[tomato-sauce]

It feels like in the last few years I have been constantly hearing about new research showing “fun” drugs as cures to a wide array of medical conditions. There’s marijuana for chronic pain, mushrooms for depression, mdma for ptsd, and now ketamine. They are often talked about as if they have little or no harmful side effects. I’m glad we are moving away from the incredibly destructive drug policies that have been in place for so long but I fear the pendulum may be swinging too far the other way. The opioid epidemic was largely caused by the idea of them being non addictive being heavy pushed by the pharmaceuticals industry. Are we going to see similar harms from these drugs a few years after they gain more popularity? So far the evidence doesn’t show anything near this level of harm. I’m just skeptical of anything that seems too good to be true.

[DoreenMichele]

So far the evidence doesn’t show anything near this level of harm. I’m just skeptical of anything that seems too good to be true.

People with rare diseases (and their families and caretakers) get excited about anything at all actually helpful, especially if it comes through official, approved medical channels, because they suffer a whole helluva lot every single day while listening to the medical community promise "cures" that never seem to arrive. It's an amazingly hard psychological thing to live with.

On a Cystic Fibrosis list years ago, a parent said "My child turns 18 today. The life expectancy now is 36. When he was born, the life expectancy was 18."

So gains get made but these are people who need a miracle cure and needed it "yesterday" who are, instead, getting incremental improvements at what feels like a glacial speed while they live tormented lives.

So, yeah, they get excited. But that doesn't mean they are going to all throw caution to the wind and jump on the band wagon. Some that do -- or seem to -- are basically "already dead anyway" if they don't try something new and are happy to take a gamble in hopes of one last hurrah and at least it's more data for others like them if it doesn't help them.

[irthomasthomas]

Sorry to burst your bubble but U.S. drug policy is not as progressive as you might think. Cannabis is still illegal under federal law. And right now America is petitioning the WHO for a GLOBAL ban on KRATOM, a herb which has been used in Asia for hundreds of years with no recorded deaths. It has been in use in Europe and America for a couple of decades and still there are no deaths recorded from pure Kratom use. Kratom can be used to treat or replace alcohol, cocaine and opiate addiction. It is a herb harvested from the leaves of a tree related to the coffee plant and has incredible pain relieving properties, as well as being a mild stimulant and mood regulator. For more info see this recent study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6612999/

And please tell the FDA and WHO not to ban this awesome herb. The deadline for comments is August 9th. https://www.americankratom.org/

[PragmaticPulp]

Please don’t glorify Kratom as some sort of miracle herb without downsides.

Kratom is an opioid, full stop. People are under the mistaken impression that it’s less addictive because it’s less potent on a per-gram basis, but addicts simply end up consuming more grams to get similar highs.

It’s not a “mood regulator” in any magical sense other than it’s an opioid and opioids temporarily put people in good moods.

There are many communities dedicated to quitting Kratom and handling Kratom withdrawal, which is the same as withdrawing from other opioids (For instance: https://www.reddit.com/r/quittingkratom/ ).

Whether or not you think Kratom should be legal, we shouldn’t be glorifying it as a harmless substance that somehow defies the realities of every other opioid.

[jfk13]

I'm not familiar with that "awesome herb", so I wondered what other sources might have to say.

While the numbers are small (unsurprisingly, if it's not nearly as widely known and used as some other substances), it may not be quite as innocuous as you seem to imply:

> "A 2019 paper analyzing data from the National Poison Data System found that between 2011-2017 there were 11 deaths associated with kratom exposure. Nine of the 11 deaths reported in this study involved kratom plus other drugs and medicines, such as diphenhydramine (an antihistamine), alcohol, caffeine, benzodiazepines, fentanyl, and cocaine. Two deaths were reported following exposure from kratom alone with no other reported substances."

> "In 2017, the FDA identified at least 44 deaths related to kratom, with at least one case investigated as possible use of pure kratom."

(https://www.drugabuse.gov/publications/drugfacts/kratom)

Actually, even the study you linked has some disturbing statements:

> Deaths attributed to the use of Kratom have been reported in Europe and the United States but not in Southeast Asia.

> The increasing trend in Kratom consumption in the West has corresponded with an increase in reports of Kratom-related exposures to Poison Control Centers in the United States, care received at a health care facility due to Kratom consumption, and association with overdose fatalities.

> Kratom was identified as the cause of death by a medical examiner in 91 of the 152 Kratom-positive deaths, but was the only identified substance in just seven of these cases.

[loeg]

Kratom is fundamentally an opioid. It happens to be cheap and relatively safe (consumed by ingesting large quantities of plant matter, rather than injection or insufflation of some extremely potent compound). I think opioids are over-vilified in general, and I'm on the side of legalization, but kratom isn't magic.

[scythe]

>Kratom can be used to treat or replace alcohol, cocaine and opiate addiction.

This is a strange claim. Kratom alkaloids appear to be opioid receptor partial agonists [1]. De-escalation from opioids to kratom makes sense. Cocaine and alcohol addiction usually do not require "maintenance" post-rehab [2,3], unlike opioid dependence which is highly persistent [4], and this seems to muddy the story of a promising treatment [5] (it may compete favorably with buspirone and methadone) by mixing in stories of polydrug users who switched from cocaine to kratom.

I think kratom deserves further investigation not because it is so miraculous but because the options for effective management of opioid use disorder are extremely limited, so I would think defenses of kratom should focus on this application in particular. It is certainly much less deadly than true opioids.

1: https://jpet.aspetjournals.org/content/376/3/410.abstract

2: https://jamanetwork.com/journals/jamapsychiatry/article-abst...

3: https://www.sciencedirect.com/science/article/pii/S037687160...

4: https://www.sciencedirect.com/science/article/pii/S014067369...

5: https://link.springer.com/article/10.1007/s40122-020-00151-x

[parineum]

>It is a herb harvested from the leaves of a tree

As opposed to heroin and cocaine right?

[gunshai]

Come to Oregon where we just decriminalized the party.

[tomato-sauce]

Thanks for pointing this out. I don’t know enough about kratom to have an opinion on how it should be regulated. I will add a comment though. Just because I am fundamentally opposed to America regulating drug use outside of its territory.

[okareaman]

> The opioid epidemic was largely caused by the idea of them being non addictive being heavy pushed by the pharmaceuticals industry

That's not true. The new idea was that a manageable addiction was preferred to chronic pain. The theory was that addiction to opioids could be managed. That turned out to be not the case. People started selling pills and buying street heroin and it spiraled out of control.

[raphlinus]

It is true. The claim was that the risk of addiction was extremely small. One of the ways this idea was pushed was cherry-picking a study that showed no addiction among 10k burn victims treated with opioids. Minimizing the risk of addiction was also a major component of the guilty plea and fine.

Obviously any reasonable person with a knowledge of opioids could see that these claims were BS, but it's remarkable what motivated reasoning can do, especially when there's profit involved.

[1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/

[amanaplanacanal]

I thought the new idea was that people who took opioids only for pain relief didn’t get addicted, which in hindsight is absolute nonsense.

[monocasa]

No, the messaging to the doctors was that there was essentially no risk of addiction.

> This pain population with no abuse history is literally at no risk for addiction

> There have been studies suggesting that addiction rarely evolves in the setting of painful conditions

https://www.statnews.com/2017/05/31/opioid-epidemic-nejm-let...

[funnybeam]

A lot of the “fun drugs” were originally used for medical purposes and only banned because people started using them for fun

[bserge]

A real shame. But I guess if you let people learn personal responsibility they won't need the government as much anymore.

[dkersten]

> and now ketamine

Ketamine has been in medical use for a long time as an anesthetic and has also been shown to be beneficial for depression in recent years. Its not "now" Ketamine.

[bawolff]

> They are often talked about as if they have little or no harmful side effects.

Most drugs have side effects, including all the legal pharmaceuticals. E.g. normal antidepressants aren't without risk.

Anyways, that's why its important to study them - see where they lie on the risk-benefit trade-off curve.

> The opioid epidemic was largely caused by the idea of them being non addictive

I don't know which idiots thought these were non addictive. Like there was even the opium wars faught over this point in the 1800s. We've known of the danger since the 1700s.

[acituan]

> Most drugs have side effects, including all the legal pharmaceuticals. E.g. normal antidepressants aren't without risk.

Risk/no-risk dichotomy is misleading in that those categories do not consist of homogeneously comparable members. Nausea from an SSRI is not the same as triggering a first psychotic episode from psychedelic drug use, or pushing your neuroticism a standard deviation higher from stimulant abuse or getting stuck in opioid addiction.

[nicoburns]

> The opioid epidemic was largely caused by the idea of them being non addictive being heavy pushed by the pharmaceuticals industry.

I definitely think the pharmecuetical industry pushing drugs is a big problem. But that doesn't mean we should deny people treatments that work. Instead we should fix the actual problem: innapropruate presceiptions. Note that opiods are mostly not a problem here in the UK for example. We're much stricter about when they're used.

In any case, I think there's much less risk here. Ketamine is a somewhat addictive, but nowhere near as bad as opiods, and cannabis and especially psychedelics are pretty much not addictive.

It doesn't seem too good to be true to me. It seems obvious that the chemicals which clearly affect the mind are the ones which are likely to have some use for... affecting the mind in a positive way. They've at least cleared the first hurdle!

[pitaj]

The US has been cracking down on opioid prescriptions to the point that a lot of people can't get opioids for when they really need them for chronic pain and even after surgeries!

In the meantime, opioid overdoses have continued to climb. Turns out that forcing people into the black market to deal with terrible pain is not a good policy.

[stakkur]

Michael Pollan would like a word. I think you’re confusing ‘recent news’ with ‘a long history’.

[sneak]

A little reminder that the (legal) tobacco causes 7x more preventable deaths every day/week/month in the USA than the entirety of the opiate epidemic.

The policies that govern substances in the US are not based whatsoever on health outcomes, only money and racism.

That may change, but thinking of it as a one-dimensional pendulum is probably the wrong model for reasoning about it.

Effective treatments for difficult diseases always seem too good to be true: take paracetamol for an example.

[scythe]

>marijuana for chronic pain, mushrooms for depression, mdma for ptsd

Is it that much of a surprise that psychoactive drugs treat psychogenic symptoms? In the particular case of pain, the two major available drug classes -- opioids and benzodiazepines -- mimic the activity of addictive recreational drugs opium and alcohol. THC is used per se instead of derivatives because of its price and safety record (contrast opium/alcohol).

For depression/PTSD, psychiatry has thrown the kitchen sink at these conditions. It's more "newsworthy" when MDMA is used for PTSD than propanolol even though both serve essentially the same purpose: allowing the patient to discuss the traumatic experience without experiencing the emotional effects of that trauma, by blocking them physiologically. In this case, "blocking negative emotions" is a naturally desirable effect of a recreational drug (propanolol also blocks many positive emotions, rendering it less fun). Modifying emotions in depression doesn't seem like a surprise either, although psychedelics can be unreliable here (and this is well-documented). I expect some negative side-effects to appear, but I disagree that this is much of a change from the norm, except insofar as it upends a taboo. Methaqualone got its start treating insomnia, and the medical history of amphetamine is too long to fit in this comment.

In fact, during the early history of psychedelics, there were developed "less recreational" analogues of the major drugs, such as diethyl-psilocin ("ethocin") and 5'-methoxy-MDA ("MMDA") which were considered as possibly safer adjuvants to psychotherapy. The rediscovery of these agents might benefit more from attention on their history of bona fide therapeutic use, rather than on their recreational past. Perhaps we shouldn't be so surprised when some psychiatric medications turn out to be recreational, and mitigate the consequences pragmatically, rather than reflexively recoiling from anything resembling euphoria. One thing you learn from Infinite Jest is that the mere materialism of emotion is especially unnerving insofar as it applies to happiness, but reality isn't going away anytime soon.

What happened in this article with ketamine is quite different: test-tube evidence uncovered an effect that modifies a rare hereditary condition. I think the story here is really more about data-mining, and ketamine just happens to be interesting.

[PragmaticPulp]

> Is it that much of a surprise that psychoactive drugs treat psychogenic symptoms?

The surprising part is the growing narrative that these psychoactive drugs are basically miracle cures without downsides.

Drugs like LSD are being explored as adjuncts to intense therapy spanning many sessions, but the pop-science portrayal of these drugs ignores that intense therapy and instead imagines that tripping on mushrooms or LSD is a cure for psychiatric illness. It also ignores the fact that bad trips are a very real possibility and worsening of psychiatric illness is not uncommon among illicit users of these drugs. There are plentiful reports of psychedelics causing weeks or months of dysphoria or even precipitating long-lasting episodes of major depression, and it’s not hard to find them either.

If we want to get anywhere with these substances, we need to quit exaggerating their positive effects and downplaying their negatives. That’s a setup for failure when they’re further studied and the reality can’t match the unreasonably loft pop-culture presentation of these drugs as miracle cures that act alone without any downsides.

It is, as the grandparent comment said, reminiscent of the early days of opioids when we were bombarded with stories about how they were miracle cures without downsides. The truth is that they’re helpful in controlled circumstances but can be harmful when overdosed or prescribed without supervision, which doesn’t sound that different then the situation with drugs like ketamine.

[mam3]

The side effects are super well documentéd on drug-positive websites such as psychonaut wiki, erowid,... even r/drugs.

Just look for it

[beiller]

I think the harmful opoids were created due to heroin being illegal. The pharmaceutical version is purified and more potent in general, helping enshrine it as the go to for smuggling due to its smaller size/volume and then cut once it's imported to its destination. Just an opinion tho.

[PragmaticPulp]

> Are we going to see similar harms from these drugs a few years after they gain more popularity?

I think we’re already starting to see this on a smaller scale.

One of my friends is a therapist who does a lot of social work predominantly for low-income people coming from difficult situations. She encounters a lot of people who have become heavily dependent on marijuana under a mistaken impression that smoking multiple times every day is a good treatment for depression or anxiety. Many of them are under the impression than marijuana is a wonder drug that treats everything from psychiatric illnesses to cancer. Meanwhile they’re clearly too impaired and unmotivated to get their lives together due to being constantly high. She spends a lot of time convincing people to moderate their consumption or even abstain entirely. The results are great if she can convince them to stop, but that’s a difficult task.

More worrisome is the increasing number of parents she sees who are trying to medicate their juvenile children with marijuana. Some of the stories she tells about parents who are convinced they’re doing their kids a favor by giving them THC edibles before school (supposedly for anxiety) are downright tragic.

There is a growing mistrust of pharmaceutical companies and mainstream psychiatry that mirrors the rise of things like anti-vaxxers and belief in essential oils. Many companies are rushing to fill this demand for alternative medicine with products and services ranging from pushing heavy THC consumption to ketamine clinics that will give ketamine to anyone willing to pay a few hundred dollars per dose.

In the case of this article the discovery of ketamine’s actions is more likely to spur development of new molecules that can be used without the obvious side effects of ongoing ketamine treatment (which is not as harmless as it sounds when repeatedly dosed over a lifetime).

[chillwaves]

Did you ever compare the side effects of marijuana to the popular antidepressant, antianxiety and ADHD medications being given to children?

> There is a growing mistrust of pharmaceutical companies and mainstream psychiatry that mirrors the rise of things like anti-vaxxers

This statement seems to ignore the crisis brought by narcotic drugs. People should be skeptical of pharmaceutical companies. There is a long history of their drugs killing people. It's really not worth my time to post it all, but feel free to do a little research yourself.

Comparing them to antivaxxers is inflammatory and inaccurate.

[TulliusCicero]

What we're seeing is data from studies. What we need is yet more studies.

Yes, there's probably negative side effects, but that's true for medicines in general.

[closeparen]

Recreational doses are quite a bit bigger than therapeutic doses. Take enough of any legitimate pharmaceutical and it’ll mess you up, too.

[standardUser]

"They are often talked about as if they have little or no harmful side effect"

Unlike all those "unfun" drugs? I think side effects are part and parcel of virtually all drugs. Do we need a special all-caps disclaimer anytime a drug is mentioned to remind people that side effects exist? If we did, most of the biggest disclaimers would be reserved for fully-legal, commonly-prescribed drugs.

[samstave]

I'm not sure how old you are, nor your familiarity with the history behind Silicon Valley and "Drugs"

---

>The opioid epidemic was largely caused by the idea of them being non addictive being heavy pushed by the pharmaceuticals industry.

False - there was never the "idea" that these were non-addictive - it was an active, malicious, evil fucking LIE.

---

One of the co-founders of Cisco, and one of the fathers of the Border Gateway Protocol (BGP), (as well as RIP, etc) - - which is aurguably the foundations of routing which makes the Internet possible, stated, in response to Hoffman's 100th birthday celebration (the discoverer of LSD):

(Paraphrased, mostly: "I was opposed to drug testing of employees at Cisco as we scaled -- if it weren't for LSD we wouldn't have been able to come up with many of the complex concepts behind BGP"

Here is one article on it:

https://www.wired.com/2006/01/lsd-the-geeks-wonder-drug/

I know first hand how much Drug/"anti-Culture" is imbued in Silicon Valley, computing in general.

I have done many a drug with many a people who have built the shit that the world lives and thrives on daily.

There is a STARK difference between a mood altering suppressant such as an opioid and expand nootropic drugs, such as LSD and Shrooms. Both of which are IMO some of the most important psycho-actives we have.

You are touching something (your machine) and consuming content (netflix etc) built by many people who have benefited, and thus had you benefit, from their experiences with 'altered-conscious'....

The Sackler Family is an evil piece of shit family that should be worse than in prison....

But The internet and Computing as we know it, would not exist if it were not for people who do not accept the simplicity of base reality and can operate at higher levels at times with the help of LSD/Shrooms.

its funny how one may equate "harmful addiction" with the USE of such substance.... in fact, my counter-culture DNA has shown me my entire life - that "the establishment" literally is quelling human growth because of the fact that using these reveals the fragility and tenuous control they actually have.

In fact, I am sitting here with a book that one of my best friends just sent me - "The Fabric of Reality" (by David Deutsch) and in all likelihood, this evening you will be using tech that he has helped build...

The only thing that is "too good to be true" is when someone else tells you definitively that you must do and act "this way" because we said so. (Look at the fucking state of the world at this moment -- you think that all these governments and institutions know what the fuck they are talking about? - no...)

Go microdose some shrooms for good measure.

[wyre]

Cannabis, psilocybin, and LSD have been used recreationally for decades with death rates approaching zero and there have been 0 cases of overdose. I was under the impression that these drugs were made illegal because their use promotes an anti capitalism mindset (see Timothy Leary being called the most dangerous man because of his research on LSD) and the medical industrial complex isnt able to extract as much money from them. I’ve never heard that opioids where once known to be non-addictive. Weren’t the Opium Wars started because China wanted Britain to stop selling them addictive opium?

It’s fair to be skeptical, but the data is not there. Cannabis, MDMA, and ketamine all have high potential for addiction and the latter two potential for abuse but it is possible to find Ketamine clinics for safe administration. I’m not familiar if there is public MDMA treatment available.

[gunshai]

>Weren’t the Opium Wars started because China wanted Britain to stop selling them addictive opium?

Yes and out of the opium wars I believe is why the state of Hong Kong came into existence. China had contractual obligations to buy opium, I believe they ended up dumping it into the bay in sort of a Tea Party type scenario but it was the Chinese government who did the dumping.

The opium wars are pretty damn fascinating. OH and if I'm not mistaken it was a contractual obligations with the East India Trading company and the British government backed the EITC by making a trade blockade.

[sandworm101]

Oxycodone was pitched as non-addicting. Opioids generally were pitched as non-addicting because they were by prescription, under control of doctors. That protection scheme obviously failed miserably.

[elevaet]

One danger of chronic ketamine use is bladder damage.

[dkersten]

From what I've read about people using Ketamine for antidepression, they tend to use a very small dose at as long an interval as possible while still being effective, while the reports of bladder damage seem to be when people use large quantities (a few grams) per day for months. That is, if you're using it medically, rather than for recreation, its probably not a risk. Even recreationally, unless you're abusing it, its likely not a big risk.

I think a big part of the issue is that you quickly develop a tolerance to Ketamine, so if you're a daily user, there's a strong tendency to up the dosage to maintain its effect. If you're a casual user or are careful to spread it out to avoid tolerance buildup, I think it can be avoided.

With that said, you're absolutely right that it is a danger that needs to be kept in mind, but from what I've read, if you're not abusing it, the risk seems low.

[dllthomas]

But note https://astralcodexten.substack.com/p/drug-users-use-a-lot-o...

[chefkoch]

You have to take really large amounts daily to get bladder problems.

[nickthemagicman]

What there a really are no or very few side effects?

[narag]

Ketamine seems to be a commonly used drug in emergencies because it's a safer anesthetic than propofol when you don't know specifics about the patient and can't determine dosage.

[rscho]

There are. Hypertension, arrhythmia, confusion, delirium... Mostly at anesthetic or at least pain killer dosage, though. Ketamine can in fact be a dangerous drug when you don't know what you're doing.

[shadowgovt]

(interpreting as "What if there really are no or very few side effects?")

That would be great, but it would be something we learn on the other side of controlled trials.

[IBCNU]

The idea of the pendulum swinging too far is a huge over-reaction. The pendulum has 40 years of swinging back to a "normal" state if you include the overprescribed industry of prescribing mood altering drugs to suburbanites, adderall, etc. Yes, the boomer and gen-x generations were raised in a lie: their doctors told them they could take drugs without side effects. However, this is now well known.

[dghughes]

>I’m glad we are moving away from the incredibly destructive drug policies that have been in place for so long

The point of the polices was to counter the incredibly destructive result of the surge of cocaine, crack, heroin use in the mid 1970s and early to mid 1980s. And the deaths from the drug use and the gangs fighting over the spoils. It really was a war. Mexico didn't seem to make it, I think the drugs won.

I know for some people these days it's cool to poo poo the so-called "war on drugs" but to Gen X who lived through the surge it was not a great time. Every day some news of deaths, fights, we were constantly reminded of it. Something had to be done and the free-for-all didn't seem to be working. I guess just like psychology you hear of examples where the stern family raises a wild child and the carefree family raises a straight-edge child the program backfired.

Drugs are chemicals just as is water and yes if a drug is useful then study it and use them for good if possible. But to others it seems many view all drugs as holy and that they can do no wrong is ridiculous.

[ihunter2839]

"The point of the polices was to counter the incredibly destructive result of the surge of cocaine, crack, heroin use in the mid 1970s and early to mid 1980s."

This would be plausible if the policies were focused on those drugs exclusively. However, I see the draconian policies targeted towards cannabis, hallucinogens, and amphetamines as pretty ample evidence that the "war on drugs" had much wider ambitions than curbing the usage of these hard narcotics.

Edit) To your point of folks speaking harshly of our current drug policies - look at where we are now, 50 years later. A nationwide opioid crisis created by pharma companies. A generation, if not two, of young men and fathers locked up in prison with little to no room for upwards mobility. Communities, already economically deprived, losing stability, obliteration of the nuclear family core, and enduring oppressive policing policies. So yes, I think its entirely fair for a new generation to shit on the war on drugs. Even if the policy was formed with good intentions (which is, frankly, debatable), it is still bad policy.

[throaway46546]

Ironically you are describing the consequences of the "war on drugs" which started in 1971. Many overdose deaths are directly related to the unknown quality of black market drugs. There would be no gangs "fighting over the spoils" if it were legal. You are conflating the consequences of prohibition with the consequences of drug use. That isn't to say all drugs are good, but as we learned in the 1920s prohibition is assuredly worse.

[Klinky]

The "War on Drugs" did little to solve the social causes of drug addiction and dealing, and mainly focused on expensive law enforcement operations and penalizing impoverished people further. With the opioid epidemic, white-collar drug dealers were free to make huge profits getting people addicted, with little repercussions for decades. The "War" was targeted to a very specific demographic.