by Jach | 2025-07-14 02:32:38+00:00
$1000/mo is very high, yeah, but Ozempic isn't the only thing in town. My price info is from looking at https://www.brellohealth.com/ and similar ($133/mo semaglutide, $166/mo tirzapatide) -- i.e. just getting a prescription for compounded semaglutide. Reading anecdotes on twitter and elsewhere about grey market sources suggest the prices can be even lower. The innovation of Ozempic having the dose in a ready-to-go single-use injector is probably not worth an extra ~$900/mo for most people if they have to pay for it themselves, and if these things were available on shelves (or just over the counter, like sudafed (pseudoephedrine version)) you'd probably see that reflected.

> it would be a difficult situation if they could pick them up impulsively from the medicine aisle

It would be a different situation, not necessarily any more or less difficult. Anorexics and bulimics are already in difficult situations. Without research into the actual patterns of GLP-1 abuse and their problems, I'd still bet on it being a better situation. That is, abusing GLP-1s is probably better than destroying your esophagus from bulimia. But perhaps not.

I was persuaded by libertarian-minded arguments when I was younger, too -- though not typically ones framed from "who cares", but rather those rooted in a framework of freedom. People will always be free to destroy themselves in numerous ways, singling these things out to try and curtail destructive use is an unprincipled exception. Furthermore, the methods typically available for such curtailing (laws, law enforcement, and medical gatekeeping) are crude, heavy-handed, and often inconsistently applied themselves, leaving a lot to be desired in preventing abuse while certainly doing a good job impeding legitimate use which causes harm. When you go drug by drug, we also see the argument from other countries with laxer (or no) regulation not becoming anything like what you might predict if you just listen to what medical professionals say will happen if you got rid of requiring them as middlemen.

I'm older now, and I still believe such arguments, for the most part, despite direct experience with people trapped in cycles of abuse, not just anecdotes from people with an incentive in perpetuating the current system. (If you want sad stories, you can hear them from all sorts of people, not just from doctors. If you want tragedy, open your eyes, it's everywhere. Nevertheless such things by themselves aren't evidence and shouldn't weigh strongly in policy decisions.)

The first qualifier to unpack "for the most part" is that I think if society turned a lot more totalitarian, it would be possible to actually prevent almost all abuse. But if we did, we would also need to crack down on already legal and available things. You bring up tylenol, but I raise you alcohol. I don't drink, I think it's bad for you, tens of thousands of deaths each year support my claim, I don't even need all the rest of the non-death negatives affecting/afflicting far more. I'm not going to advocate making it as illegal as fentanyl. I do think there's a missing consistency here though and it's better for policies to be consistent. But consistency and the medical industry mix as well as oil in water. Modafinil, a stimulant that seems as harmless as caffeine, is regulated in the US as Schedule IV (same as Valium, which Eminem and many others were famously addicted to). But adrafinil isn't regulated that way, you used to be able to get it OTC / ordering online e.g. from walmart pharmacy, there's even an over-priced energy drink containing it now https://adraful.com/ yet it metabolizes to modafinil. Fladrafinil works similarly, is unregulated, and you can buy it in powder form by the gram on Amazon. Or just get modafinil from grey market sites (not even on the dark web) that ship generics from India because its status is never enforced, and save your liver some effort.

The second qualifier is that restricting access can sometimes be a good thing, and worth it on margin, when such restriction is considerately targeted and probably temporary. Part of the cycle of abuse for a lot of people is voluntarily committing themselves to a rehab center where their freedom of choice and access to many things is severely restricted for a while, and after enough cycles, it can work out in the end. That's a targeted restriction on the individual level, and having it forced on someone (involuntary commitment) is something hard to do and generally requires other harmful crime. Since fentanyl was brought up in the other reply chain, it's notable that this year fentanyl related deaths in the US continue to decline, this year by quite a lot. NPR gives 8 guesses as to why that is, with the top one being increase of access (just as I want for everything) for naloxone, which can reverse overdoses: https://www.npr.org/2025/03/24/nx-s1-5328157/fentanyl-overdo... Notably none of the theories are directly related to restricting access on top of current efforts, only in reason 2 (weakened product) do they suggest that some have thought the current enforcement in China, Mexico, and the US might be a factor in that. (I would have naively guessed as one of my theories that the current administration's various efforts could have something to do with it.) And notably none of the theories, except weakly 2 (weakened product) and 7 (skillful use) suggest that removing the barriers to getting fentanyl would lead to significantly more deaths. So while I think there's room for the government to make targeted time-limited society-level decisions that can produce marginal benefits by restricting access to something, the current poster child case of fentanyl doesn't seem like a strong candidate to support that view for either it or other drugs (especially those with more positive uses). (Indeed, a common libertarian point is that a lot of fentanyl harm specifically is because of reduced access to other drugs, so users get surprise-fentanyl from their illicit sources. And no, people getting those other drugs is not from growing up with the dark web, it's still often just "I know a guy who knows a guy" -- or just strolling down to various bus stop hubs in major cities like Seattle and looking for the loiterers with hoodies.)