phenomenon.. How about people who read books while driving, or eating, or a thousand different things?

You only need 1 law for this: distracted driving. Distracted can be from doing things unrelated to driving, or being high, or drunk, sleepy, or whatever.

And I also have issue with "drunk driving". The .08 standard is not based in science. It's from MADD lobbying. And to be honest, if someone drives well at .08, so be it. People have different sensitivities - you should reasonably know if you're not safe.

You seem to think that these controls exist for the protection of the addicts. They don't. They exist to protect the society and economy from a downward spiral caused by widespread drug addiction - which is what will happen if you remove all controls.

So throwing people in metal cages is a good solution here? Cause that's the cost that the US has accepted when violating these controls. And these laws don't exactly have a good result either.

s0rce• 9 years ago

The solution to all three is probably to offer more support for addicts and other mental health issues.

CodeWriter232• 9 years ago

I’ve never heard of a court ordering drug addicts to consume alcohol or tobacco as part of their sentence. In certain states however, courts routinely order addicts into opioid drug replacement therapy programs during sentencing.

djur• 9 years ago

We haven't criminalized alcohol or tobacco addiction in the same way we have other drugs, so that's not really a reasonable comparison. Tobacco cessation programs do use tobacco substitutes like gum, patches, etc. though, and there's been some experimentation with providing small doses of alcohol to people recovering from serious alcohol addiction.

CodeWriter232• 9 years ago

Actually, most of the opioid epidemic is perfectly legal, as they are pharmaceutically-manufactured substitutes for the Opiates found in street drugs like heroin. Which brings up my secondary point, doctors don't prescribe tobacco nor alcohol. Nor do doctors receive incentives from pharmaceutical companies for prescribing tobacco and alcohol, but they do receive incentives for prescribing opioids. https://arstechnica.com/tech-policy/2017/10/doj-billionaire-...

That said, are you asserting that society's answer for someone out of control on Opiates is for the state to mandate Opioid use? The addicts I work with all tell me on no uncertain terms that kicking opioids is much harder than kicking opiates.

drinchev• 9 years ago

Living in Berlin and coming from Eastern Europe I would say that people smoke and drink a lot more than US.

It’s quite normal to have a glass of wine with your business lunch in Italy and Portugal. As well as a cigarette allowed restaurants in Czech Republic, and smokers bars here in Berlin.

Almost everyone drinks and smokes at least on the weekend. I was really shocked when I visited SF 2 months ago to discover that having a beer and a cigarette is impossible at any bar I tried ( smoking was forbidden 20 feet from entrance ).

Not sure how does it help reduce the death percentage compared to here ( Europe ) where most people consume moderately.

Bromskloss• 9 years ago

This doesn't seem to be the right metric. Surely, alcohol and tobacco are more common than opioids. To judge how defensible a certain consumption or action is, surely you need to see to the danger _per instance_. If not, I'm sure there are many other, perfectly normal, things that would en up on top of the list.

ChrisGranger• 9 years ago

Indeed, falling down the stairs probably kills more people annually than opioid overdose does, but you're never going to hear anyone complain about how dangerous they are.

tialaramex• 9 years ago

Actually slip, trip and fall accidents are a huge safety focus. Regulations can ensure stairs are designed to make falling less likely to cause serious injuries. Or, of course, as with most things Americans can insist their "freedom" to suffer so that somebody else can make a buck comes first.

Another big cause of household accidents is excessively hot water. Sure the kitchen sink might need the possibility of water hot enough to clean grease off a steel pan, but you don't need that for bathing your baby. So some countries legally require bathroom outlets are thermostatically controlled to a fixed limit, if there's not enough cold pressure to hit the limit, the water shuts off safely rather than char you. Simple mechanical valves can do this, and they're not that expensive - once a country is buying them for everybody.

peterwwillis• 9 years ago

Why do we spend billions of dollars on airport security when nobody in this country dies from terrorism, yet 66,000 people die every year from guns and cars? Because we're fine with people dying en masse if it doesn't bother our morals or make us afraid.

Also, thanks for flagging this article. Intellectual discussion about critical health and safety issues is clearly off topic.

Omnius• 9 years ago

We should make them illigal like illegal drugs that fixed everything.

stmfreak• 9 years ago

This article tackles death from hundreds and thousands of individual choices as if it were death by accident which a few regulations could cut in half. Everyone knows smoking kills you quicker, but still 11% of U.S. adults choose to smoke. You want to increase the burden on their already burdened existence? Have a heart. Let people slowly kill themselves in peace.

Alcohol and tobacco kill far more people than opioids

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