Yay. Recreational marijauna user here and opioids scare the crap out of me. Had to take 10 oxycodone after a surgery and if they can hand those out they can hand out marijauna capsules or whatever. It's really that simple.
They’re not completely useless, but I agree that we overprescribe them.
I had a kidney stone with complications that required three procedures to take care of. The only thing that would touch that pain was opioids.
It was a miserable experience and, thanks to the opioids, I essentially have a four-month hole in my memory. They made me nauseous, dizzy and cognitively useless. I had to titrate off of them because I had developed some degree of dependence.
Still, in that situation I would take them again, the pain was unreal.
>The only thing that would touch that pain was opioids.
I had a similar experience, albeit (and thankfully so) much more short term. I had spine surgery (lumbar laminotomy[0]) to address spinal stenosis[1] that significantly weakened my right leg and was prescribed oxycodone after the surgery.
I had prepared for this by acquiring significant amounts of cannabis (concentrate, butter and flower) to address the pain, but for four or five days, cannabis was insufficient to address the pain.
After the first two days I reduced the dosage and frequency of taking the oxycodone as I was concerned about dependency.
I will say that the first two days (full doses at four hour intervals) made me understand why some folks end up dependent on opioids.
My takeaway was that short-term use for acute (vs. chronic) pain, opioids are very effective.
For lesser pain levels, cannabis is also useful, with the caveat that cannabis doesn't actually get rid of the pain, you just don't care.
Your experience (and mine as well as that of many others) make it quite clear that (at least in the US -- elsewhere too, but legal regimes are different elsewhere and I'm not necessarily familiar with those) cannabis should be removed from schedule I (and potentially moved to schedule IV or removed completely) of the Controlled Substances Act[2], which would allow more widespread research into pain management and other medical uses.
I hope you don't find yourself in that situation again.
I find kratom superior to cannabis in this regard. Of course kratom is not without concerns, but in the scheme of things they're just unpleasant rather than deadly.
>I find kratom superior to cannabis in this regard. Of course kratom is not without concerns, but in the scheme of things they're just unpleasant rather than deadly.
Is your implication here that cannabis is deadly, or am I misunderstanding your point?
Kratom has abuse potential and requires mindful tapering to get off if used on a daily basis. Nothing fatal but I'm trying to acknowledge that it is not without some concern.
I have chronic pain and some headspace stuff that it really helps with but at this point my relationship with it could be construed as, um, er, addicted -- but same thing with coffee.
Cannabis can be psychologically addicting (a close friend is a chronic cannabis user who wheezes like a 2 pack a day cigarette smoker). It is not for everyone but should absolutely be legal everywhere.
Maybe not, I read that as compared to opioids, both Cannabis and Kratom being safer, with this person saying Kratom is more useful than Cannabis for this. Hopefully I read that right!
Not only cannabis isn't a good painkiller, but it comes with very strong side-effects: it makes you totally unable to do any activity. This is fine for a recreational usage, but for a therapeutic usage, it's a serious problem. Especially when alternatives exist.
>Not only cannabis isn't a good painkiller, but it comes with very strong side-effects: it makes you totally unable to do any activity. This is fine for a recreational usage, but for a therapeutic usage, it's a serious problem. Especially when alternatives exist.
I disagree. There are varying levels of pain. The pain from being cut open and (metaphorically speaking) my spine scraped out with gardening tools, then being stitched up again is much more significant than pain from muscle aches, mild nerve pain and many other sources.
Cannabis was insufficient (for me) immediately (and for a couple days) after surgery. However, it was absolutely sufficient after three or four days.
Yes, the psychotropic effects can be debilitating, but that's not true for everyone.
N.B.: The observations below are anecdata, so obviously YMMV.
I find (as an InfoSec/Infrastructure guy) that I can't give the level of focus required to do my job effectively if I use cannabis regularly.
However, I know several lawyers and other folks with mentally rigorous professions that use cannabis multiple times daily and are able to function reasonably well. Note (as I mention above) that I am not one of those people.
The impact of cannabis on an individual is subjective and nuanced, so I don't accept your assertion that "[cannabis] makes you totally unable to do any activity."
In fact, different strains of cannabis (presumably based on THC/CBD/other cannabinoids levels) have different effects on different people.
I don't doubt your (and/or others you know) experience has been that cannabis is disabling. But that's not true for everyone in every circumstance.
Which is why I strongly believe (as I stated in the comment to which you replied) that cannabis and the chemicals it contains should be thoroughly researched to determine its impacts, both positive and negative.
tl;dr: I disagree with your statement because it was categorical, not that it was necessarily wrong in all cases.
I consume cannabis occasionally and recreationally. I tested it for different types of pain. Back pain, nerve pain... For me, the effect was mild to none. But if I want any effect at all, I need to consume so much that I'm not productive.
I also know people who smoke cannabis all the time and are able to work. But I suspect their tolerance is so high that it's also ineffective as a pain killer.
Of course, this is anecdata as well. I'm willing to concede that on some very specific cases, cannabis may work as a painkiller (right type of pain, right dosage and so on). But I'm convinced there are always better conventional choices. And same thing for anxiety, depression, sleeping issue, and most things people try to advocate cannabis for.
Cannabis should be legal for recreational use, and may have some niche therapeutical applications. But it's certainly not a miracle drug as some people try to picture it.
Have a mix of nerve pain and a number of kidney stones.
A bad kidney stone will leave you suicidal after awhile. Tramadol was only thing that go me through those.
Nerve pain is harder as it’s long term. Never as bad as a kidney stone. But it is it something you can live with indefinitely. Tramadol works. But then you get long term addiction. I would stop for a month every few months just to detox some.
Eventually I discovered LDN. Which got pain under control. Plus side you can’t take opioids.
Was a nightmare finding a doctor that would prescribe it though.
I have some nerve pain. I tried LDN for maybe a month and it did nothing for me.
What dosage are you and how long have you been taking it before seeing an improvement?
4.5
Started at 1.5. Fairly quick results. Only side effects being externally vivid dreams.
After a week went to 3, week later to 4.5
I alternate between 3 and 4.5 mostly because dreams can be a bit much. But pain reduction is great.
I have Sjogrens autoimmune as underlying condition.
Other trick I found was I was taking a b complex. Removing the b-6 seemed to help.
I’m always curious about using ketamine for situations like this.
I’ve found that with medical marijuana you still feel the pain but you just don’t care because you’re stoned, granted I haven’t had pain such as yours.
With ketamine, at low doses you get a disassociated effect without much cognitive load but I haven’t taken it when I was in pain and unfortunately don’t have ready access to it anymore.
I’d taken Vicodin for 2 days after a surgery and quit it immediately because I couldn’t think clearly, nausea, etc and didn’t want anything to do with it.
I bulged a disk in my back, new job, no health insurance. My boss was a friend and knew I was a weirdo. I would bike (!) to work, take a keytip of ketamine, program for about an hour, lay down, do a gravity inversion (had one shipped to the house we were using as an office), do another minimal key, I could get three, maybe four of those out of a day.
I hate the effect of opiates except for the part where they make physical pain go away, and even if I had a doctor at the time, to get a scrip, it was a non starter for getting work done.
Worked out ok, still use a standing desk, lift weights, my back has been at least nominal every since, no surgery. I don't recommend it, the bulging disk part, and I'm not here advocate for off-label use of controlled substances, ketamine is habit-forming and can be quite destructive. It was effective however.
It does seem to be gaining in popularity for anxiety and depression.
I really can’t imagine it being as destructive as opiates having known plenty of people who have done both to the extent of having a habit with only opiates ruining people’s lives and killing some them. As far as I understand it ketamine is more of a psychological dependence than a physical one.
I said "habit-forming" rather than "addictive" for a reason, yes. That habit can be quite physically destructive, you can find papers on the effects of a heavy habit out of China which are somewhat toe-curling. It's not capable of stopping breathing or causing cardiac arrest, dying of an overdose isn't practical.
However, ketamine can make the brain go... weird. Like cocaine and amphetamine, habitual/binge use gets psychotogenic, and while bizarre delusions won't usually kill you (or anyone else), they can absolutely fuck up relationships, or earn someone a brand-new one with the authorities. Opiates, for all their terrible flaws, don't do this.
They gave me opiods after an invasive surgery that had me on crutches for a month. That stuff was strong enough that I could not safely crutch to the bathroom, I was too dizzy. Switched to low dose edibles and had no problem falling asleep, they didn't make it impossible to get to the bathroom safely, and I didn't have to worry about addiction.
I got sent home with opioids after a collapsed lung surgery many years ago. I was in a lot of pain, so I took one, felt great for a half an hour and then things started to spin and I felt nauseous for like 4 hours where I just stared at the ceiling. Even a sneeze hurt like hell where I'd been stitched up - I really did not want to barf.
After that, I took over the counter painkillers and just kind of dealt with the pain, as it was better than feeling all wobbly and dizzy.
I have kidney stones from time to time. NSAIDs + "deal with it" are an underappreciated pain approach - it's ok to be in pain. It's not OK to be in so much pain you're going to blind and writhing, but those are totally different things.
I had to take oxycodone + NSAIDs every 6 hours when I had my stone, but I had complications that required a stent and I did not react well to it. In fact, on both medications I was still in so much pain that it was barely manageable.
I can imagine a stone being less painful, I don’t think my experience represents the mean. It definitely makes me a bit shy of being anti-opioid, though. As miserable as they are, it would’ve been absolute torture without.
Unfortunately, there are a ton of incentives from insurance companies and Medicare for patients to be pain-free. Part of your hospital and surgeon's reimbursement is determined by their patient satisfaction score, and uncomfortable patients provide low scores so docs overprescribe and steer clear of uncomfortable topics like behavioral changes, etc;
I'm really glad for you, but I don't know how I would have survived my wisdom teeth removal without them. Even with the pills the pain was still excruciating. I lost a lot of weight from inability to eat or even drink.
In my opinion, giving somebody pills who doesn't need them (what used to be the norm) isn't great but the vast majority of people don't suddenly become junkies. Most people are perfectly fine. You yourself is evidence of this.
But not giving somebody pills who does need them (which is now the norm) is literal torture, and the practice disgusts me. I'm really glad you were fine, but not everybody is so lucky, and the number of people who say as you do but also have the power to enforce their views on everyone else have literally been responsible for torturing others. The only thing worse than sitting in pain and misery is knowing that the means to relieve some of that pain is readily available, but some person decided you shouldn't have them so you get to suffer.
The problem with talking about "giving somebody pills" is that it's extremely imprecise. A coworker of mine was once given a two week script for oxy after they injured their arm, they had two days of serious pain and then just mild soreness - this was an insane over prescription and my friend knew it.
They used cannabis to manage their pain for two days and never filled the script. I think a script for two or even three days would have been perfectly reasonable with a "Call me back if the pain is too much after that period".
I think one problem is people have vastly different thresholds of pain. Somebody else having the same injury might be calling their doctor back begging for a refill because they can barely function. Of course determining how much of that is a medical need versus how much is "the pills talking" is never going to be easy.
That's one of the beautiful things about Cannabis legalization - it provides a non-addictive pain management solution where the pills will talk much less.
I fully agree with you on Cannabis, but I don't think that's an argument for restricting opioid pills. I think we can and should make Cannabis widely available, and should absolutely encourage people to give it a try first, but if it doesn't work for them I think they should have the option of trying the pills.
>fully agree with you on Cannabis, but I don't think that's an argument for restricting opioid pills. I think we can and should make Cannabis widely available, and should absolutely encourage people to give it a try first, but if it doesn't work for them I think they should have the option of trying the pills.
I'd go further and say that all "drugs" should be easily available and the tiny percentage of folks who develop dependency issues should be provided treatment and support.
Not only would this reduce suffering and provide a wider range of pain management strategies, it would also significantly reduce the societal costs of substance prohibitions in terms of reduced economic impact in the following (not a complete list) ways:
1. Interdiction/enforcement is hugely expensive, and providing treatment to those who require it would cost a fraction of that;
2. Criminalization of substance use stigmatizes those who are caught in that particular net and, at least in the US, limits their ability (because many folks won't hire you if you have a criminal conviction) to increase economic activity/output;
3. Because of (2), many communities as well as the economy as a whole are negatively impacted both economically and socially;
For some reason, when it comes to "substance" use issues, we tend to examine the possible alternatives to address them, then choose the least effective, most harmful one.
I hope that changes, but I doubt I'll live to see it.
Edit: Clarified that the impacts I mention are not all of the impacts that drug prohibition has on society.
I don't understand what the problem is with the imprecision in your story. Did your coworker abuse the extra pills? Did he become an addict? If not, then why is it so bad for him to have gotten more in case he needed them? Don't you think needing them and not having them is worse than the situation your friend was in where he needed to throw them away?
He was a trained pharmacologist who knew that being on a constant dosage for that long can be habit forming so he didn't take them - a decent portion of people are handed a bottle of pain meds "Here's a two week supply" and assume they're supposed to take them at the prescribed rate continuously. It takes an active personal decision to decide not to take the meds prescribed for you and that you've already paid for.
I certainly wasn't advocating that no one should get opioids because I have a high pain tolerance, rather that we maybe shouldn't be prescribing them by default for everything.
In the same vein, I think a lot of research ought to be done into non-addictive painkillers. Then the risk would basically be zero and everybody's happy (except for pharma companies that make bank off of opioid addicts, of course)
> I certainly wasn't advocating that no one should get opioids because I have a high pain tolerance, rather that we maybe shouldn't be prescribing them by default for everything.
Many, many people assume that if the doctor doesn't offer pain medicine, then it's because they don't need it. Once you've left the office and the pain gets bad and you realize you should have asked for them, it's too late. But also, a ton of doctors won't prescribe them anymore ever because of the extreme risk of losing their career to the DEA if they make a bad call in favor of prescribing. There's virtually zero risk for under prescribing, so human nature for self-preservation makes this decision a no-brainer for the doctor.
> In the same vein, I think a lot of research ought to be done into non-addictive painkillers. Then the risk would basically be zero and everybody's happy (except for pharma companies that make bank off of opioid addicts, of course)
That's changed a lot. I had hydrocodone prescribed after mine (~15 years ago?).
On the other hand, my son just had his out and got 800mg ibuprofen and 625mg tylenol alternating. Seemed to do okay as long as he kept on the schedule.
I had the same prescription about 10 years ago, I didn't even bother filling it because I barely had any pain.
High-dose alternating ibuprofen & acetaminophen seems to be the go-to regimen nowadays, with oxycodone only for severe pain control and only in combination with acetaminophen. Apparently oxycodone and acetaminophen have synergistic effects; anecdotally, when someone I know had a major inpatient surgery recently, they said that the oxycodone made them feel like shit unless they took the acetaminophen along with it.
I don't know why they use high-dose ibuprofen instead of meloxicam, but I guess there are good reasons for it (maybe greater risk of GI damage?).
I used one, and really just a preemptive use before I went to work (I only took a half day off).
The weird thing is, though, I felt very normal at work. I had never tried a drug, so I wasn't sure what to look for, but I just felt normal. No pain, no other effects.
I have some from a dentist thing last year, too, and I would say similar now, but with a mild high.
I was never tempted to take extra. I threw them away before I moved countries.
Reminds me of this excellent comment from Reddit about what heroin is like:
---
Actually this is an obvious question but it's not what you might think. Let me explain it to you, I've been an opiate addict for a long time and tried many drugs. Drugs that are 'uppers' have the most 'obvious' euphoria. For example if you take adderall/coke/meth/speed/MDMA you will get this shining bright euphoria, self confidence, energy, and other drug-specific feelings (for meth like you are king or for MDMA like you love everyone). However, you owe these drugs back what they delivered to you. After a meth binge, or lots of MDMA use, or staying up all night on coke you will feel like shit. To an extent this aspect is similar to an alcoholic hangover.
On the other hand, for many people who experiment with heroin they are underwhelmed (not including IV usage, but most experimenters rarely ever IV first time). They just feel good, chill, happy, but they feel like this spooky drug 'heroin' hasn't delivered. They are just mellow. Oh obviously it has all been a lie they will think. Heroin isn't spooky, it's chill. It's not addictive like everyone else thinks. It doesn't make you do stupid shit or stay up all day and hallucinate like amphetamines or coke. It doesn't empty your serotonin like MDMA or give you a hangover like alcohol. People tend to just think oh, what a nice drug.
So the next day they wake up and everything is normal. No headache or shitty feeling--just a slight afterglow of that nice feeling. Oh it was cheap as well! It only cost $10 for a whole night of being high! I thought people said heroin was expensive? And then next weekend comes... There are all these drugs I could do but I liked heroin. It didn't 'fuck me up,' I could still think clearly. No hangover. No feeling like shit later. I still was awake. It just made me happy and content with life. Oh and it's only $10! Well, I should get some more for the whole weekend. This is great! I will use Heroin on the weekends now!
Now let's say this person works and has responsibilities. He knows he can't go into work drunk, or on MDMA, or high. So he doesn't. It's actually simple. But heroin... Well the user might actually find they do better work on heroin. Instead of being sad or grumpy or depressed with his job... he is just... happy. Mellow. Content. Everything is fine and the world is beautiful. It's raining, it's dark, I woke up at 5:30AM, I'm commuting in traffic. I would have had a headache, I would have been miserable, I would have wondered how my life took me to this point. This point I'm at right now. But no, no, everything is fine. Life is beautiful. The rain drops are just falling and in each one I see the reflection of every persons life around me. Humanity is beautiful. In this still frame shot of traffic on this crowded bus I just found love and peace. Heroin is a wonder drug. Heroin is better than everything else. Heroin makes me who I wish I was. Heroin makes life worth living. Heroin is better than everything else. Heroin builds up a tolerance fast. Heroin starts to cost more money. I need heroin to feel normal. I don't love anymore. Now I'm sick. I can't afford the heroin that I need. How did $10 used to get me high? Now I need $100. That guy that let me try a few lines the first time doesn't actually deal. Oh I need to find a real dealer? This guy is a felon and carries a gun--he can sell me the drug that lets me find love in the world. No this isn't working, I need to quit.
So if you are miserable, opiates will make you feel content. Not euphoric, but merely content, normal. But if you already feel content, opiates will not make you feel much different.
That’s sad if true. Opiate users are not chasing a high, they’re merely chasing a normal.
That's what research is starting to suggest for at least some opiate addicts.
Opiates have a very strong anti-depressant effect, that also tends to make the depression worse after coming down. Well, really it's the activation of "opioid" receptors (becoming a bit of misnomer) that have a very strong anti-depressant effect, which is the same mechanism that the anti-depressant effects of ketamine derive from despite not being an opioid (anti-depressant effect is almost entirely negated if taken with naloxone, aka NARCAN, to inhibit the opioid receptors).
This worsening of depression symptoms after coming down from opiates causes a vicious, psychological feedback loop in addition to the physical dependency. This also may be why ketamine has higher risk of addiction than other psychedelics like psilocybin.
Dissociatives seem to be in their own class when it comes to addiction, and I wouldn't compare them with your classic psychedelics that work at 5HT2A on that metric. A lot of people get addicted to dissociatives like DXM where you don't that kind of dependence and abuse with most 5HT2A agonists.
Many dissociatives also inhibit dopamine and norepinephrine transport, or induce their release, which can have rewarding and addictive results on their own.
I agree, it wasn't a great comparison. I didn't want to get too into the weeds on specifics since I figured the average person would lump them all under "psychedelics" or "hallucinogens". I just wanted to point out that the activation of opioid systems may be a contributor in its more addictive nature, but it's certainly not the only factor in its addictive potential. Especially so since those dissociatives that activate dopamine or opioid systems tends to be more addictive than their more selective counterparts.
Yeah that was basically my experience. I took a few of them but nothing noticeable happened so I just didn't bother taking more. Funny enough that was also true when I tried a couple ADHD meds. Didn't feel a difference, not even withdrawal symptoms from going cold turkey after a few months.
vitamin C can stop/reduce the absorption of adderall...took awhile to figure that one out when I restarted while on an orange juice/smoothie/berry kick
I'm a medical cannabis patient in the UK (medical cannabis was quietly legalised in 2018, there's only 10-20k private patients and virtually none on the NHS so even a fair few police officers don't know it's a thing yet!) and opiates scare me too. Anecdotal I know but I was given a box of codeine after having my appendix out recently and didn't even need a quarter of them so I could definitely see cannabis displacing the less powerful opiates to some extent in the future.
I guess it depends on the type of pain but I find cannabis more effective than codeine for the neurological pain I'm prescribed it for anyway.
I've had pain killers prescribed maybe a half-dozen times and the only one for which pot wouldn't have been at least as good was the time I had fairly serious abdominal surgery—and even in that case, I'm not 100% sure weed wouldn't have done the job. Plus, they usually prescribe me way more than I want or need—I may take one or two pills, and they prescribe me six or eight or ten—which inflates sales for these companies while doing no actual good.
For most of those cases (plus some times when I don't/can't get a prescription but still feel really bad—which makes weed a super-hero because I don't have to do the "will I still feel bad enough in 24 hours that it's worth losing 3 miserable hours to driving and waiting rooms and lines, trying to get a prescription?" gamble, I just already have some on hand or can go out and get it in like 30 minutes, guaranteed) I really just need something that can let me sleep at night. Weed does that just fine unless the pain or discomfort is really extreme.
After minor abdominal surgery I found that the prescribed opiates made the pain go away to where I felt like I could do everything I normally did. So, instead of resting like I should have I would try to do things and be in serious pain when the opiates wore off. Cannabis, on the other hand, I could still feel the pain but I could put it in the back of my mind. This allowed me to be aware that I needed to rest and heal and not be completely focused on the pain. I stopped taking the opiates after the first day.
I didn't mean to make the point weed should be substituted for opioids. But all of weed's symptoms are a proper subset of all of opioid's. Less powerful but less addicting and harmful to simplify.
And that alone means we should be able to prescribe weed where appropriate.
I like to search and replace 'cannabis' with 'cake'. It has been a while since I have baked a cake but there is only an absence of a cake tin to stop me doing that now.
Cake has sugar in it and I am addicted to sugar. I can talk about sugar with my doctor, he can ask me how many cakes I am scoffing and answer almost honestly.
Unlike most food there is VAT on cake. If I make my own cake I deprive the tax man but I did pay tax on the cake tin, the electricity and the chocolate.
I could make cake and sell it to my workmates, putting that vending machine out of business, partially since I am not yet frying 'crisps'.
Imaginably HR could be onto me after a while, the stern email would arrive and a multitude of issues relating to the validity of my 'food hygiene certificate' could come to the fore. But I would still be fine bringing in cake for a workmate's birthday.
Really cannabis needs to be something you can do at home without anyone coming for you. If you want to spend months growing plants then you are probably going to learn more about horticulture and get significant benefits from just doing that, growing plants. Much like making a cake, there is enjoyment in the baking that is separate to the eating.
This might be fun to do as a student but, in a world where one can't be bothered to bake a cake, I imagine people will move on with their lives and not have a mini cannabis plantation at home.
It used to be the same with beer, you could brew your own at home with much fun to be had perfecting your brew. There is nothing to stop you doing that now, however, the kit is not generally sold on the High Street like it used to be - people stopped bothering, they just buy booze rather than brew.
If you are growing your own weed and medicating for pain or childhood trauma, you should be able to tell your doctor, much like how you can discuss alcohol or sugar consumption. In that way we can better understand these things.
Getting back to the article with search and replace on, the active ingredient for cakes and beer is yeast or a yeast substitute. I can't see how sales of yeast or sugar for home grown cake/beer making can affect the stock value of the big industrial food concerns or brewers.
> From 2006 through 2014, the Rite Aid in Painesville, Ohio, a town with a population of 19,524, sold over 4.2 million doses of oxycodone and hydrocodone. The national retailer offered bonuses to stores with the highest productivity.
> Roughly 80 million prescription painkillers were dispensed in Trumbull County alone between 2012 and 2016 — equivalent to 400 for every resident. In Lake County, some 61 million pills were distributed during that period.
But 30 generic percoset, for example, looks to cost about $14 locally where one struggles to pay less than that at lunch outside McDonalds. Doesn't really seem like a cash cow.
At scale it probably costs pennies to make a Percocet. If the drug maker gets $7 for a prescription that costs them $0.50 to manufacture, and they do that 150 million times in America in a year, that’s a billion dollars in gross margin.
They're available from the distributor at around 10¢ each. So $3 goes to the manufacturer and distributor and $4 goes to the pharmacy.
Incidentally, the huge difference between street price and wholesale price is the reason why diversion is a problem. If the drugs were sold at $10/pill but with instant rebates to the recipients of $9.90 then they'd probably be kept very strictly controlled, even without the DEA involved...
This also fails to account for those that demand a specific brand of pill, and will gladly pay more for it. You'd be suprised how large the difference is to an addict when comparing a yellow pill to a white one.
You are saying that selling something for $14 per month with no information about cost of goods sold or sales volume is sufficient to conclude one is doing “alright”?
That was precisely the point I was making to the commenter I replied to (unit price doesn’t determine business scale on its own), but interesting info on Spotify regardless.
They make the money in volume. They're really following the same business model as illicit drug dealers -- get their users hooked on an addictive substance, then become their exclusive supplier. Except this is at industrial scale.
