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Comment by treis | Hacker News Reader

>I presume the main reason for the controversy is the prevailing dogma "Drugs are evil".

Eh, I think this is too dismissive of some pretty deep ethical and philosophical considerations. Effectively they are giving drugs that alter ones perception of reality and then judging their effectiveness on the patients perspective. But since they alter their perception of reality it's tough to rely on patient reports.

Anecdotally speaking, there's a lot of people in this world that think drugs make their lives better when an objective observer would pretty strongly disagree. That raises a lot of difficult questions. Most notably, do we give someone a drug that will make their life worse but also make them think their life is better.

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It seems that as we live in a classically liberal society, we treat other adults' right to make what look to us like bad choices as absolute. Anything that changes our fellow man's perception of reality complicates the matter because we're no longer sure it's 'them' making the decision.

Would that be a fair wording of your position?

Did any of your anecdotal cases have terminal cancer? And did they take the drugs in a professional therapeutic context?

In a medical context, we can evaluate this as objectively as we evaluate painkillers or antidepressants. We can use our normal tests for anxiety and depression, run studies where we watch outcomes, etc. From what I've seen, the effects have been very positive for these patients.

My aunt died of cancer a couple of years ago. She took an unorthodox treatment of extremely high doses of marijuana, which her husband encouraged. It was frustrating for the rest of the family since it was impossible to have a coherent and meaningful conversation with her in her final months. My dad and I had some doubt about it, but the decision was entirely in the hands of her husband because she was too inebriated to think for herself. I’m not saying it was a wrong choice necessarily, but there are downsides.

This seems like an awfully self-centered way of viewing the situation.

How so? I was respectful of her decision -- although I suspect it was more her husband's decision -- but I wouldn't have made the same myself. It seemed like there was a lot she had to say, but couldn't in that state due to the drug. I suppose she thought she was making sense, but objectively wasn't.

Maybe cancer was giving her bigger challenges to deal with than making sense to you which lead to extreme measures like high drug doses (chemotherapy, marijuana, opioids).

To me it sounds like complaining that your friend with cancer is objectively a worse friend because he doesn't feel like playing Mario with you anymore after taking his cancer drugs or painkillers. He thought he was a good friend, but he objectively wasn't >:(.

Maybe there's reasoning behind the trade-offs they chose that involves more than you?

As I said, I respected her decision. But I question whether it was the right one because it left her unable to communicate despite an obvious desire to do so. I’ve had conversations with people on high doses of opiates, and while they were far from their full mental capacity, they were intelligible. My dad tried to convince her husband to use conventional painkillers, which I supported, but he wouldn’t hear of it.

You say you respect her decision, but then in the same breadth go on to say you think it wasn't her decision at all. You've written much in this thread to strangers on the internet about how you believe it was a wrong decision. You have a peculiar way of respecting others' opinions.

By respect I meant that I didn’t attempt argue with her husband about it, or say anything to her, which would have been pointless anyway.

But did behind her back?

respect is orthogonal to agreement. why would it even be necessary to say you respect someone's decision if you agree without reservation?

Respect seems incompatible with airing your criticisms to strangers on the internet. That, to me, is not respectful.

My aunt passed away a few years ago now. Her husband will never read this. The rest of the family agrees with me as far as I know. I don't see who I'm disrespecting by publicly and semi-anonymously questioning those decisions in retrospect.

Victimless disrespect is still disrespect.

So that's entirely different from what the article is talking about. Psychedelic treatments for terminal patients often involve a single large dose of psilocybin in a clinic, and that's the end of it. In the article, the first case study is like that, just one dose and three months later the patient still felt profoundly changed.

Cancer is just a bad illness. I too have had the experience of trying to interact with family members in the terminal stages. Neither of them were using marijuana, and they were often not coherent (when they were even awake).

Not to diminish your grief, but your aunt might not have been any more available if she had been using other pain management methods. It's just a terrible, overwhelming thing to happen to the body, and it saps a huge amount of the sufferer's energy.

Unfortunately, there has been quite a few deaths in my family in the last decade, and most were on some form of pain management. They weren't always lucid, but none were as perpetually loopy as my aunt was in the last few months of her life. Someone in the forum accused me of being self-centered for simply mentioning this, but her incoherence did add to my, and particularly, my father's (her brother) grief.

> her incoherence did add to my, and particularly, my father's (her brother) grief.

I sympathize completely, and I'm sorry for your loss.

> Anecdotally speaking, there's a lot of people in this world that think drugs make their lives better when an objective observer would pretty strongly disagree.

what does it even mean to "objectively observe" whether drugs make someone's life better? we can look at a crack addict living in squalor and plainly see how their addiction inhibits material success. we can also imagine how deeply unhappy we would be to live in such circumstances. but if we want to know how that individual person experiences their own life, all we can do is ask them.

I agree that "objective observation" doesn’t mean much.

However there is no doubt people under destructive addiction are very well aware that their condition sucks. It doesn’t mean they can overcome the addiction and the urge of scoring.

I think the parent was related to behaviours such as "pot makes me more creative when playing music" or "cocaine makes me a better dancer" or "alcohol makes me funnier". All of which can be externally appreciated with a different opinion.

> However there is no doubt people under destructive addiction are very well aware that their condition sucks. It doesn’t mean they can overcome the addiction and the urge of scoring.

agreed, and most of them will freely admit this, as long as they trust you not to use that information "against" them.

> I think the parent was related to behaviours such as "pot makes me more creative when playing music" or "cocaine makes me a better dancer" or "alcohol makes me funnier". All of which can be externally appreciated with a different opinion.

I can also agree with this, as long as we are limiting the observation to extrinsic qualities.

maybe I read too much into GP's comment. I am wary of these sorts of statements, because they are often a jumping-off point to advocate for compulsory treatment of mental health issues.

This is the kind of post that appears when drugs come up. It's personal opinion, without any facts, strong on unfounded typically assertions and word-weaseling ("..when an objective observer...") and ignores what has been done over a thousand times before, with answers. Answering posts like these is a treadmill for everyone and an ascent for none.

Effectively they are giving drugs that alter ones perception of reality

Like over the self painkillers do? Personally I don't see the philosophical difference in alleviating physical pain from alleviating psychological pain.

Of course, if the psychological pain is caused by a condition that can be fixed the fixing the condition itself is of course better. But in many cases of depression and anxiety there is no clear root cause that could be fixed.

Anecdotally speaking, there's a lot of people in this world that think drugs make their lives better when an objective observer would pretty strongly disagree.

Substance abuse and addiction are a problem, sure.

But that is entirely a different thing from providing substances that reduce anxiety and depression.

Painkillers are temporary. The drugs we are talking about are meant to effect a permanent change on the user.

And pain killers, at least OTC ones, don't alter someone's psyche. We can, more or less, rely on their judgment that painkillers are helpful. You can't necessarily say the same for mind altering drugs.

You can't necessarily say the same for mind altering drugs.

All things are bad if not taken in moderation.

My experience (personal and thus merely anecdotal) on mind altering drugs has been only positive.

My SSRI medication was very welcome when I needed it, and I am very happy they 'altered my mind' and helped through some very dark times.

If I was hit by depression again I would not mind trying a psilocybin based medical regimen.

The problem is we are talking about something that is orthogonal to the effect. An example is more like getting prescribed anti-depressants for back pain. I hear it helps with the pain, but you are getting personality alteration as a side effect with it.

Like if im suffering pain, I don't want to get drug-induced quasi religious epiphanies from psychedelics. I Just want the pain managed. And what's really annoying about LSD is how it keeps getting promoted as a wonder drug here.

What happens when docs start prescribing it for back pain too?

> Like if im suffering pain, I don't want to get drug-induced quasi religious epiphanies from psychedelics

That's you buddy. Then don't take it. Others who have chronic back pain might be totally fine with this.

It's not just about pain management - it's about accepting and making peace with dying. If there's a possibility that a drug can make this process easier for terminally ill patients, why would you object to its use by people who choose it?

> The drugs we are talking about are meant to effect a permanent change on the user.

You'd only say someones judgement about themselves is unreliable if they will contradict themselves later. But if it is a permanent change, then you are talking to the "new" person who is capable of judging this as well as anyone.

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