[Nursie]

On the one hand, I'm sure that the post you're responding to is referencing many previous failed attempts at making non-addictive opioid painkillers.

But on the other, non-sarcastic side... if addiction is the only remaining problem with them, should we care that much?

I.E. if both the chronic and acute health risks are gone (which I don't think they are for a second, but follow me along on this little thought experiment)... does it matter quite so much? Clearly addiction, in the abstract, is not exactly a good thing. But if it's not coupled to risk of death it seems to me it would be a great thing to transition addicted people to, and take away some of the urgency of the situation.

[tim-kt]

I agree. I would say that I am addicted to caffeine. I definitely get withdrawal symptoms if I don't have a coffee. But since it is so accessible and there are no health risks, it does not affect me negatively to "feed" the addiction.

[mrbluecoat]

Not a great analogy. Caffeine is not as addictive as opioids. Opioids strongly stimulate the mesolimbic dopamine pathway, leading to intense euphoria, compulsive use, and severe health and social harm.

[cactusplant7374]

Tyler Cowen has said that he doesn't drink coffee and he is worried about what it might be doing to us. There is a big unknown.

[ViktorRay]

By definition addiction involves pursuing substances or engaging in behavior repeatedly despite negative consequences in one’s life.

Any behavior or substance that causes serious addiction is still bad regardless of whether it causes death or other negative health effects. The addiction itself inherently causes suffering because the addict is engaging in something despite the negative consequences in the rest of their lives. The negative consequences cause suffering and the psychological pain of wanting to stop and not being able to stop also causes suffering.

I know some other commenters mentioned caffeine addiction but nicotine and opioids (and also behavioral addictions like gambling) are vastly more addictive than caffeine.

Negative consequences from addiction can involve more than loss of money (although loss of money is still a significant thing of course.) They can cause damage to one’s career, family relationships, friend relationships and so on. Even if the addictive behavior or substance has no other inherent negative health effects.

In high school I had a really bright and motivated friend. He went to an Ivy League school. He became horribly addicted to World of Warcraft as a freshman. He spent so much time playing the game that he damaged his grades and GPA. He almost failed out of school. He had to make serious effort to stay in school. And he had to spend tremendous mental effort to avoid playing additive games anymore. That’s just one example.

[throwaway173738]

> .. if addiction is the only remaining problem with them, should we care that much?

I think we should because it’s undignified to have people who want to stop taking them but are unable to resist the compulsion. I feel the same way about basically every addictive substance. Even if it was freely available and risk-free I still think that being trapped in a cycle of use and withdrawal is such an affront to someone’s dignity that we should still try to prevent that.

[tyingq]

There's already buprenorphine and methadone. But, using either means some degree of responsibility, punctuality, etc. So unless you mean freely distributing it with very little process, it wouldn't change much.

[Nursie]

Those, from what I understand, don’t hit the same and someone needs to be ready to quit to go on them, they help with withdrawal etc, definitely, but are not always successful as they don’t scratch the full itch. A bit like nicotine replacement therapy

But there’s a whole space of harm-reduction before then, which is where things like the Swiss program to provide heroin in controlled circumstances can fit in.

An opioid without respiratory depresses on problems could fit into that sort of thing pretty well.

[xienze]

> if addiction is the only remaining problem with them, should we care that much?

Have you _seen_ what the streets of major cities look like these days? Ever heard of "fent zombies"?

[Nursie]

I’m in one now. The problem here is meth. But then I’m not in the US and things are different in different places.

It was a thought experiment about addiction if the other negatives could be removed, I doubt we’re actually anywhere close to that anyway, but it might imply that zombification had been solved.

[temp0826]

I mean I guess it depends on the level of use? Do you need to be nodding off, drooling on the verge of respiratory collapse to cope with the dread of your situation? (I feel like people are mostly only considering the physical reasons for starting opiates in this post btw). Or is it a more reasonable dose that allows you to participate in society unencumbered by your pains? (Which in any case is a slippery slope with long term use)

[Nursie]

Ha, you won’t find me arguing addiction to meta products is harmless ;)