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I think TI alone isn't the right metric to look at. Wiki would put cocaine and alcohol as similar (15 and 10, respectively), even worse than morphine. Rather than it being only a manufacturing concern, I think there's a significant consumability concern, probably with factors of tolerance/euphoric dose/need-to-try-more as you mention, as well as the culture around consumption. Like, you still have to try pretty darn hard to physically consume enough alcohol before your body starts rejecting it (or build up enough of a tolerance). "I'm already drunk as hell, but I want to push to even higher levels.... oops, now I'm asleep," seems to be somewhat of a limiting factor. "I'm already high as hell, but can you imagine popping one or two more before dozing off?" ...takes about five seconds. And that doesn't even account for mixing drugs. Been drinking half the night, just took a hit of whatever, now you're not thinking straight, just thinking about how desperately your body wants to get suuuuuper high right now. You're probably not going to be rationally counting out your pills or whatever according to a dosing chart (for values of "you" that include far less intelligent/conscientious classes of people than you, particularly).
Alcohol is safer (at least in the short term) for various reasons, like the dose one can survive goes up with tolerance, and the difficulty of getting a fatal dose into you without working at it (though college students regularly manage). But I don't think those kinds of differences exist between the commonly-abused opioids. I'm not saying fentanyl would be as safe as alcohol if the dose was controlled, I'm saying it would probably be at least as safe as heroin. And that the massive increase in OD deaths that coincides with the introduction of fentanyl is primarily due to the inconsistency, not the inherent danger.
Also in the alcohol case, I suspect if instead of the common packaging for serious abusers being bum wine or some sort of standard-proof cheap liquor (which are easily distinguishable from each other), it was whatever the addict could get ranging between 5% and 90% alcohol, plus perhaps some isopropyl alcohol mixed in, and the addict couldn't immediately tell the difference by the taste/burn, we'd have a lot more overdoses.
I maintain that "I can imagine a product being adulterated by bad things" is not sufficient reasoning for population rates. One data point that would have to be explained in the chart I linked is the prevalence of prescription opioid deaths. Why aren't other illegal substances, which are presumably adulterated with rat poison, also off the charts in comparison?
My point isn't about adulteration with "bad things", my point was about uncertainty of dosage. I mentioned isopropyl alcohol because it might be considered analogous to fentanyl; it's a stronger alcohol than ethanol in some ways but not toxic in the way methanol is.
Really, the bigger problem for my theory of uncertainty of dosage caused by the introduction of illicit fentanyl into the recreational opiate trade being the main reason for the increase in overdose deaths is the fact that cocaine and meth went up (though not as much) at the same time. As far as I know nothing changed pharmacologically there, so your "inherent danger" theory can't explain it either.
Fentanyl is a colourless white powder and sometimes used to cut cocaine and meth by unscrupulous dealers. Terrible idea, but it will make people feel more fucked up... not to mention make a nice contribution to overdose death statistics.
Interesting, but it unfortunately doesn't distinguish between "inherent danger" and "uncertainty of dosage".
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Most definitely agreed. And now with xylazine, you've got straight methanol or rat poison or something in 1/a few hundred or so? of these bottles of "booze".
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