Interesting. It would be good to have more ways to relieve pain, and ways to help patients avoid addiction.

One of the best ways to help patients avoid addiction would be to decriminalize these compounds and reduce or eliminate the prohibitions against them. That's a strong statement, so please allow me to make the case.

(1) the iron law of prohibition says this: prohibition drives out all but the most potent, and hence easiest-to-smuggle, formulations of the prohibited substance. During alcohol prohibition in the USA, NOBODY smuggled lite beer. It takes the Busch Clydesdales to move the stuff around, and it's too obvious. It was ALL strong stuff like whiskey and "white lightning." The most potent formulations of opiates are easier to misuse in a way that promotes addiction.

(2) a corollary to the iron law is this: people without training in chemistry or sterile procedure will adulterate the strongest stuff so they can sell more nickel bags, or whatever, on the street. That makes the dosages unpredictable. Unpredictable dosages promote addiction by unpredictably pushing a user's thresholds. Adulterants can be be dangerous and can induce pain.

(3) if the stuff's illegal it's expensive. Then addicts have the incentive to sell some to their friends to help pay for their habits. Teenagers get addicted this way.

(4) offering the substances to addicts at reasonable cost in competently supervised circumstances allows for a variety of treatment options for addiction. At the same time, addicts' lives don't fall apart. Treatment regimes can, brought out of the shadows, be examined for their success rates by agencies like Cochrane: http://www.cochrane.org/CD011117/ADDICTN_opioid-maintenance-... . The current "state of the art" in treatment is cold-turkey twelve-step. It works for some people, but is it evidence-based? Sure it's evidence based, like reducing stress helped people with stomach ulcers until pylobacter was discovered.

(5) if the government stops demonizing addicts as they have been doing for almost a century then they can come out of the shadows and deal with their problems.

(6) decriminalization weakens the incentives for pharmaceutical companies like Purdue Labs to create supposedly "safe" time-release formulas like Oxycontin, and then promote those formulas in ways that lead to addiction. http://www.latimes.com/projects/oxycontin-part1/

(7) We won't have to hear news about people with names like El Chapo any more. Any aura of underworld glamour around this stuff will evaporate. It will become boring and fluorescent-lit like pharmacies should be.

Why is this change difficult? It challenges the narco-industrial complex. Decriminalization means lots of police will be laid off. It will cut profits for big pharma. It will cut government revenues by cutting into civil asset forfeitures. http://www.newyorker.com/magazine/2013/08/12/taken

It's also difficult because of recent successful efforts to decriminalize cannabis. The successful argument in Massachusetts USA and Colorado USA for decriminalization has been one of recreation. "It's safer than alcohol, so go for it." That's obviously a crazy argument to make for decriminalizing opioids : because it's NOT safer, and because it plays into peoples' prejudices (see point 5 above).