Saturday assorted links

by on January 9, 2016 at 12:49 pm in Uncategorized | Permalink

1 Asher January 9, 2016 at 1:18 pm

#6 – We (I?) used to think that overdoses were themselves mostly a function of drugs being illegal hence impossible to know the strength of the drugs you have hence easy to make a mistake and over-dose. Overdoses of industrially produced pills certainly seems to give the lie to this understanding and does indeed show up some weaknesses in the traditional pro-legalization narrative.

2 Jan January 9, 2016 at 2:20 pm

The other thing he leaves out with painkillers is that these drugs had massive increases in utilization not due to the fact they are just “legal,” but because they are legal and sanctioned (oftentimes pushed) by doctors. As of 2015, the top three most trusted professions are nurses, docs and pharmacists, in that order. This removes a lot of the stigma associated with taking the drugs, which is a major factor in discouraging their use.

http://www.gallup.com/poll/180260/americans-rate-nurses-highest-honesty-ethical-standards.aspx

3 PD Shaw January 9, 2016 at 5:19 pm

Drum’s point is that if addictive substances become easier, we can expect more of the negative consequences of addiction. If doctor’s are helping make it easier through lax prescription policies, then its not likely to be different if no doctors are involved. Also,this: “It appears that most addicts are not getting their drugs directly from a doctor.”

4 Jan January 9, 2016 at 5:27 pm

I’m actually not so sure about that. Drugs–even if they are basically the same as heroin–have the veneer of safety when they are prescribed by a doc. Even if not to the person taking them. It’s still “medication.”

On the last quote, it is well known that most people abusing rx opioids get them from friends and family. Doctors prescribing excessive amounts of these drugs increases the supply of remaining unused (and sometimes completely unnecessary) painkillers into the gray and black markets. Grandma’s medicine cabinet.

5 Thomas January 10, 2016 at 12:04 am

Also,this: “It appears that most addicts are not getting their drugs directly from a doctor.”
Where did they begin to get their supply from? If you create an addict, that addict will look to other sources. Most addicts start real addict behavior from an outsider position. For the type of non-conformists and losers you remember from high school, they could go straight to the illegal drugs. For the suburban moms, they never would have gone that direction if not for their doctors convincing and reassuring them from a position of power within the government-drug system. Rule followers become addicts by following the rules, not seeking out corner dealers. Oxy addiction is a failure of the system, not an indication of what +-2 sigma folks would do absent laws on heroin.

6 Thomas January 10, 2016 at 12:01 am

Yes, Jan! You’re absolutely right! No middle-class schlub (and I speak as one) feels shame in telling their peers that they have to take their prescription. “I need to take my Meds, hahaha, oh yeah, the Doctor says I have to take these, what can you do?”

Try that with a heroin needle or stolen prescriptions!

7 The Original D January 10, 2016 at 1:11 pm

That’s just the pendulum swinging. I remember in the late 90s reading about how doctors were too stingy with pain meds because of malpractice, and a lot patient advocates made a stink about it.

8 albatross January 11, 2016 at 9:21 am

Yep, this looks like an ugly trade off to me–either accept more addicts or more people in terrible untreated pain. There aren’t any zero-cost choices there.

I would guess that the liver failure and accidental poisoning mortality stats have to do with how many medicines are orescribed. I think it is a rare 45 year old who is not on some kind of prescription for something. That creates a lot more opportunity for accidental overdoses and drug interactions.

9 buto ijo January 9, 2016 at 2:55 pm

The clip of the article fails to make clear what % of the OD’s are due to illicit drugs as opposed to the abuse of pharmaceuticals. My understanding of the recent rise in opioid OD’s is that people initially become addicted to the pharmaceutical versions and then move onto illicit versions once they run out of the money or ability to continue getting the pills. (Oxycontin is substantially more expensive on the black market than heroin.)

Perhaps even with cheap, regulated, legal opioids, OD’s may go down (compared to now) if people didn’t have to resort to illegal opioids of dubious provenance. Though, the rate will always be higher than that in a world were it was possible to completely shut down a black market in opioids.

10 Jan January 9, 2016 at 5:49 pm

I forget exact numbers, but I think it is 2 or 3 painkiller and benzodiazepine deaths for every 1 heroin death. Heroin overdoses have shot up dramatically the past 3 years. The vast majority of heroin users say in surveys that they used Rx painkillers before they tried heroin. That is in stark contrast to previous heroin epidemics.

11 Thomas January 10, 2016 at 12:06 am

Let’s not forget that there isn’t a single heroin user that wouldn’t pop an Oxy or a Benzo, whereas the vast majority of suburban prescription addicts would never approach something that required a pipe for smoking, let alone a lighter, a spoon, a needle.

12 Bryan Willman January 9, 2016 at 3:37 pm

There’s another problem in all this. Oxy is used in very large quantities by large numbers of people to treat real pain (like for the knee replacement I had last summer), and I suspect most view it as I do – very useful, but also very unpleasent. Something like it would HAVE to be used for people to recover from many surgeries. And the costs to citizens and society of forgoing those surgeries would be huge.

The real policy must be to really grok what drives people to addiction, and mitigate that issue. Given history, I am pessimistic about this.

13 Gochujang January 9, 2016 at 4:27 pm

I wonder how uniform the policies are. For a bone graft at my wrist I just got Vicodin.

14 So Much For Subtlety January 9, 2016 at 4:45 pm

Some people may be taking Oxy for pain, but the explosion in use clearly has little to do with pain management. White America likes getting stoned, but they like safe, medical pharmaceuticals. Since the 50s people have been using a lot of prescription drugs – until the Feds catch up and ban them. It used to be barbiturates. Then it was Quaaludes. There is always something. Now it is Oxy. What these have in common is shame – people don’t want to break the law. They don’t want to pay street prices. They want their doctor to give them “social permission”. Not “I am a drug fiend and so I take oxy”, but “Thank the Lord for providing a medical necessity for taking my pain away and let us pray that I am better soon so I don’t have to keep taking them”.

(Actually I think much of the English speaking world has the worst of all possible worlds when it comes to pain management. You get doctors that give anyone anything, and you get doctors who won’t give anyone a thing. Professional drug users know which to go to if they want to get high. The rest of us have a crap shoot. If we are unlucky we will get some stony faced medical practitioner and we will writhe in agony in the hospital bed. If we are equally unlucky, we will wake up in 2035 from our gall stones operation to meet the grandchildren we never knew)

15 Jan January 9, 2016 at 5:42 pm

A lot of the problem with the excess supply is that most prescriptions are for greater quantities than necessary. I bet last time you or someone you know had a major dental procedure the dentist prescribed 5-20 days of opioids, even though 2 days worth is likely enough for most people. The same goes for surgeries. Prescribers don’t want to deal with the one in 10 patients who still have pain and need to call in for a refill after a couple days, or come in and get reevaluated. This results in a lot of unused meds in medicine cabinets. They often get passed on to friends and family, or plain stolen and then make their way onto the street.

There are of course people who benefit from long-term use of long-acting opioids. However, the best medical research really does not show much benefit for long-term use of opioids for chronic pain. For most people, it simply doesn’t work that well and leads to unsustainable dose escalation. Medical society treatment guidelines generally recommend against it.

Of course, some people are plain addicts–whether they started with legitimate need for pain control or just began abusing opioids, it doesn’t really matter. Some of them get meds by doctor shopping and lying to get excessive amounts of unnecessary prescriptions. A lot of the policy work in this area has focused on this population, and it seems to have had some impact. Most states that implement prescription monitoring programs for docs to check before prescribing to a new pan patient enjoy a decline in doctor shopping. But this is really only the tip of the iceberg in terms of solving the problem.

This is not an easy issue to deal with. It probably makes sense to invest the majority of efforts in improving access to and the effectiveness of addiction treatment. Dramatically expanding methadone and suboxone treatment would be a good start.

16 So Much For Subtlety January 9, 2016 at 6:08 pm

The problem is that methadone doesn’t really work. In fact it may cause more overdoses.

It is not an easy issue to deal with. One approach would be to say that people who want to get high are going to get high. Give them Valium. We have had drug after drug come on the market, become hugely popular and then get banned. Perhaps it is time to quietly accept that users are going to use? Let them eat phenobarbital!

But if we aren’t going to take that approach, then there are things we can do to minimize overdose deaths. The advantage of smoking heroin over injecting it is that it is much harder to overdose if you are smoking it. So perhaps these drugs should be given in a very dilute liquid form? You can have your oxy but not as a pill. You can have it diluted with a liter of water. If you’re in pain you might drink a liter, maybe two. But then you will have to wait for a while. If you are a user, I don’t see you trying to down four liters.

17 Jan January 9, 2016 at 6:40 pm

The evidence on methadone is actually pretty extensive. It is the most effective treatment we have for opioid addiction, especially compared to behavioral therapy alone. ( http://www.cochrane.org/CD002209/ADDICTN_methadone-maintenance-therapy-versus-no-opioid-replacement-therapy)

You’re right about overdoses, but the methadone causing the uptick in deaths these days is the methadone on the street that is prescribed in high dose for pain, something that became much more common in the late 90s, largely due to its low cost. Methadone used for treatment of addiction is regulated completely differently. It is typically taken once a day in a supervised setting and patients almost never overdose on it. They do sometimes overdose on heroin when they relapse, however. Don’t get me wrong, opioid addiction is a terrible thing and people in any kind of treatment are more likely to eventually relapse than stay clean. Medication assisted treatment is relatively effective and too many people don’t have access to it.

The valium approach is interesting. I haven’t heard that one. I’m torn on whether total legalization would make sense. I truly don’t know what impact it would have for harder drugs, like heroin and opioids generally, but I agree we need to come to terms with the fact that some people are just going to use and we should try to minimize harm.

18 anon January 9, 2016 at 7:16 pm

“. It is the most effective treatment we have for opioid addiction”

Better than buprenorphine or heroin maintenance? Heroin maintenance can be very effective at least for addicts who have failed with methadone.

19 Jan January 9, 2016 at 7:34 pm

Some evidence suggesting methadone is a little better than bupe for some patients, but for the most intents and purposes the two MAT options are about the same.

I am not aware of the evidence on heroin maintenance. Has that been studied much? Would love to read about it.

20 So Much For Subtlety January 10, 2016 at 1:48 am

Jan January 9, 2016 at 6:40 pm

The evidence on methadone is actually pretty extensive. It is the most effective treatment we have for opioid addiction, especially compared to behavioral therapy alone.

That link does not appear to say that to me. It appears to say giving heroin users another opiate (methadone) works better than not giving opiate users no opiates at all.

You’re right about overdoses, but the methadone causing the uptick in deaths these days is the methadone on the street that is prescribed in high dose for pain

A lot opiate overdoses are directly related to methadone given out to heroin users although it is some times sold on.

<i.It is typically taken once a day in a supervised setting and patients almost never overdose on it. They do sometimes overdose on heroin when they relapse, however.

Sure. That is to say, they continue to use heroin and they get their doses mixed up.

Medication assisted treatment is relatively effective and too many people don’t have access to it.

There is no evidence that any treatment is effective for opiate abuse. As you would expect. Drugs are fun. People like them. They take them no matter what until they get bored. Then they stop. Doctors simply pretend they are doing something useful. They aren’t.

I’m torn on whether total legalization would make sense.

Valium and other “Mother’s little helpers” were legal for years. A lot of famous people chose to kill themselves with them so it is not as if it is a secret. Abbie Hoffman and Margaux Hemingway killed themselves with phenobarbital. Also popular with Hitler’s euthanasia program. Marilyn Monroe, Judy Garland, Jimi Hendrix, and Edie Sedgwick died from other barbiturates either deliberately or accidentally.

21 Jan January 10, 2016 at 6:43 am

That link does not appear to say that to me. It appears to say giving heroin users another opiate (methadone) works better than not giving opiate users no opiates at all.

The link is to Cochrane, the most comprehensive review of the evidence on methadone treatment. I think there are over 100 studies in it. It says it is effective–not highly effective, because nothing is highly effective for opioid addiction. But it is much better than the other types of treatments, mostly behavioral. So, as I said, methadone is the most effective treatment we have for opioid addiction.

There is no evidence that methadone for addiction is the cause of the increase in methadone-related overdoses. If you look at the magnitude of the increase in methadone dispensed by pharmacies (that is how methadone for pain is dispensed, not how methadone for addiction is dispensed) you will see it is obvious the increase in supply is coming from its prescription for pain. I’m not sure you aware, but methadone for addiction is given in a clinic one dose at a time, and the staff actually watch the patient take it. So that methadone simply doesn’t make its way to the street–and they obviously don’t give addicts enough to OD on their daily dose. Now, they may go and use heroin, but the evidence is rock solid that patients are less likely to go take heroin if they are methadone maintenance than if they are not. So, the methadone is not causing these overdoses.

There is no evidence that any treatment is effective for opiate abuse. As you would expect. Drugs are fun. People like them. They take them no matter what until they get bored. Then they stop. Doctors simply pretend they are doing something useful. They aren’t.

I’m curious what definition of effective you are using. Do you think that length of time without relapse is not a good measure for gauging effectiveness of treatment? People on heroin or who abusing Rx drugs are more likely to not work, to overdose and generally cost society a lot of money. Again, the evidence is very strong that methadone–and buprenorphine–are effective for opioid addiction. But they are not a panacea. They don’t prevent all or even most people from ever relapsing, but they much better than nothing. Do you have a fundamental dispute with the science?

22 So Much For Subtlety January 10, 2016 at 4:39 pm

Jan January 10, 2016 at 6:43 am

The link is to Cochrane, the most comprehensive review of the evidence on methadone treatment. I think there are over 100 studies in it. It says it is effective–not highly effective, because nothing is highly effective for opioid addiction.

Highly effective at keeping users in the program. If you give opiate users opiates, they are more likely to stay in the program than if you do not give them opiates. This is not the same as working, if by that you mean stopping them using opiates.

So, as I said, methadone is the most effective treatment we have for opioid addiction.

Giving opiate users opiates is not a treatment. That would require them to stop using opiates.

There is no evidence that methadone for addiction is the cause of the increase in methadone-related overdoses.

If I could be bothered to walk over to the other side of this room and take down the book that claims precisely that, I would. Virtually all overdoses of methadone are related to treatment programs. It is not otherwise widely used.

I’m not sure you aware, but methadone for addiction is given in a clinic one dose at a time, and the staff actually watch the patient take it. So that methadone simply doesn’t make its way to the street–and they obviously don’t give addicts enough to OD on their daily dose.

Users have been found to regurgitate their methadone and sell it. There is a problem of tolerance so you have to give habitual users a lot – enough to cause someone else to OD. But that is not the point. Most deaths seem to be among those on the program who continue to also use street heroin. Which makes judging the right amount difficult.

Now, they may go and use heroin, but the evidence is rock solid that patients are less likely to go take heroin if they are methadone maintenance than if they are not. So, the methadone is not causing these overdoses.

I have not seen the evidence. That link did not measure if they continued to use heroin. Just if they turned up for their free methadone. Nor does it follow that if they stay on their programs, methadone is less likely to cause ODs. I have seen evidence that says cities that do not run methadone programs have virtually no ODs at all because street heroin is actually quite safe. Even your link says:

Methadone is an effective maintenance therapy intervention for the treatment of heroin dependence as it retains patients in treatment and decreases heroin use better than treatments that do not utilise opioid replacement therapy. It does not show a statistically significant superior effect on criminal activity or mortality.

Does not show an effect on mortality. Does not reduce ODs.

I’m curious what definition of effective you are using. Do you think that length of time without relapse is not a good measure for gauging effectiveness of treatment?

If in fact that is what they did, that might be a good way. But how do you measure heroin use among people with so much methadone in their system they will test positive for opiates? You have to ask them I assume. Not all that reliable.

Do you have a fundamental dispute with the science?

I have a dispute with the idea that drug use is a medical problem that is open to medical solutions. It is not. Opiates are trivial to come off anyway. Users do not have an effect like alcoholics and the DTs. They feel a little low for a day or two and then they are fine. They stop using all the time. And then they usually start right back up. Because it is a moral issue, not a medical one. Drug users use because they f**king love the drugs. Not because they need to. Thus treatment programs don’t work. You may as well treat someone for liking his X Box too much.

23 Mark January 11, 2016 at 12:20 pm

Coming in late, but a couple points:

Some (many/most) users are addicted, and some users are abusers. Physical withdrawal is easy to point to in alcoholics, but psychological withdrawal is not merely wanting something a lot. A drug addict’s brain responds to initial uses by developing a craving for more of the drug. The decision-making (motivational) part of the brain is damaged and needs time to heal. Even after a period of abstinence, triggers may re-introduce craving. Therapy can help an addict avoid/address/manage environmental triggers that lead to relapse. Moral framing is of limited use for an addict (may help with avoiding/managing triggers) and inconsequential to an abuser (a casual user who has a brain that is less susceptible to addition).

Methadone has a long history and has shown some effectiveness. It does have a lot of issues that clinicians are aware of. Suboxone (bupe/nalaxone) should be safer but it isn’t perfect either.

Going down the slope, brain alterations from gambling have been studied, and in addiction-susceptible brains they look similar to those seen from drug use. In terms of the surge of dopamine that might damage the brain, computer games seem to be more like food and sex: a bad habit when there’s too much, but not brain-altering in the same way as drugs. Not everything is addictive in the medical sense, but for such cases, treatment is possible and should be encouraged.

24 rayward January 9, 2016 at 1:30 pm

2. Summers: “I am more worried that the economy will drive the financial sector down than I am that the financial sector will drive the economy down”. That view is in stark contrast to the view of the religious zealots, misfits, hucksters, and demagogues that make up the Republican field for president. My fear has always been that a demagogue would rally right-wing populists to his cause and destroy us all. And to think that our best hope may be for a misfit or huckster to save us.

25 Sam Haysom January 9, 2016 at 1:45 pm

My biggest fear is that whatever Soros-backed organization pays rayward to post changes their pay structure away from paying by the word. Nothing makes me happier than to see Soros’s money wasted.

26 William January 9, 2016 at 2:13 pm

Oh jeez we have Soros nutters here now, too? MR commenters used to be so (relatively) good 🙁

27 Derek January 9, 2016 at 4:16 pm

Rephrase that. The health of the economy and the country depends on the scams and corruption emanating from the Salt Lake City financial district. Or my biggest worry is that the mining promoters on the Vancouver stock exchange are not able to pull off their salted mine samples scam.

Summers is an overeducated fool as only the overeducated csn be. A financial system is necessary in a healthy economy, but The Financial System is not, especially one who requires a once in a decade rewriting of Federal Reseve practice accompanied by a very large check.

2008 was a large and overdue mucking out of assumptions and practices of an industry who through regulatory capture was too large.The percentage of gdp it represented as well as the proportion of profits generated by the economy as a whole was out of balance and extremely unhealthy, and the market corrected the imbalance. Summers dislikes the functioning of the market. It must be stopped.

28 Sam Haysom January 9, 2016 at 1:38 pm

How terrible that in Poland the populist right might build in the judicial and media advantages that the cultural hard left has enjoyed in every Western country for at least thirty years. Who can imagine a country in which the national news service is as deferential to the interests of cultural conservatives as the BBC and NPR are to cosmopolitan antinomianism?

29 Art Deco January 9, 2016 at 1:50 pm

Pretty much it. That paragraph was the only substantive complaint he offered, and even it was rendered in vague and tendentious terms. The rest was rhetoric.

30 Alain January 9, 2016 at 8:52 pm

+1

Exactly what I got from the article. Oh and that there needs to be a call to arms from the ‘west’ to stop it in its tracks.

31 Michael January 10, 2016 at 11:13 am

And how does the Guardian have an entire article on the current state of Polish politics and not once mention Russia?

32 AIG January 10, 2016 at 6:55 pm

TC should put a warning next time he posts a Guardian article, so that we all may know not to waste our time reading it.

33 Jason Bayz January 9, 2016 at 2:14 pm

5. Yet although Britain does not have a written constitution, like the US and Germany, it does have powerful checks and balances: an impeccably neutral head of state; fiercely independent courts that do not hesitate to find against government ministers; the BBC; a professional civil service; security services that (these days, so far as I know) don’t do the bidding of one politician against other politicians; a robust culture of civil political debate … Need I go on?

So, True Democracy, as the Guardian wants it, requires more power to be given to unelected rather than elected officials, a powerful ‘supreme court’ is the most important, even a monarchy is seen as a positive factor for Democracy. He claims he is “not criticising a party with a clear parliamentary majority for pushing through its proclaimed conservative, Catholic, Eurosceptic policies, cleverly combined with an almost leftwing set of economic and welfare promises. I may not like those policies, but that’s democracy.” But that is clearly what really bothers him, he says what Poland’s ruling party is doing would be like having the “Daily Mail editor-in-chief Paul Dacre appointed by the ruling party to direct the BBC.” As opposed to the current man in charge of the BBC, who has no political views at all.

You can make the case for a “system of checks and balances” or a large amount of power being given to unelected officials. But don’t confuse that with “democracy,” which simply denotes a system of rule by the people.

34 Richard January 9, 2016 at 2:53 pm

Exactly, “democracy” in elite discourse means a media that sets the agenda and covers up what it wants, and a Supreme Court that makes the final decisions.

Judgeocracy is what they have in Iran, except the guys in robes are called ayatollahs instead of judges. That’s bad though because they enforce Islamic law rather than open borders and social liberalism.

35 Peter Akuleyev January 10, 2016 at 4:38 am

Unlike Americans, Europeans don’t trust the masses and purposely rig their political systems to prevent the uneducated and the lower classes from having much of a say. This is for the most apart an advantage. In Poland the educated elites are horrified by PiS. I work in Poland and among the Polish business community there is complete disdain for Duda, Sydlo, Kaczynski and their “weird cult”, as many Poles call it. PiS is viewed as the party of society’s losers – peasants, unemployed young people and pensioners. Even if you suport PiS social policies you have the problem that PiS economic policies are unadulterated left wing populism and will be a total disaster (which is also true of “conservative” Orban in Hungary). The best way to get rid of PiS however is not EU condemnation, which will just encourage nationalistic Poles who hate PiS to support Kaczynski out of national pride, it is to let Poles deal with PiS by themselves.

36 Ricardo January 10, 2016 at 5:40 am

A democratic country with checks and balances necessarily has some power sitting with elected officials and some with appointed officials. This isn’t a novel idea. The American constitution, for instance, provides for appointed instead of elected federal judges and bans bills of attainder. If you want to play semantic games, that is arguably an “undemocratic” arrangement. Why trust unelected federal judges more than elected members of Congress to imprison people and take away their rights?

If you simply equate democracy to holding elections and giving huge amounts of power to the winners, you raise all sorts of questions such as whether the people in power will allow free and fair elections in the future, whether their official actions can be investigated by prosecutors or judges and whether the rest of society can have a robust debate about their policies and actions through a free press and freedom of speech.

37 chuck martel January 9, 2016 at 2:14 pm

2. “That said, we’re not doing as well as we could in growing the economy. We’re very short on public investment in infrastructure, which contributes to congestion, which contributes to transportation problems, which contributes to the United States being a less attractive location for investment.”

Public investment in transportation infrastructure can only mean more limited-access highways and more airports and maybe more parking ramps. The only locations in the US without easy access are Indian reservations. The problem with transportation is that it hasn’t achieved magical status. Delivering pizzas by drone isn’t going to be a huge stimulus to the economy. Stuff still has to be put on a truck or in an airplane to get from point A to point B, even with concrete poured all over the place. While we’re still stuck in a non-magical situation, so is everyone else. There are other factors that make the US less-than-perfect for investment, an army of bureaucrats binding entrepreneurship being one of them.

38 chuck martel January 9, 2016 at 3:15 pm

2. More Summers balderdash: “Immigration reform is probably the single most important issue that could raise the underlying growth rate of the economy. If we were prepared to take more high-skilled immigrants from asia, it would be a substantial shot in the arm for the economy.”

Why? Does the Bell Curve of the US population preclude economic growth because there aren’t enough US citizens capable of becoming skilled? What skills does he mean? Are the potential skilled asian immigrants somehow more versed in those skills than Americans or does adding to the pool of skilled workers make the economy grow, regardless of their origin? Maybe shredding the social safety net and then demonstrating to youth that failure to maximize individual potential is a guarantee of misery and suffering would encourage skill development, since that’s what’s generally been the impetus for acquiring skills in Asia and other uncivilized places.

39 Mike B January 9, 2016 at 3:34 pm

“Why? Does the Bell Curve of the US population preclude economic growth because there aren’t enough US citizens capable of becoming skilled?”

— Summers mentions at the beginning that there is an industrial world short on demand. For the US economy to remain strong he is under the impression that by bringing in talented workers into the a US economy would allow them to increase their demand and capitalize on their labor better than they can from their home country. This would push growth out a little higher, for a little longer. But it fails to address the underlying problem that domestic (and global) population is not consuming at a fast enough rate for producers, and that is the result of lagging human capital, and (IMO) a shitty definition of “growth.”

I would argue against the social safety net being the cause of this lagging human capital growth and runaway asset pricing. but I do think it’s worth questioning Summers’ answer of just increasing immigration.

40 mulp January 10, 2016 at 2:21 am

So, you do not see a problem if a sink hole opens up and swallows your car because the lack of investment in infrastructure means the 100 year old water main with a maximum use life of 80 years breaks and erodes the ground out from under the road your driving on?

I’m seeing news reports at least once per month of local road problems from water undercutting the road that are so big that they merit sending live reporters to the scene, even on nights of shootings with live reporting from those scenes.

I do see most of my news in NH where political ads fund WMUR news departments generously enough so they have every one of the latest gadgets, but in my time in Baltimore, water main breaks hit the news as well.

41 chuck martel January 10, 2016 at 9:06 am

You must mean that all infrastructure should be replaced before the end of its design lifespan. This, in addition to the construction of new infrastructure. In the end, all infrastructure would thus be replaced continuously.

You do have a point, however. Cities older than those in the US, like in Mexico, have an older, failing infrastructure. Water and sewer systems are leaking, ancient streets are too narrow for modern traffic. This will be the fate as well for the US and it will be more dramatic as a larger and larger percentage of public funds are tapped to pay retirement benefits for cops, firemen and other municipal employees.

“I’m seeing news reports at least once per month of local road problems from water undercutting the road that are so big that they merit sending live reporters to the scene,”

You’re seeing them reported on TV because they’re unusual. Media seldom dwell on the mundane and unspectacular. Soon after the failure the problem is fixed and normality returns.

42 Axa January 9, 2016 at 3:03 pm

#6: files under “legal substances way more dangerous than marijuana”

43 Floccina January 9, 2016 at 3:16 pm

#6
“It’s easy to favor drug legalization when you’re middle-class and well educated.”

I think the war on drugs actually has a leftist tilt, in that it is supposedly to help the addict and also the punishment is more for selling than using (over using) though using does the damage.

We need to convince people to avoid drugs not command they not use.

” Drug addiction is financially ruinous. It often leads to petty crime.”

Legalization would make it very cheap helping with that.

And to be consistent we need to ban the motorcycle ans booze. For people’s own good.

44 Sam Haysom January 9, 2016 at 3:34 pm

A government that can force its citizens to save for retirement at the barrell of a gun can likewise force its citizens to not consume drugs at the barrel of a gun. It’s really simple. The lack of consistency is from those that pretend the War on Drugs is categorically different than the War on Bad Savings habits.

45 Ricardo January 10, 2016 at 5:55 am

Of course, government can do all kinds of things. That doesn’t mean certain policies can’t be questioned on various grounds.

The comparison is also silly because individuals who fail to contribute to Social Security are not arrested and given criminal records (thus further hindering their future employ-ability and integration with the rest of society). Employers who employ non-exempt employees and fail to withhold and contribute may face harsh penalties. But individuals can avoid payroll taxes several legal ways such as not having wage income, being a member of certain religious groups, working as a student employee, or working abroad (even temporarily) for a non-U.S. company. The people with “bad savings habits” rarely if ever face any legal sanction at all.

46 Jan January 9, 2016 at 6:05 pm

It’s not really a partisan issue at all.

47 mulp January 10, 2016 at 2:24 am

It’s non-partisan when the drug addicts are mostly white adults.

When targeting non-whites, then it’s partisan.

48 Anslinger January 10, 2016 at 3:08 pm

Except that the War on Drugs was started by Democrats and carried on by Democrats until they passed the baton to Neocons (i.e. Democrats catering to military industrial complex lobbyists, AIPAC, etc.) after WWII. The War on Drugs’s main purpose both in 1914 and a century later was/is to provide an always-ready excuse for global interventionism.

49 Jason Bayz January 9, 2016 at 4:30 pm

6. You hear a lot from supporters of drug legalization about how easily available drugs are. That is true, but only for some. Think about the demographic most hard hit by the opoid epidemic: a lower middle class white guy in his early 50s. He hasn’t used illegal drugs in a long time. He knows a few people he strongly suspects are drug users, but he wouldn’t want to ask them. They aren’t great people, he doesn’t want to be mocked, and he wouldn’t want his wife to find out he’s interested in buying drugs. He knows how people talk, so he’s leery about asking his friends. He knows there’s a part of the city where drug dealers are known to be, but he’s afraid he’ll be robbed, cheated, or worse if he simply goes there and asks people on the street.

This isn’t describing every guy in that demographic, some may easily be able to get it from a drug-user buddy, but I’m sure it’s describing a lot of them. They can get illegal drugs if they want it enough, but they’d have to go through a significant amount of trouble. If they’re in a depressed mood one day they may find it better to just suffer through it, or drown it out using legal booze. But if, in contrast, they could take a half hour to drive over to Drugs R Us and get adulterant-free drugs….

50 Jeff R. January 9, 2016 at 4:59 pm

#6: poor people ruin everything.

51 Alain January 9, 2016 at 5:48 pm

#6 motherjones. Ha. Nope. I do, sort of, wonder what their statist theory is in this case. Bah, not really.

52 Jan January 9, 2016 at 6:43 pm

I don’t understand what your critique of this particular article is.

53 Alain January 9, 2016 at 8:49 pm

My ‘critique’ is linking to motherjones. I don’t really need to go to the site to understand the broad strokes of any of their articles: they want a more powerful state and less freedom for individuals, they desire allies to run these powerful institutions and they will cry bloody murder if at any time a non-ally is in charge.

Not really my cup of tea.

54 carlolspln January 10, 2016 at 12:32 am
55 Joe W January 9, 2016 at 6:44 pm

4. Submission, Michel Houellebecq. I read it toward end of 2015 and over Christmas read anything else by Houellebecq I could find. Funny, rude, contemplative, prescient?

56 Thomas January 9, 2016 at 11:59 pm

Kevin Drum misses the obvious. The drug market is bifurcated in to legal and illegal substances. Middle class people do not feel bad entering in to an oxycontin addiction because it their need for oxycontin is certified by a doctor – an integral part of ‘the system’. Oxy and heroin are primarily different in those respects, and oxy prescriptions leading to addiction says nothing about whether people will partake in drugs without official approval and certificate of need!

57 ivvenalis January 10, 2016 at 12:50 am

“So it’s not the policies, the politics or even the ideology that requires all friends of Poland to sound the alarm; it’s the winning team attempting unilaterally to change the rules of the whole democratic game.”
In other words, the problem isn’t that they’re saying stuff I disagree with, but that they’re actually attempting to do something about it. No wonder he thinks they should be more like the Tories.

“New legislation and judicial appointments will effectively neuter the constitutional court”
Courts shouldn’t have any checks on their power, like Iran’s Guardian Council.

“a new media law subordinates public service broadcasting directly to government”
You mean that, unlike the worthless Tories, PiS isn’t willing to fund politically hostile (if not immoral) propaganda? Mein Gott! What’s next, the US Republicans deciding that they won’t fund Planned Parenthood’s baby chop shop? Perhaps the “public service” journalists could find a new patron. I hear George Soros has a lot of money.

“political appointees will be allowed at the highest level of the civil service”
Elected officials actually telling the civil service bureaucracy what to do. The horror…the horror. I actually wonder what I’m missing here. Isn’t this the norm? Does Poland’s civil service really have no executive political appointees?

“German media have given particular prominence to this dangerous turn in Poland”
Who cares? Seriously, even aside from the whole Lugenpresse thing, why would anyone care what “German media” have to say about Poland’s government? If this guy were writing an article about Thailand’s government, would he support an assertion by pointing out that Chinese media organizations agree with it?

58 Josh M January 10, 2016 at 1:33 am

“It’s easy to favor drug legalization when you’re middle-class and well educated.”

Not nearly as easy as it is to favor prohibition being middle-class and well-educated. I’ll give you a minute, if you’d like, to calculate the odds that the cops will send a SWAT team to my house, given my neighborhood, on the say-so of an informant trying to avoid a decade-long sentence for “intent to distribute” however much coke they found on him. And then once you have those odds, feel free to multiply them against the odds that upon breaking down my door and seeing the inside of my house, they’d toss a stun grenade into a toddler’s crib.

Drug prohibition, like alcohol prohibition, doesn’t hurt middle-class white people except insofar as they end up collateral damage of bootlegging crime. There’s plenty of wink-and-nod ways to get what you want, and the cops don’t care if I smoke weed or do a little LSD in college.

59 msgkings January 10, 2016 at 2:14 am

Outstanding post.

60 Jason Bayz January 10, 2016 at 3:59 am

In one case they suffer from having more drug use around them, in the other they suffer from more drug crime enforcement around them. It sucks to be poor, you’re going to suffer more than the middle class from most things. Ultimately I think the poor are going to suffer much more from an increase in drug use than in the occasional wrong address raid, tragic as it is. Hard drugs should be kept illegal.

I have mixed feelings about marijuana legalization. There is definitely a good side to it, an industry is taken out of the hands of criminals*, plus lots of people get a lot of enjoyment out of smoking it without seemingly any ill effects. However it will inevitably result in more use of it, including by chronic users and children. It will become more socially acceptable which will lead to a (greater) culture of drug use which is amenable to people switching over to use hard drugs. People say alcohol does the same thing, and right it does, but just because you’ve shot yourself in the foot doesn’t mean you should shoot yourself in the arm.
become.

*Eventually.

61 The Original D January 10, 2016 at 1:20 pm

If everyone who drank to excess switched to weed the crime rate would fall through the floor, not to mention drunk driving accidents. Stoners stay home rather than hitting bars, and when they do drive they do it slowly.

62 Nathan W January 11, 2016 at 3:36 am

For many people who value freedom and rebel against a paternalistic state, illegality is precisely the attraction of drug use.

Making it more socially acceptable could perversely make it less socially desirable.

63 Kevin January 10, 2016 at 2:06 am

#6 – There are no good solutions and anyone who tells you their preferred policy will make things better with no or very low costs is lying to you or themselves.

My basic sense is that very broadly (and with lots of exceptions) the war on drugs raises the costs for the poor (who suffer through more crime and heavy handed law enforcement responses) but reduces them for the middle class (whose children, etc., use drugs and thus suffer bad consequences at a lower rate).

64 mulp January 10, 2016 at 2:49 am

Drugs were pretty easy to get in the 50s and 60s, but mommies little helpers were not that attractive to most kids, and using non-prescription drugs was done with far more caution.

It might be the war on drugs reset the culture to such a degree that going back to the 50s policies would unleash massive waves of drug abuse.

But that was not what happened with the repeal of prohibition. Not only did use and abuse of booze not increase much from the prohibition years, it did not return to the rather high levels of abuse before prohibition, a level that was so high and widespread that it was possible to pass prohibition in the first place.

Of course, the booze pushers were self interested in responsible drinking to prevent local prohibition (like still remains in Kentucky). But the global drug pushers don’t seem to be responsible because they have been pushing them heavily in the US by way of doctors. Pharmacy has fought restrictions on high volume prescribing of psychoactive drugs claiming they are needed pain killers. Just as they did in the 60s and 70s and 80s. Small drug stores on the Mexican border were getting shipped millions of pills per month, obviously sold in bulk and driven back into the US, if not removed from the trucks before the empty cartons were delivered into Mexico.

65 Nathan W January 11, 2016 at 3:37 am

“anyone who tells you their preferred policy will make things better with no or very low costs is lying to you or themselves.”

A good first assumption. But when the policy is to correct one of the most wasteful, counterproductive and damaging policies on history, then they might be right.

66 richard January 10, 2016 at 3:49 am

In the Netherlands we have a system of ‘free’ herion for addicts. (Don’t confuse this with the famous Dutch cannabis regulation etc).

People who are addicted to heroin can get their daily dose -twice per day- at a small building somewhere on the edge of town. This is now in operation for more than a decade. Beause giving away heroin is illegal (international treaties etc) it ofcoarse is labeled an ‘experiment’ that must be ‘evaluated’ when ‘enoug data’ is available. But take my word for it: Nbody cares about that part.

Crime wrt heroin virtually disappeared. No more junkies in the street. (Thre used to be quite a lot wandering like zombies at any big railwaystation) No more junkies breaking in cars/houses etc. No more black market. No more pushers pushing get kids to try it.

But most of all: The amount of people that use heroin is decreasing rapidly and the heroin addicted group is aging fast.

Here is a nice graph on the age of heroin addicted people. It’s in dutch but you’ll get the idea easily: The group is aging rapidly:

https://logicfreezone.files.wordpress.com/2015/11/leeftijd-heroine-gebruikers.jpg

It seems to me that the american example shows exactly what happens if you don’t regulate drugs but keep it illegal.

67 Harun January 11, 2016 at 2:43 am

Here’s a song that could explain Poland:

https://www.youtube.com/watch?v=MJ_dMaQP7tw

Its quite high ranked on Youtube for anti-communist songs.

Interestingly, there are not many such songs.

68 Nathan W January 11, 2016 at 3:42 am

1) The point of free speech is to be able to discuss controversial ideas, not to protect assholes who treat groups they dislike like garbage.

5) Why should NATO lift a finger to protect a country that wants to run the judiciary and media from parliament?

6) Laws of economics applied to drugs may not always apply in the way one might assume. Some people just want what they’re not allowed to have. Let them have it, but berate them for doing so, might just lead to less usage. Not sure it applies to pain killers though, since some people’s lives are presumably immeasurably better with pain killers, regardless of risk of overdose. With $100 billion a year (perhaps) saved in police and court time, plus taxes from legal sales, there will be plenty of money left over to educate against overuse and to help those who suffer from addictions.

69 GregS January 11, 2016 at 9:55 am

6) Recent events do *not* support drug prohibition. Law enforcement has been cracking down on pain doctors and patients who “prescribe too much” or “take too much” by some arbitrary (but surely objective!) guideline. It’s the sudden removal of the legal source that’s driven some people to heroin. Since doctors are wary of law enforcement, they tend to cut off patients who they suspect of being addicts (who could actually just be legitimate pain patients who need a large dose). This is an instance of drug prohibition failing, not of legalization failing.

It’s also worth thinking about how “overdoses” happen. Most of these deaths aren’t overdoses per se; people don’t just irresistibly pop pill after pill until they’ve taken too much. Most of these prescription painkiller deaths are drug interactions. Restricting the supply of pain killers is a very ham-fisted approach to that problem, which could be better solved by better education and cross-checking of medications. Perhaps a stark warning would go a long way, such as “Don’t take these with alcohol or benzodiazepines. It will kill you!” And heroin overdoses are mostly (certainly not entirely) a product of prohibition. Disrupted supply chains lead to product of uncertain quality and concentration, so people don’t know what they’re shooting into their veins.

I doubt the CDC’s numbers anyway. This story by Radley Balko has a few good quotes by Steven Karch, who has written a textbook on drug pathology:
http://www.huffingtonpost.com/radley-balko/us-painkillers-abuse_b_1263565.html
“”I don’t know where they got their numbers,” Karch says of the CDC estimates. “There’s no peer review of those figures. You follow the footnotes, and it looks like they’re getting the information from medical examiners. But it doesn’t say how the medical examiners are concluding that these were overdoses–if, say, they’re just relying on toxicology results.” Asked if that’s usually how overdoses are diagnosed Karch says, “That fits my experience.””

Also see the part about how cocain overdoses were “increasing” as usage of that drug was declining. Are we really seeing more overdose deaths, or are we just doing more thorough toxicology screenings? If someone with a high tolerance and high blood concentration of opioid metabolites drops dead of a sudden heart attack, are they more likely to be labeled an “overdose death” than they were 15 years ago? I would like to see people be a little more skeptical of these figures. It’s possible that the trend is real, but the levels are exaggerated (or understated for all we know). It’s possible that the levels are right, but the trend is just a statistical artifact due to changes in reporting.

70 Brian Holtz January 12, 2016 at 2:47 pm

Wisdom from Larry Summers: “The essence of democratic governmental institutions is that they’re supposed to distill the conventional wisdom and act on it, and the essence of bubbles is that the conventional wisdom is dead wrong. To expect democratically accountable institutions to be good at recognizing and puncturing bubbles is unrealistic. “

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