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Portugal treats addiction as a disease, not a crime (nytimes.com)
572 points by fanf2 on Sept 22, 2017 | hide | past | favorite | 195 comments

I used to live not far away from Casal Ventoso, in the 80's. Anyone crossing that neighborhood in those days would easily see hordes of alienated people, in soiled clothes, gazing idly, sitting in the sidewalk and sometimes even injecting right there. Whenever you saw them running in one direction, you'd know some drug dealer had arrived. There is a cemetery nearby, and so it looked like death ruled the place.

Today it is still a poor neighborhood, but you don't see that kind of thing anymore. Taking the bus there is no longer a gamble. You still see a couple of people looking somewhat emaciated, but nothing like the walking cadavers of 30 years ago.

There were some slums outside Lisbon, like Pedreira dos Húngaros, where the police (other than SWAT teams) simply wouldn't go. It was just too dangerous. One would occasionally hear the blasts of fireworks, telling people drugs had arrived, or gunshots, warning drug dealers an intervention squad was near. This slum no longer exists, and many others are simply gone.

It's nice to see this article in HN, for many reasons.

António Guterres is an engineer, and when he graduated he was the best student of his year. From what I know, he considered a PhD in Physics before taking his chances in politics. Back in those days, his university (Instituto Superior Técnico) didn't have a Physics course, so many of its first faculty members came from IST's Electrical Engineering course or Physics courses from other universities. He lectured Theory of Systems and Telecommunication Signals.

Guterres is an intelligent man, and he would've probably become a great physicist, an excellent teacher, or a renowned engineer. Instead he chose politics, and now he's Secretary-general of the UN. His drug policy from his Prime-minister days saved thousands of lives and definitely changed Portugal for the better. I think that was a really nice hack.

As a Portuguese, I have to add:

Guterres is a worldclass facilitator full of good will. That's his edge - not intelligence - and how he got his position in UN.

In 2001, Guterres was forced to resign from his job as Prime Minister of Portugal. Not the best indicator of great leadership or management skills.

From Wikipedia:

> In December 2001, following a disastrous result for the Socialist Party in the local elections, Guterres resigned, stating, "I am resigning to prevent the country from falling into a political swamp".

Could you clarify why you believe resignation implies a lack of leadership or management skills?

Why do you think the Socialist Party got "a disastrous result in the local elections"? Because their leader showed great managing skills and charisma?

(IMO) his fall, on the eyes of the public opinion at the time, started here: https://en.wikipedia.org/wiki/Hintze_Ribeiro_disaster

Few years later, Guterres found the perfect employer for his skills: UN.

I've often thought that substance access needs to be completely deregulated, for drugs of abuse as well as other medications. This would increase access and competition among providers, and avoid rent-seeking kinds of economic problems in the health care market. It would also lead to better treatment of substance use problems, and kill cartels by decreasing their monopoly on production and distribution.

In doing so, you could move to a kind of competency-based system akin to what happens with people who have dementia or cognitive impairments. Basically, you're legally entitled to buy whatever meds you want, until you're deemed incompetent to make that decision. Processes could be set up whereby mental health professionals (psychiatrists, psychologists), ethicists, and the judicial system could make determinations that an individual is not competent to make decisions about the substance use purchasing due to addiction.

This might sound kind of draconian, but decisions about competency could be make pretty thorough, requiring a petition, stringent evaluation criteria involving panels and a judicial decision. It would also be dramatically less restrictive than the current system, that basically assumes everyone is incompetent to make drug-related decisions based on the specific drug.

It would also emphasize that the lack of competency is a health-related problem, and not a criminal problem.

There are loads of problems with that. I agree, in principle, but I'll give you an example of a problem that already is happening.

Not every drug you take is limited to impacting just you. A good example is antibiotics. We are having serious issues with drug-resistant bacteria. Allowing people to just take antibiotics of their own free will is absolutely certain to increase the number of drug-resistant bacteria. This will, with absolute certainty, result in an increase people being killed through no fault of their own.

Could this be prevented? Nope. One might say people could be educated and that they'd make the right choices, but the very idea of that is farcical. The planet is not populated with people who make bright choices and exhibit a propensity for long-term thinking.

I very much believe in allowing autonomy over self, and I've strongly supported these ideals. However, that has to have limits in a functioning society. As much as I'd like to say we should be able to take all the drugs, there is a need to draw some lines. We can move those lines, and I think we should, but eliminating them entirely is absolutely certain to harm innocent people at a level I am unwilling to support.

Do you really think, that general populace's misuse of antibiotics could cause the development of resistant bacterial strains en masse?

I might be wrong, and if so, please don't hesitate to provide some factual paper, yet my intuition suggests that in order to obtain solely by selection (under the pressure of a _single_ bioactive substance), a bacterial strain, that is, simultaneously:

- resistant to the aforementioned substance

- stable: resistance is not lost after the generation or so, past the moment when exposure is over

- contagious: strain is resistant to different immune systems (w/o losing its resistance to the substance, of course),

one either needs to perform a directed selection (eg. like that for apple-trees), or to create an environment, where really _huge_ bacterial population could thrive and persist for a long time: like that in hospitals or farms, - where not only frequent turnover of living organisms along with the regular exposure to antibacterial substances do happen, but also some intermediate vessels (medical instruments, ground, water supply, etc.) are available for bacteria to flourish in-between living hosts.

> Do you really think, that general populace's misuse of antibiotics could cause the development of resistant bacterial strains en masse?

Of course not. There's 7 billion people, and just a tiny percentage uses antibiotics.

There's around 60 billion land mammals raised by humans every year, throughout their life most of them use the strongest antibiotics. It speeds up growth, it prevents silly deaths, increases profit.

Diseases, plagues will come from livestock, as they always did, not from humans.

In the absence of antibiotics, there is selective pressure to eliminate the genes or mutations that confer resistance. However, there are opposing factors - antibiotic resistance genes are often carried on plasmids, independent genetic elements that can be exchanged between bacteria. Plasmids that contain antibiotic resistance genes frequently also contain heavy metal resistance genes[1]. This allows for co-selection, where the presence of, for example, mercury pollution from coal-fired power plants will maintain antibiotic resistance in antibiotic-free environments[2,3]. Plasmids can act as parasites on their bacterial hosts - many carry pairs of genes that encode both a toxin and a less stable antitoxin. If the plasmid is lost, the bacterium will die[4]. All of these mechanisms can maintain antibiotic resistance without antibiotic exposure.

[1]: http://www.cell.com/trends/microbiology/abstract/S0966-842X(...

[2]: https://link.springer.com/article/10.1007/s00284-012-0194-4

[3]: http://www.tandfonline.com/doi/abs/10.1080/01490450902889072

[4]: http://www.annualreviews.org/doi/abs/10.1146/annurev.micro.5...

I think bad policy leads to bad outcomes. When people are given good information, they make good decisions, on the whole.

As a parent, I was pretty pissed off when I learned that over use of antibiotics harms my child, my society.

As a citizen, I'm pretty pissed off that (one aspect) of the opioid epidemic is because doctors changed pain management protocols, without any followup testing, assessment.

“We started it”: Atul Gawande on doctors’ role in the opioid epidemic


Deregulated (or decriminalized) doesn't mean unguided, untracked.

Why should antibiotics be treated any differently than psychoactives? And how could empowering individuals, accepting mistakes will be made, be any worse than our (USA) current system? We currently have people self-medicating with supplies from pet stores and veterinarians.

Actually, thinking about it, to your point, poor compliance is because of barriers to care. Making it easier to receive care will improve outcomes.

The most successful efforts replace enforcement (of controlled substances) with treatment, counseling. Imagine if all drugs could be bought at your local pharmacy, where customers can be advised, counseled.

My pharmacist is just a pill pushing bookkeeper. I'll have to ask her if she'd like to use her degree, training, experience for actually helping people, rather than just checking eligibility and collecting copays.

>Could this be prevented? Nope

Pharmaceutical marketing has a role in antibiotics mis-usage, and it can be regulated a lot better. I know people that take AB for the flu, or simply don't take the whole prescription. But at least where I live one cannot get AB without a prescription. Why would a doctor prescribe AB for common viral diseases? Bahamas, that's why.

>We can move those lines, and I think we should, but eliminating them entirely is absolutely certain to harm innocent people at a level I am unwilling to support.

I agree. It's a bit like seat belts or bike helmets: they're mandatory for our own good. Before it was mandatory, people use it if they wanted and took unnecessary risk.

But there's always a fuzzy middle ground...

The general reaction for substance usage goes around 'well it's really up to you, unless you're driving/someone depends on you'.

But as for driving a bike not wearing a helmet, people are a lot less lenient, even if the only person harmed is the self. And this is even before considering welfare, hospital expenditure and such.

Do we need protection from ourselves? Does this just boil down to economic and state welfare efficiency? Less diseases is good because Economy? Or is this a way of maneuvering Economy towards a place where economic interest aligns with principles of human dignity? Sometimes I wonder.

The comment I was responding to was suggesting that we deregulate all drugs, including prescription drugs without addiction potential. I was mostly addressing that and using antibiotics as a good example.

With antibiotics, it's a bit like vaccinations. Vaccinations are as effective as they are because they provide herd immunity. Not everybody is vaccinated and the vaccinations aren't always effective, but enough people are vaccinated so that it provides protection for everyone, including those who haven't been vaccinated.

Antibiotics are similar, though the effect probably has a different name. Bacteria reproduces very, very quickly and the growth is exponential. We already have a problem where bacteria has evolved to be resistant to our current crop of antibiotics.

It's also important to note that developing safe antibiotics is extremely difficult. I believe I read that there are only two new antibiotics currently in the human testing phase and that no new antibiotics have made it to market in over a decade.

So, we already have a problem with antibiotics being over-prescribed and bacteria evolving to survive the attack. This is a known problem and an increase in people taking antibiotics is going to speed this up. This isn't something that's in doubt, it is absolutely what will happen if humans are given unrestricted access to antibiotics.

We will take more, we will see bacteria evolve, and that is going to result in stringer infections that kill people who may have, as individuals, never once abused antibiotic medications. It's not quite the same as herd protection, but it is fairly close.

I'm pretty much in favor of legalizing drugs. I absolutely believe we should be able to take drugs. I even believe we should be allowed to take drugs that have a good chance at killing us. I firmly believe the right to life should also include the right to die.

What I don't believe in is that the right to life includes the right to harm others. With all rights, there is a risk of harm to others. That is just a fact of a free society. The problem here is that these acts will harm many. Many, many people would be harmed by this.

I absolutely support the right to own a firearm. In no way do I support the right of an individual to own a weapon of mass destruction. I'm okay with someone owning a fully automatic firearm. I'm not okay with someone owning a nuclear weapon.

Does that make sense? I'm trying to explain it as well as I can.

It's not really protection from ourselves, unless you mean collectively. It's protection from others who would cause us harm through ignorance. From an economical viewpoint, healthier people are more productive - to touch on your last thoughts. Fewer diseases is good. Fewer diseased people is even better. Unfettered access is going to increase the number of sick and suffering, and not necessarily through the fault of the afflicted.

The antibiotics example is one type where I admit some kind of regulation (aside from competency) might be in order. I.e., where tragedy of the commons-type scenarios arise.

Still, even in that case, I think you might be better off regulating at the point of sale by pharmacists, kind of akin to pseudoephedrine. I also think situation isn't quite as clear cut as it seems on the surface, in that currently antibiotics are overprescribed anyway, suggesting that our current regulatory regime isn't really working in those cases well either. In any event, my sense of the antibiotics literature is that a, if not the, major contributor to environmental antibiotic resistance is agricultural in nature.

Regarding antibiotics, although I don't have numbers, in most 3rd world countries they are freely available in shops for prices starting at less than $1. I wouldn't mind betting more lives are saved by their free availability where there isn't easy/cheap access to doctors than are lost through drug resistance.

What do you get for a dollar? A whole course or just one pill? And how much of a person's income is that price, is it really cheap or does it just seem so to those of us who are in rich countries?

Last time I did it it was 30c for a course (8 pills) of Cipro in Cambodia. I assume that's fairly cheap for locals too - you can't buy much of anything for that even in Cambodia.

I still think anti-biotics should be heavily taxed, with exceptions if you have been diagnosed with a bacterial infection

They currently come with the added price of needing a prescription. Doctors usually charge for this service. I'm not sure that a tax is going to do much to dissuade people.

A large amount of anti-biotics are used livestock. Also I think I'd anti-biotics cost an extra $100 if the doctor is giving you a just in case anti-biotics then I think some people would think twice.

Don't worry, many wouldn't think twice. They simply can't afford $100 USD meds.

> Not every drug you take is limited to impacting just you. A good example is antibiotics.

Is there anyone addicted to antibiotics? No? Red herring.

Red herring? It was a direct response to your comment about making all drugs, including prescription drugs, deregulated. It was YOU who mentioned, specifically, drugs of abuse and other medication.

That wasn't my comment..

Actually, yes.

It turns out there's some HIV antiretroviral that, instead of being ingested, is smoked proves one hell of a high.

The problem is that in Africa where these drugs are readily available, they are being smoked. The worry is, that HIV will mutate and become immune to those ARV's.

I can only see this ending up like the earlier psychiatric practice of mass-lobotomization did. The same types of alliances of ethicists, the judicial system and mental health professionals collaborated then, too. They really believed that they were doing the humane thing by taking the matter of competency into their own hands and justifying what can only be called torture in the name of therapy.

The existence of any social or institutional mechanism that gives one esteemed category of people the right to deny someone else's rationality is always abused. Not even only abused with small probability, it becomes the norm. Therapeutic authoritarianism produces labels like "drug addict" which only results in widespread persecution of people who don't follow society's preference of correct drug usage; soon people who are the wrong weight might also become deemed 'incompetent to make good-hearted decisions based on the specific drug', or their specific religion, or their "oppositional-defiance disorder" etc..

Could you imagine if we said "people who go to work everyday are helpless because their incompetence prevents them from seeing that they are only doing it because their brain has been rewired to make them depend on their salary for satisfaction" or the seemingly innocuous but even more insidious version, "oh, I did hear that new studies showed that some people are just genetically predisposed to employment.. it's not their choice, it's a disease, you know. Haven't you heard about the long-term epigenetics in the reward center? The brain becomes rewritten!"

The thing called addiction is itself little more than the fear that drugs make a person incapable of choice, their free will. Not surprisingly, in pursuing the desire to correct individual behaviors with state-sanctioned superstition, a decades-long nightmare of rights violations and moral duty to dehumanize 'addicts' in the name of therapy ensued. It's like using thermite to put out a candle. Any transformation of the approach to drug use that forfeits the people it's supposedly benefiting from the regularity of the guaranteed rights granted to all of society is doomed to be the opposite of their freedom..

> The existence of any social or institutional mechanism that gives one esteemed category of people the right to deny someone else's rationality is always abused.

Unless you qualify that statement more, I read it as a blanket indictment of basically any institution with any decision-making power over individuals.

This logic can be equally used to indict:

- courts (because they can throw people in jail and take away their rational decision-making power)

- the military (killing people obvious removes their ability to make decisions)

- taxation (removes the ability to rationally how to allocate a portion of their resources)

- laws (it restricts the freedom of rational individuals to decide right and wrong for themselves)

A heuristic that is so broad that it can be used to paint nearly every social relation in a negative light is not a useful heuristic, because it doesn't let us profitably separate the chaff from the wheat.

The question should not be whether turning addiction into a medical rather than criminal problem would be completely free of abuse. It will not be, because humans and human institutions are imperfect. The question is whether this would be better than the status quo, and it seems like it would be.

What's worse -- no longer having the right to purchase certain drugs, subject to the decisions of a medical bureaucracy, or letting the legal system imprison you for years, like we currently do?

Those things are all perfectly indictable, though - and my indictments do not stem from a failure to attain perfection; but rather, because of the way their real world implementations behave, they are prevented from anything but the complication of society's ability to achieve their noble goals.

I don't intend to say that coercive systems are abusive because they contain an element of coercion by design. Rather, the people they (aim to) abuse (by design) in practice diverge significantly and often hypocritically from the malefactors whose intolerability was so great they caused the hunt in the first place.

I am not simply arguing coercion is empirically unethical, nor that coercion must be perfect, nor that there are no differences between different instances of coercion.

A difficult example where you need to coerce is when someone has Alzheimer's. If your mother has Alzheimer's, you had better provide care for her because the very material (therefore identified because of reliable differentiability of physical matter) brain disease (the opposite of an immaterial, and only socially-identified disease) that prevents her from accessing her existing body of evidence of the world can still be supplanted for her sake, by you as her child, so the kind of capacity of 'self-honesty' that Alzheimer's steals from the elderly can be compensated in a way where you take responsibility to 'donate' her self-identity back to her.

A simpler example is: if you are crossing the street with your young child, and your child darts out into the street in the path of an oncoming car, your duty is nonetheless to forcefully grab them by the arm if possible, because the child wants to survive instead of die by mistake.

I guess that I am trying to say that exactly because each of your examples (courts, law, taxes, mil) fails to meet the exceptional ideal they establish to allow their exception, they just tend towards abuse of privilege (in the sense that the expectation of the injustice from using the privilege is greater than the expectation of the injustice resulting in not using the privilege of coercion).

The thing they have in common is overestimating the frequency of hard successes that their proponents intend. They often inflict more damage to 'false positive' peripheral individuals than they prevent by coercing the 'true positive' individuals they are meant to stop. Therefore they stray very far from their aim. It is the aim that society is improved - but still respects the individual - that necessitates justifying the coercion that transcends the danger of catastrophically legislating coercion.

- courts are currently so beyond their capacity that the norm in >90% of cases (iirc the number correctly, but i am unsure that the statistic is accurate; merely that the percentage is unbelievably high suffices) is to state a lie over one's guilt and accept a plea bargain because the courts are so crowded due to draconian law that they cannot serve as instruments of justice without causing greater, indiscriminate injustice; the pressure for courts to move forward hastily + the laws whose inappropriate scope and severity harm the ability to achieve justice means their combination results in a failure to meet their social obligation to their optimal capacity of ensuring justice for all. You really have to believe there is a benefit to the guilty for living in a society where punishments for crime must be optimally minimal in misallocation. Justice is not the most ruthless form of litigation that results from encouraging self-inflicted punishment a priori for people who become accused. This is more self-referentially crucial to the ideal of justice itself, irrespective of the drug war at all.

- the military often grows because of the work of people who would prefer less of their taxes go to killing and more towards American prosperity. An example of this is Trump's "America First" doctrine having the opposite cost of his more important doctrine of devoting a plurality of funds to national security. The contradiction between the military and taxes is not because the military kills people that Americans don't want nor that taxes don't improve expenditure towards things America wants, but rather because they achieve unity in spite of expression as contradicting ideals:

+ A) our national security is the most important thing we can spend money on, because survival comes before the ability to even benefit from any other expenditure, and

+ B) we only permit taxation in the first place because taxation gives a non-zero-sum benefit for fulfilment of society as a collective beyond each individual only worrying about their own security

My argument is itself a heuristic argument, I would say:

expectation of iatrogenics (harm of the healing) of avoiding iatrogenics of epistemically-flawed institutions < expectation of iatrogenics of epistemically-validated but non-institutionally-remediated concerns < expectation of severe unknown iatrogenics you become exposed to by succumbing to compulsive institutional remediation of lesser, known iatrogenics

If I understand correctly, all you need to do to heuristically estimate which is most harmful in the big picture is to pick a large number K that you use to compare probabilities [0]. The severe outcome for which the probability P(Outcome | Outcome > Harm severity K) is most harmful for those probabilities where P(outcome | outcome > k) is proportional to k*outcome; so large, widespread minor policies can incur massive damage.

[0] Taleb, Silent Risk (forthcoming), Chapter 1

I agree that most recreational drugs should be legalized, even if I would never take them. Some would require a few tests to check how much you can safely take, along with education about safe use and so on. This would include a few prescription drugs - such as "study drugs" - that are taken recreationally. Some things might require limits on frequency of purchase to limit side effects. I think this does help for not only addiction, but to help folks not freaking overdose or get a different drug than promised. They should have the same purity and strength standards as something like alcohol or prescription drugs.

A few prescription drugs could easily be considered safe for the public to use, some of which might require a pharmacist's advice. This would include things like birth control pills, 400 or 800mg ibuprofen, erectile dysfunction pills, and things I have never really considered.

But I disagree with most prescription drugs being sold without a doctor's orders. Some drugs are outright dangerous to overuse - antibiotics, for example. Some (most) drugs are really helpful to the right patient, but they need some medical oversight. Lithium, a psychiatric drug, needs to be monitored through blood tests to make sure the dose is within the therapeutic range. Some antifungal pills (as well as a range of other medicines) can cause liver damage. Sleeping pills have their own risks, as do prescription cough syrups. And so on. These aren't things folks are taking in their spare time for the fun of it. I think the actual solution is to make sure folks can afford their doctor's visits and medicines as well as having a comprehensive protections to make sure folks can take care of their health, including paid sick days (more for parents, since they are responsible for other's health as well and can't exactly leave the 7-year-old at home).

I strongly disagree. Yes, most substances should be decriminalized. But they should not be completely deregulated. Not even alcohol or tobacco are deregulated. And for a good reason, we don't want to give 10year olds free access to alcohol for example.

Many drugs should be taken only under supervision of a medical professional. So the current system of doctors and pharmacies overall is a good system. We might give pharmacists more powers - they tend to be more knowledgeable about pharmaceuticals anyway, but drugs don't belong on supermarket shelves.

> Processes could be set up whereby mental health professionals (psychiatrists, psychologists), ethicists, and the judicial system could make determinations that an individual is not competent to make decisions about the substance use purchasing due to addiction.

These would be abused. People would be told that they're categorically unable to consent for being LGBT.

Without meaning to be dismissive, I doubt that would happen in the US at least at this point in time. And to the extent it did happen, there would be bigger problems to worry about.

Determinations of competency already happen in the US for all sorts of reasons. I'm not saying it's perfect by any means, and that it doesn't get abused, but the abuse of that system pales in comparison to abuses under the current drug enforcement and regulation system.

Personally, I am for complete unrestricted deregulation, but I can see issues around liability for providers, arguments about actual competency to decide, etc., and treating it like other forms of competency decision seems like one mechanism to address that.

Medically speaking it seems like the same situation to me as competency issues due to other forms of neuropsychological incapacitation.

"Processes could be set up whereby mental health professionals (psychiatrists, psychologists), ethicists, and the judicial system could make determinations that an individual is not competent to make decisions"

Isn't that allready pretty much the case?

If a person gets demented, cracy, whatever - then other people around them notice and take action. Hospital, Judge s. There are also other issues than drugs, like driver license, firearms, childcare etc.

Not that it is really easy to determine if a person is sheep-like. Lots of gray area and abuse in that area, so barriers are quite high.

(is a suicidal person for example crazy? I think not necessarily, only in rare exceptions)

But I very much agree, that a normal, mature person should have every right to consume whatever he or she wants. While beeing still fully responsible for all her action s ...

> This would increase access and competition among providers, and avoid rent-seeking kinds of economic problems in the health care market.

That would also incentivize increasing total substance use to make a profit, just like for-profit prisons create an incentive to increase the incarceration rate to make a profit. Any checks you make against use (like those competency tests) would be undermined by that incentive.

> I've often thought that substance access needs to be completely deregulated, for drugs of abuse as well as other medications.*.

Now paracetamol (depon) in Greece costs 0.75 EUR. In Greece the market is regulated. In the UK where the market is not regulated and you have pharmacies selling burgers to survive while the same drug costs more than 5 EUR.

How is that possible? :-)

The monopoly you speak of in distribution (pharmacies) happens when you deregulate the market because few big players end up owning what was distributed among thousands.

I agree that more steps need to be taken, but I don't think deregulation has ever worked the way you'd think it did, for the health industry.

Ultimately many decisions stem from your personal belief on the topic:

- Do you think that drugs ought to be social goods and regulated? (social welfare) - Do you think that drugs ought to be public goods and not regulated? (private welfare)

Also note that drug research costs, a lot. Especially if done correctly. It is a fair for some firms to retain the patent for a few years (say 5?).

You can buy 16 paracetamol for less than 50p.


This costs 1.5 EUR GR:


I would not buy or use paracetamol from Tesco. I prefer the one made by Bristol-Mayers, which I know and trust.

What do you mean "pharmacies selling burgers"? I'm rarely the [Citation Needed] guy but come on that's an outlandish claim that needs to be backed up somehow

"The [Portuguese] Health Ministry spends less than $10 per citizen per year on its successful drug policy. Meanwhile, the U.S. has spent some $10,000 per household (more than $1 trillion) over the decades on a failed drug policy that results in more than 1,000 deaths each week."

That's a intellectually dishonest and misleading statement: it's comparing Portuguese annual cost per citizen to US cumulative multi-decade cost per household.

So what's the average number of citizens per household? 3? 5? Even at 5 which seems high, that's $2,000/citizen with ~56k deaths vs $10/citizen and deaths in the low tens of people.

I agree it would've been better off with a more apples-to-apples comparison, but let's not miss the forest for the trees here.

You missed the part where the cost is split by decades not just household.

It's not to say that I support US drug policy, because I don't, it's that this really is dishonest journalism.

$2000/40 years is still five times as much.

When you hear:

- ..spends less than $10 per citizen per year

- Meanwhile, the U.S. has spent some $10,000 per household...

Do you think to yourself, "yeah, that sounds like about 5x"? The presentation of the data is clearly cherry-picked to make it sound as bad as possible for the US.

The first step of solving a problem is usually accepting there is a problem.

Well, sure, but it's still 5x as much per person however you put it.

Absolutely, USA's war on drugs is an expensive waste of human life. Although, even 5x seems a bit high - is that controlled for higher wages in the US (not just exchange rates)?

Arguments are not soldiers. I was criticizing the yellow journalism, not saying anything one way or the other on the efficacy of US drug policy.

Let's correct that and estimate it ourselves: The War on Drugs was launched in 1971, so that's 46 years it's been going on. And the average household size in the US was 2.58 in 2010 and 3.11 in 1971 according to census - let's take the higher number to get a conservative result that is generous to the US. That comes out to $10000/46/3.11 = $69.9 annually per citizen on average. It's a pity they muddled it up by comparing apples to oranges, because it's actually very favorable for Portugal if you compare apples to apples.

That's a reasonable estimate. While the journalist used 'household', I don't think there was a reason to. Looks like there was a lot of news articles published between 2010-2015 with the $1 trillion figure being cited (haven't found a break down of that yet though).

Anyway for fun here's my estimate: The mean US population between 1971 to 2015 (inclusive) was 262.1 million [1]. There were 44 years in that period (inclusive). Therefore:

1E12/(262.1E6*44) = $86.71/person annually

[1] http://www.multpl.com/united-states-population/table and a spreadsheet

Unless the US has 10 citizens per household and the period in question is 10 decades, the point still stands that the Portuguese policy is cheaper per citizen as well as more successful.

(The actual numbers are more like 2 and 4 than 10 and 10.)

Uh... it seems honest in that the facts seem correct and is only misleading to people too dumb to figure that "per citizen per year" !== "per household over the decades."

You're implying that the US has a more effective drug policy than Portugal, which is absolutely ridiculous

Not at all. GP is implying that there's some shitty journalism going on.

Your comment bothers me more than it should. Why do people who feel strongly about stuff allow, or even encourage, shitty reporting and intellectual dishonesty as long as it suits the narrative they support?

I mean, you're calling out a commenter for being 100% right, putting words in their mouth and then calling those words ridiculous. What's the point?


Thanks. I never heard of either term, are they good or bad?

Accusing those you dislike of Virtue signalling is also the worst bit of self-branding from the right since the idea of accusing opponents of fighting for social justice. Or more recently, that their enemies are all anti-fascists.

Where in the comment is that implied? Seems like he/she disapproves of the apples to oranges comparison of the stats presented and not making any further judgment on policy efficacy.

Addiction is a chemical dependency. It is neither a disease or a crime, it's usually a symptom of something else.

Substance abuse and addiction tends to originate from either a variety of sociological factors, or treatment (self or prescribed). A very large number of addicts are simply self medicating for one reason or another. Or at least they started off that way.

Even if society determines addiction and substance usage to be criminal, it's a victimless crime and a waste of resources.

"Addiction is a chemical dependency. It is neither a disease or a crime [...]"

Apparently the AMA and others disagree:


"Addiction is defined as a disease by most medical associations, including the American Medical Association and the American Society of Addiction Medicine. Like diabetes, cancer and heart disease, addiction is caused by a combination of behavioral, environmental and biological factors. Genetic risks factors account for about half of the likelihood that an individual will develop addiction. Addiction involves changes in the functioning of the brain and body. These changes may be brought on by risky substance use or may pre-exist."

That's OK, not everyone has to agree about a particular description.

If medicine gets to the point where a single substance or chemical can be easily avoided to entirely prevent diabetes, cancer, or heart disease, the same way that someone can entirely avoid alcoholism by simply not drinking alcohol, that will be quite an achievement.

But this ignores the strong sociological component of addiction and substance abuse. Nobody is choosing to try cancer to self medicate depression, nobody is testing out heart disease to treat their pain or torment, and nobody is giving diabetes a whirl to address a sociological condition.

>But this ignores the strong sociological component of addiction and substance abuse...

Bullshit. All kinds of medical conditions and their treatment involve sociological factors. Treating drug abuse as a health issue in no way precludes dealing with its sociological context.

Picking and choose medical conditions that differ markedly from substance abuse and contrasting them is disingenuous. What about other medical conditions that are much more similar such as dietary conditions, overeating disorders, etc? There are a whole range of metabolic diseases caused by or associated with patterns of consumption that are very similar and often even have sociological factors associated with them. These are treated as public health issues. Substance abuse is just another category of related conditions.

> and nobody is giving diabetes a whirl to address a sociological condition

Actually, yes, they are. There's no more perfect disease that you could have chosen to disprove your own argument.

Adult-onset diabetes is almost always a variant of substance addiction. It's just that we classify the drug "food" and sell it in the grocery store. But we shouldn't kid ourselves, sugary, highly-processed "foods" are a drug that is intended to be every bit as addictive as alcohol. The sugar high is like being drunk, the subsequent crash is like a hangover and diabetes is like the liver damage that results from alcoholism. The two diseases are remarkably similar.

> not everyone has to agree about a particular description

Well, we do if we want to have a discussion about a particular problem. Using the description from the experts in the subject certainly seems like a good place to start.

You can define food as shards of metal and glass but that means I'm probably not going to take culinary advice from you.

> That's OK, not everyone has to agree about a particular description.

Unless you are an expert, I suggest you follow the guidance of the people who have been studying the subject for almost a hundred years.

> Nobody is choosing to try cancer to self medicate depression, nobody is testing out heart disease to treat their pain or torment, and nobody is giving diabetes a whirl to address a sociological condition

Like addiction, all of those can be side effects of things people do for exactly those purposes. In fact, heart disease and cancer are, like addiction, specifically frequently consequences of substance use directed at those purposes (and not just illegal substances; tobacco and alcohol are major culprits.)

People chose lifestyles that can cause cancer etc. So yeah I'll go with the medical definition of a disease.

What lifestyle choice did a baby born with a cancer or type-1 diabetes make?

What life style choice did a baby born with a opiate addiction make.

> it's a victimless crime

Not always, not for the worst drugs out there. Heroin and meth addicts regularly commit violent crimes as a direct result of their addiction. You can say that the actual violence is the crime, but if there is a common root cause for a lot of crimes, doesn't it make sense to criminalize the root cause?

Heroin and meth addicts regularly commit violent crimes in order to procure more heroin/meth. The only reason they need to is because prohibition makes those drugs orders of magnitude more expensive than they would otherwise be. The only reason the drug cartels engage in ruthless violence is because they operate outside of the law and thus outside of the government's monopoly on force. Criminalization is the root cause of the crime.

It's not a direct result. Also no it does not, if it makes matters worse. So if you ban heroin, price will go up, addicts need more money, plausibly the criminality will go up, not down. Which is exactly what happened. The quality will go down and dealers/smugglers will optimize transport costs by using more effective and deadly drugs like fentanyl. So now the ban is directly harming the population of addicts, their relatives, and even first time/ recreational users.

And alcohol, no stranger to huge amount of crime, is still legal. As it should be, but this perfectly shows the hypocrisy around drugs.

no, because poverty is largely what causes those (and most) crimes

There are many types of addictions where no (external) chemistry is involved at all, caused by purely psychological mechanisms.

Things get a little more muddy if you take the view that there really is no mind-body division, and that human behavior is the result of chemical and neurological processes in the brain, which in turn is just another part of the body.

It's easy to draw a distinction when physical withdrawal leads to death, but how do you differentiate between physical and psychological pain and suffering when abstaining is not fatal?

Right, that is why I suggested that addiction is usually more of a symptom of something else.

The headline reads eerie, almost as a quote from some anti-utopian novel. "This weird place treats diabetes as a disease, not a crime!". "That weird country over there treats depression as a disease, not a crime!". I mean, how messed up should we be to not see this as the only way to treat it?

The difference is that addicts are actively malicious to their family members and broader society.

Depressed people and diabetics are hurting themselves either through action or inaction, but I've never been threatened by a diabetic or depressive outside a Circle K. I have been threatened by a criddler outside a Circle K. Similarly, few people get all of their stuff stolen out of their house by a diabetic or depressive. They do all the time when their son is addicted to heroin. Depressives don't prostitute their kids to drug dealers for crack, etc.

Drug addiction is one of the few diseases where the patient actively attacks all of the people who are in a position to help him. That generally alienates people who tend to be otherwise generous toward the down-and-out. The laws reflect that, and it takes a superhuman effort of rationality to say, "Yes, addicts do terrible things. Other solutions produce better results than the natural impulse of doing terrible things back to them."

Edit: We see this in the nastier forms of mental illness, too. People are generally compassionate toward those with OCD, eating disorders, and so on. Those with borderline personality disorder or bipolar disorder tend to be relegated to "batshit insane" and viewed with utter contempt. Again, the difference is that someone with anorexia nervosa isn't going to pull a Carrie Underwood[1] on your car, but someone with BPD might.


> I've never been threatened by a diabetic or depressive outside a Circle K

Mentally ill people can be dangerous to the surrounding people, especially if not treated properly. This is known, and it is also known that the way to deal with it is to address the disease, not hurt them and yell at them "snap out of it, you bastard!"

> The laws reflect that, and it takes a superhuman effort of rationality to say, "Yes, addicts do terrible things. Other solutions produce better results than the natural impulse of doing terrible things back to them."

Calling this "superhuman" only reveals how low the expectations of "human" are. It is truly sad state of affairs that acting rationally and trying to do something that actually might make dent into a solving the problem instead of instinctively biting back is something that is considered "superhuman". If going a tiny step above animal is "super-human", what is left for "human"?

> Depressed people and diabetics are hurting themselves either through action or inaction, but I've never been threatened by a diabetic or depressive outside a Circle K.

Well, make the treatment for diabetes unavailable through legal means and very very expensive - and you soon will be.

Not sure why you think depression is not a severe mental illness. If your parents are depressed, this has very much the potential to affect you as a child. For one, since you got the same genes and the same risks involved and two, since you grow up in an environment where your two examples (mom and dad) are depressed with all the effects attached to that. Its difficult to give examples, but say you never see your parents smile or do anything with a smile. Don't you consider that actively malicious to their family members and broader society? Whereas a random heroin addict who sleeps under bridge and doesn't steal is just out of sight, out of mind. And what's to say the person isn't a heroin addict precisely because of mental illnesses?

Yes, that does seem odd doesn't it? I think the problem in the US is the US WoD has a playbook with just 1 play in it: tough on drug crime. Coupled with the unwritten rule that politicians of the same party should never openly criticize their own publicly, that one play in the one playbook is very difficult to change. Couple that with the fact that both of the two political parties in the US use that same one play from their one playbook and you can understand why it's taken 46 years to not solve the problem.

Well technically everyone treats addiction as disease. It’s the possession buying and selling part that’s a crime. You’re free to be addicted to anything you want as long as you’re not buying keeping or selling prohibited substances.

That's like saying "you are free to require food and feel hungry, it's just actual eating that is a crime" and then calling people criminals when they still try to eat.

It isn't a crime; it is punished by the ruling warlords. And it isn't the buying/possession of narcotics which is forbidden. What they forbid is to buy narcotics which have been grown/made by the warlords enemies (free independent people)

This is an aggressively unproductive way to frame the situation.

I think if you polled American's on whether the legal drinking age should be lowered from 21, most people, if not a significant majority would probably be in favor of it. In fact, a majority have probably violated such a law.

If it turns out true, then it means there's something fundamentally wrong with the legal and voting system where somehow it completely restricts itself from the ability to enact a change in the laws in this area. And if this can't be achieved, there's no hope for any progressive drug use laws.

The legal drinking age in the USA has a long and storied history that mainly has to do with MADD and the Reagan administration. The most straightforward and sensible opposition can be explained in a single sentence: “If I am old enough to die for my country and mandated by law to sign up to do so, why am I not legally allowed to have a beer before doing so?”

Regarding your comments about the voting system: of course they are true. How long will the hypocrisy manifest itself before it is changed is the true question.

They have done that poll. It's exactly opposite of what you think. They've done this poll lots of times. The results are rather consistent.

Here is one such example:


That was just the first result.

Anyhow, we don't always want majority rule. At one time, the majority of people felt it was okay to own people. I suspect you can find areas where the majority of people don't think we should have equal rights for certain classes of people.

>Anyhow, we don't always want majority rule.

You do in a democracy.

>At one time, the majority of people felt it was okay to own people.

Until they decided it wasn't ok, and an abolitionist president was elected.

>I suspect you can find areas where the majority of people don't think we should have equal rights for certain classes of people.

Like civil rights for gays. Also solved by voting.

The problem I have with the 21 year old drinking age is it now allows police to jail college kids at will, essentially limiting their life's prospects. Again the punishment is worse than the crime.

I'm not sure the graph entitled "A Stark Difference: Drug-Related Deaths" proves any point: Portugal has indeed the best stats and the US the worst, but you cannot conclude that it results from Portugal's vs US's policy on drugs. In fact, France, right below Portugal on the graph, still has quite repressive policies.

Tell me about these policies. Why are the French policies repressive

Well, they're repressive enough that the French come to NL and Portugal in droves to get their drugs.

This article changed my view on the subject a bit.

Lately, I had been watching various documentaries and YouTube videos about the opioid crisis in the USA and Canada. Often, the public policy seemed absurd to me, as it was just as if the first responder services were offering free customer support for the drug business. They used Naloxone to save the lives of customers who should normally have overdosed, and with no supervision afterwards, those addicts were soon back in the street where they keep buying and consuming.

A drug that is too lethal has very little commercial viability. By decreasing the lethality of drugs, first responders support the drug business, which is absurd.

I started reading this article expecting it to enforce my position, but I had to acknowledge the fact that apparently, this policy did indeed reduce drug usage in that country. That puzzled me a bit as I was struggling to see how making consumption easier could reduce consumption, but then they mentioned how they provide methadone, and that seemed like a sensible explanation. They don't provide customer support by just giving naloxone for instance, as I saw they do in US and Canada, they also provide an opioid substitute, which should hopefully reduce the likelihood of a relapse.

Many countries take this approach.


Amsterdam, 1985, the government supplied methadone using an old city bus they transformed into a drug dispensary, they even supplied clean needles for free.

> Amsterdam, 1985, the government supplied methadone using an old city bus they transformed into a drug dispensary, they even supplied clean needles for free.

In the documentary I was mentioning (sorry, can't find a link or remember the title), I saw something like that in Canada (IIRC). It was a room with needles, with a nurse or something to supervise and monitor injections. And of course there were doses of Narcan in case an OD happens.

But no methadone whatsoever was offered. Or if there was, it wasn't mentioned. So basically the government was paying to provide an infrastructure for drug consumption. In other words : customer support. It's as if they were working for drug dealers. To me that's outrageous.

> So basically the government was paying to provide an infrastructure for drug consumption.

So what?

> customer support. It's as if they were working for drug dealers. To me that's outrageous.

What's outrageous is that you'd rather see those people die. That's the alternative. To get them off the streets, registered and out of the risk of getting hepatitis or HIV is the beginning of giving them a chance to clean up. The government even competed with the drug dealers: they gave out free heroin to those that were already addicted.

And it's not as if any of this isn't a selfish thing by society, the cost of an addict over the longer term is far higher than the cost of helping them, so it is actually better for everybody.

I really don't understand these extremist viewpoints when it comes to healthcare.

> What's outrageous is that you'd rather see those people die. That's the alternative.

You're not supposed to save lives at any cost. Not if that means you'd associate with or reward crime. That's why you don't submit to blackmail, for instance. In the same way when someone is selling drugs illegally, you're supposed to put him in jail, not help him with his business.

> You're not supposed to save lives at any cost.

The cost is quite manageable.

> Not if that means you'd associate with or reward crime.

They don't.

> That's why you don't submit to blackmail, for instance.

What does that have to do with any of this?

> In the same way when someone is selling drugs illegally, you're supposed to put him in jail, not help him with his business.

I'm sure you will feel right at home in AG Sessions office or with the Philippine leader. Me, I'm much more comfortable starting from root cause analysis rather than to just hunt symptoms, I think hunting symptoms is a waste of time, effort and resources.

Heroin was introduced by a corporation to the masses, and they kept selling it through illegal channels after it was made illegal. We live in a society where the governments are controlled by those same corporations - would you be more offended if Bayer was running those clinics and charging those who overdose?

What are you suggesting the first responders do, other than save lives?

Edited to add: I saw your response before it was deleted. I appreciate your honesty but I'm really glad you are powerless. I suspect you have some bias issues and that they may be rooted in a lack of understanding.

A resource I recommend is the book, Chasing the Scream, by Johann Hari.

It lays out the complex and remarkably individual history of the war on drugs and its consequences to great effect. If you read it and agree, buy a few copies to pass on to random people you encounter.

Great to see this in the NYT.

Drug use should be treated as a health issue, not a criminal issue.

This has been understood in policy circles for decades, with the WoD incontestably the most egregiously failed policy driver in modern times. It's hard to imagine even a fairly prominent NYT article extending discussion very far in the US public sphere, given that nation's current subjection to tribal and atavistic affiliation rather than rationality.

Drugs are a social justice issue. Not a health issue.

Drug abuse is a health issue. Most drug use is not abuse.

Yes, good correction, thank you.

Addiction is a health issue. Experimenting prior to addiction is clearly not.

This thread is full of smartasses 'well actualy'-ing irrelevant picky distinctions of no particular substance. I'm not going to go at all of them, but lucky you!

Medical problems associated with drugs go way beyond just addiction. Kids can die on their first use of a drug, even on a dose that would normally be forced be harmless, due to other factors such as dehydration, alcohol consumption or overheating. Even without becoming addicted, drugs can have other harmful medical effects. The sheer scale of the simpleminded ignorance of this comment is staggering.

10s of thousands of people go to the hospital every year for Tylenol overdoses and hundreds die. That doesn’t mean any use of Tylenol is abuse.

Of course not. Lots of controlled substances have legitimate medical uses. I don't get your point.

Life is dangerous, and it is more valuable to work to educate people on the danger around them than to try banning it by rewriting reality to treat dangers like they don't exist by outlawing them.

It is why kids think "that cannot happen to me". Because its criminal. Because its the plight of the "other". Because its told like a monster in a fable rather than a fact of life and an emergent property of our society and biology.

I agree I'm pro-decriminalisation of drug use and for regulated legal distribution.

Kids can die on their first use of a horse or a bicycle. Or any subsequent. With higher probability than lots of illegal drugs.

Not sure if you are trying to distinguish a difference but, surely you aren't suggesting that drug experimentation or recreational usage should be criminal?

The parent poster is explicitly saying that smoking a few joints in college, or taking some LSD once at a rave is not a health issue. They are right.

Saying that does not imply that they endorse criminalization.

Not taking a stand on that, just pointing out that not all users of illicit drugs are addicts.

Thanks, yes. I should've said 'drug abuse is a health issue.'

Having lost several friends to the opioid epidemic, I wrote an article about it on decriminalization. I wish we would help addicts instead of treating them like criminals.

The war on drugs has failed. We must not be a part of the suncost fallacy, but just embrace another way.



Good sir, please note that I was not about to seek stock images that were worse off than what I could present without presenting images that may have disgusted my visitors, though I know the situation could definitely be presented much worse and it certainly is.

I do not seek to argue with you, or pretend I know everything.

I only know that I lost two my of best friends to the opiate epidemic, one of whom was a veteran marine, and I also lost a cousin who happened to be an army veteran due to overdosing on prescription pain killers.

I have even more Facebook friends, who happened to be acquaintances in my life, whose profiles are no longer active because they no longer are alive.

I do feel that if they were able to seek the help they needed, they would've done so.

If you wish to argue, than argue with logic and facts, not calling people "normies" as if they don't know what drug addicts go through. I myself was getting addicted to oxycontin before I was able to ween off of it.

My condolences to you for those you have lost in your life, good sir. Or might I add, I hope you are able to deal with your own demons in an appropriate manner.

Are we really, seriously, debating the success of a proven successful program?

The real interesting thing is not whether opiod addiction is a disease or not- it clearly is - but why the behavior-controll-fraction trys so violently to clamp down on drug-behaviour with the law.

It just doesn't sound rational. And its not. Many oxy-addicts of today, where former - "The police should get them" conservatives. So what compels a human being to want the state to go after his fellow being, which irony- might be his/her future self.

My guess, at the motivation is a mixture of envy (on a perceived decadent lifestyle) without hard work, a fear for ones offspring and finally grievances caused by known addicts (small time theft and crockery).

As long as these emotions are not respected, taken care off and defused, as long as this is the case, the disease that is drugs can not be handled.

An acquaintance of mine runs a rehab center for addicts. I really like his view on addiction. It's that addicts often had traumatic experiences, eg during childhood, and that drug abuse is a way of "self medication" to cope with them.

I've known quite a few addicts (> 10, this is a direct consequence of living in Amsterdam and the attraction the city has on drug users and the fact that pushers would hand drugs to school children when I was in high school, though fortunately it seems - to me at least - as if the Heroin epidemic is past its peak). Not a single one of them would fit that category. Most of them were perfectly ordinary people before sliding into addiction. It was a series of smaller steps or thrill seeking behavior in all of those cases. Some of the addicts were actually amongst the smartest people I knew before they got addicted. I'm sure there are those who use drugs as an escape route from some miserable experience early on in life but I've yet to meet them.

The life expectancy of addicts is such that I only know of two people that managed to effectively beat their addiction, both are family members and even though they got out of it they never fully recovered from their encounter with hard drugs. Ugly stuff.

Have you heard of Rat Park?


TL;DR rats trapped in cages will self-administer drugs, often to the point of death. Rats which explore freely have a much lower (order of magnitude) rate of addiction.

Interesting. Thank you very much for sharing. I don't know a single addict, so really have no insight. Probably that acquaintance's institution simply focuses on such patients. I don't know.

Wonder what Ayn Rand would have to say on the subject. That will tell us where our country is headed. She was also a user of amphetamines, btw.

Ayn Rand had lots to say on many subjects but hardly any of it was useful or constructive. Though that doesn't stop a whole pile of people from worshiping her every word because it plays into their own wishes for how they'd like the world to work.

I haven't read much Ayn Rand but what I've read so far seems pretty straightforward. I'm curious to learn more, could you tell me about some of the problems you've found with her ideas?

I hope this is in jest


At least somebody got the joke.

I kinda dislike calling addiction a disease. You can't just decide to stop having cancer unlike addiction. Even tho addiction is all about a person's brain chemistry being completely out of whack, alcoholics and other addicts will often have a so called "moment of clarity". No such "moment of clarity" exist for other diseases.

The fact that someone, in 2017, would imply that addicted people could just decide to stop being addicted seems to me as reason enough to keep calling it a disease. Just to fight that notion.


No, you can't. You may be able to stop the use, but that doesn't stop the addiction. Addiction continues, regardless of continued use.

There is a whole lot of information out there, for free and easily discoverable. If you're really interested in holding an opinion, I'd start at your favorite search engine.

Have you heard the phrase, "Dry drunk?" That is a good reference point. A dry drunk is a colloquialism for someone who doesn't drink but still exhibits the behaviors associated with an alcoholic. This is because the brain chemistry has changed.

An addict can, sometimes, learn to use in moderation - but the addiction remains. The brain chemistry remains forever altered. There has been huge efforts made in researching this. The science is fairly mature and the results are fairly well understood.

Addiction doesn't just go away. Physical dependence may go away, though that depends on the treatment and many other things. There is a difference between drug use, physical dependence, and addiction.

there are plenty of rich, workaholic, yuppie addicts. professional drive is oftentimes counterbalanced with substance abuse.

makes me wonder what kind of crazy bubble you grew up in. what a strange belief to have.

I grew up in the bubble where a few addicted people I knew managed to kick their addiction when the alternative was sufficiently grim.

Did you grow up in a bubble where that never happens? What a depressing bubble.

Are you a fan of any art? anyone prolific who was crippled by addiction? it's a human condition and that american ideal of "just straighten up" clearly no longer applies. What if I told you that using the internet was detrimental to your health? Could you just stop?

He still has a point. Often, addicts quit cold turkey after a moment of clarity.

That doesn't mean that it is not an illness.

> Often, addicts quit cold turkey after a moment of clarity.

More accurately, often addicts attempt to do so, but the vast majority who do so relapse.

But, in any case, not using drugs doesn't mean you stop having an addiction anymore than avoiding contact with bees means you stop having an allergy to their sting.

cold turkey is also dangerous - Amy Winehouse quit alcohol cold turkey and died from a relapse of alcohol, a legal and (practically, for adults) unregulated drug

That can kill you.

And the fact that some manage does not mean that all of them could.

That "moment of clarity" is literally just accepting that you are an alcoholic. Like, that's all it is.

Normies love to pontificate about the causes of and solutions to addiction, but I never get more than a paragraph in before I find a vacuous statement that highlights how completely the speaker misses the point. It's fucking exhausting.

>That "moment of clarity" is literally just accepting that you are an alcoholic. Like, that's all it is.

and what is one of the results of that "moment of clarity? They stop drinking.

You wish. Plenty of them are fully cognizant they are addicts and still can't stop.

That's the whole idea of being addicted. It is a dependency at a physical level outside of any of your abilities to reason. Only very strong people make it out and almost always with assistance from the outside.

Plenty of them is not ALL of them. The fact that any of them do is my point. Not a single person with cancer or aids can just decide to not have their disease.

>Not a single person with cancer or aids can just decide to not have their disease.

Neither can addicts the vast majority of addicts, that's the point.

Why bring up what the majority of addicts doing? The very fact ANY of them can just decide to stop is my point. Its pretty simple.

They can't decide to stop any more than you can decide to stop breathing or eating. They can certainly say they will stop and they can certainly try, but actually stopping on a permanent bases seems elusive.

I would say most addicts don't want to be addicts at some point, yet they are still addicts.

I'm addicted to nicotine since I was 12 and I don't want to be, yet I am. I've quit a few times for a few months, but always get triggered back into starting up again.

That's pretty naive.

“Peer reviewed studies peg the success rate of AA somewhere between five and 10 percent,” writes Dodes. “About one of every 15 people who enter these programs is able to become and stay sober.”


Now do you see how it's like a disease? Users literally realize they need to stop or they will die, but they do not.


People that pontificate about subcultures with no direct experience.

People that didn't mess up their brains with bad choices

> You can’t just decide to stop cancer unlike addiction.

Non-substance addict in recovery here. You CANNOT (by definition) “decide” to stop having an addiction. I’m not gonna get into a huge discussion but would like to point out the (ongoing) work looking at the various genetic markers that increase vulnerability or statistical predisposition to various substance and non-substance addictions.


> You can't just decide to stop having cancer unlike addiction

You can't just choose to stop having an addiction, either.

That's kind of the whole point of addiction.

> alcoholics and other addicts will often have a so called "moment of clarity".

A moment of clarity is just the point at which one recognizes a problem.

> No such "moment of clarity" exist for other diseases.

This is not at all true.

This is a good counterpoint and it's all true for once a person has become addicted. I think the original post and similar arguments stem from the thinking that before the person took drugs for the first time they made a choice to do so they knew what they were getting into. However the same could be said for people who have STDs and that's still called a disease. Same is true for people who might travel to a country with malaria, if they contract it, it's still a disease but they didn't have to go. I'm guessing people are more willing to be lenient in those cases because there's only a possibility of risk, whereas taking heroin or something seems more reckless. I think there is anger/judgement around someone for having decided to get into this, perhaps it should be a crime before the person is an addict but no longer a crime after they are addicted. Anyway I agree that it still has to be called a disease, you're point helped me come round to this. It's a disease once addicted, but it's not the moment before the decision is made to have it for the first time.

I'm nicotine addict. I had had at some point "moment of clarity" and I stopped to use nicotine. Almost two years I was free and than I got moment of "disclarity" and now I couldn't find one more "moment of clarity". It is simple to say "you can decide to stop having addiction", but to really decide to stop and to stop you need something more than just a will to stop.

If you believe, that decision itself can stop substance abuse, than think about what is the more probable outcome of such a decision: freedom of addiction or failed attempt to stop. I have no statistics, but looking at other nicotine addicts I would say that decision means almost nothing. Maybe in 1 from 20 cases decision to stop leads to remission. One can argue that in 19 cases there was wrong decision, but it is more likely that there are some other causes, and decision is not cause of remission, though essential accompanying factor.

Addiction is something you cannot comprehend by just abstractly thinking about it. You need explore it either by trying, or (preferrable) by studying addicts or at least reading articles wrote by scientists who are studying addiction.

Perhaps it's better thought of as a social disease or a social pathology, but you're largely right. Addiction is a chemical dependency, it is not a random occurrence.

You can choose to stop smoking. This may prevent future addiction, but will do nothing to stop your immediate withdrawl symptoms. This may prevent future cancer, but will do nothing to stop any current ulcers.

Plenty of other illnesses trace back to life choices. Unprotected sex gets you STDs. Not exercising and eating right leads to heart failure. Isolating yourself socially leads to depression. Many of these can also be stopped or reversed after a "moment of clarity" that causes you to change how you live your life. Addiction is not particularly special in this regard.

For most you can't just "decide" to stop being addicted either.

So, you do not regard mental health problems as "disease"?

Let's just call it a "health issue"

Make drugs legal. Impose a 15% tax on each sale with all money devoted to rehabbing addicts. Problem solved.

Complex problems don't usually have solutions that fit comfortably on bumper stickers.

Although I agree with your assessment, you could have tried to actually point out some problem in the parent's "solution".

I can think of one: you would still have to incentivize people to go the legal way and pay 15% more. Which could be another intractable problem.

> you would still have to incentivize people to go the legal way and pay 15% more

It seems to work just fine for tobacco and alcohol - a black market certainly exists for these drugs, but it's tiny in comparison with legal sales.

On top of this, the increase in safety - getting a pure product that is what it claims to be - would likely be a no-brainer for most users.

I read this is currently a big problem in California, most marijuana growers do not see the point in registering and doing it legally. It's just more paperwork and less profits. There's even less incentive now that the punishments have been reduced.


Discussion: https://news.ycombinator.com/item?id=15210418

The myriad problems with just getting the political willpower to legalize drugs, is a starter. Then, there is the mechanism to do so - like what do you do with those already convicted? How does one make it so that it's even a realistic discussion being had by the average citizen? What about individual States? Etc...

Why would they pay more? First, convenience - it's right in the store, you can just buy it without having to do a shady deal where you might get killed. Second, big drug companies at scale will be able to manufacture for much less. Third, there is a premium you have to pay for anything illegal to compensate the seller for the risk. So they are paying higher than it's worth anyways.


I'm Portuguese too. Maybe a bit older than you because many years ago I thought the same way as you until I lived in other lands.

I've lived across the US, West Europe, East Europe, UK and even Switzerland just to find them far more xenophobic than what I would ever imagine.

And with some more years you might realize that the large majority of nations are indeed that way.

Then going back to Portugal and looking at history, you might find that existed a long time effort for integration of different people in a very different way than say, the British empire.

So, we're not xenophobic. You likely didn't had to live through the epidemic of drug in 2000 and watch the majority of your friends getting hooked. It was sad, there was no hope. Portugal just legalized those drugs because everyone had lost someone to them and nothing else tried before had worked.

Even today in my own family, two of my younger brothers never fully recovered. They don't consume any more drugs since a decade and still it has permanently affected their brain capacity, one of them is still inside an hospital.

How does it treat the international drug dealing cartels (root cause of the disease)?

The root cause of the disease is that people like drugs. The cartels are a symptom of the larger problem, not the other way around.

If you eliminate the cartels, would people continue to use/like drugs? Would they look for other forms of addiction?

The US has spent hundreds of billions of dollars domestically and in Latin America over four decades trying to eliminate or restrain dozens of major cartels. It can't be done. It's obvious why it can't be done.

In that span of time, there has been no other nation on the planet with greater technological, military, financial resources to throw at something like prosecuting the so called war on drugs. If the US couldn't kill the cartels & illegal supply with that approach, it can't be done that way. The fact that it would fail was always an obvious logical conclusion ahead of time (we even had prohibition to reference as a blatant demonstration), but we have the benefit of vast actual results of perpetual failure and destruction to throw on top of just reasoning it through.

Fortunately the majority of Americans have come around to understanding the war on drugs has completely failed and for that reason the WoD is over (specifically it's on its last legs).

People like drugs because they like getting high, not because they like cartels or doing illegal business or being rebellious.

People like drugs because they allow an escape from their normal lives, which they don't like. Boredom, depression, etc. Read about the rat park experiment, rats like being high too if their lives suck.

The principal author of the Rat Park paper, Bruce Alexander, has a web site on addiction: http://www.brucekalexander.com

People like drugs for the same reason that consumer culture has become an uncontrollable beast - you can use the dollars you earned to bring you joy. Some people prefer it to alter their state of consciousness. Society should step in to stop people who are doing it recklessly, just as they should when people are hoarders, people are obese - it's all the same thing, somebody has only found one Skinner button that works for them in a world of Skinner buttons you're meant to press

If you eliminate one two more pop up in its place. The demand it there. If you cut off supply it will go somewhere else. If you treat it as a disease then you look at why the demand. Reduce the demand (or give a legal supply) and drug cartels can't operate.

>If you eliminate the cartels

Can't be done. It's useless to waste a single further breath entertaining that idea.

New ones would appear more or less overnight. The economic incentive is simply too large and there are always people who already are criminals who see an angle and will move into the space. Cartels are a result, not a root cause so removing them will have zero effect.

Yes, desire for altered conscious is human nature. It's why kids spin around to get dizzy.


Of course they would.

Would an individual considering whether to buy/use a drug actually evaluate the involvement of a cartel in their decision? I doubt it.

I suspect demand for drugs is largely independent of their legal status. Legalization would not open the floodgates to reservoirs of potential users previously held back by law.


Further, even if you did "eliminate" the cartels, more would pop up.

If there is a demand, someone will find a way to make money off of it.

Cartels or not, you can't have success by attacking primarily the supply side of this trade.

Your thinking is basically that supply is the problem rather than the demand?

Keep in mind "international drug dealing cartels" would not exist if there were no demand for their product.

The root cause of the heroin epidemic are the legal drugs cartels in the US. Wherever they have been banned from giving addicting painkillers to people (like Portugal) heroin abuse has been going down pretty heavily instead.

But we wouldn't jail our precious Wall Street people, would we? 60.000 people dead per year is just...a little statistic...most of them Trump voters or black people anyway!

No problem killing thousands of brown people in the war on drugs though. They shouldn't try to corrupt the American population with patent-free opioids!

Cartels don't cause addiction. Addiction + prohibition causes cartels.

Quite honestly, there's almost certainly some bidirectional feedback going on.

Drug use is decriminalized. Drug distribution is not.

Drug trafficking isn't a root cause, it's a symptom of prohibitionism of substances in high demand.

Are there no crimes for goods or services for which there are legal sources?

I decided to start with a couple of polemic questions to get a sense of how people would react to somebody a bit more inclined to the other side of the scale.

I believe addiction is a disease and the sick must be treated with high priority. My younger brother started taking drugs even before high-school, like most boys here where I live. He had no choice. He wanted to play bass with that band and hang out with them. Pot and cocaine, basically. Tobacco and booze came later when he was in college. He made it to the end and got a major in Advertising with a minor in Psychology. Two years after graduation he was struggling to find a decent job and that led him to a whole decade of drug abuse. He has developed some sort of schizophrenia and has a problem in his lungs. Today he lives with my mother, as he cannot live alone, and he makes a living selling SIM chips in a kiosk inside a supermarket. On top of all that, he has depression, so needs to control it taking medications.

My brother is just another drop in the ocean of addicts. I feel sorry for him. I feel sorry for my mother. Our family started treating him as a sick person only 10 years ago, and it was too late for him. So I strongly believe all addicts should be treated at the earliest possible while there is still a chance of recovery.

I have spent the last 40 years of my life watching how drug cartels operate down here in the third world. I hate them, of course. Their entire structure, from the 8 year-old who takes drugs to school and share them with his buddies to the drug lords who dine with politicians every night.

I'm part of the group of people who believe addiction starts at early age, adolescence, when people really enjoy taking drugs, loads of them. Distribution starts really at school, and for free. They normally choose two brothers, one must be older and outside school, the other, in school. They take the older and kindly offer him a gun/ammo or good money. In exchange, his little brother is now part of the cartel and will have to distribute drugs at school. This little man will be arrested countless times, but released in the same day once his mother pops up into the police station. He will be back to his "job" next morning. In case his mother decides to take him out for treatment, the consequence is that the elder brother now has a serious problem with the local drug distributors and will have to choose between working for them, saying goodbye to normal life he used to have, or death. In the long run, both brothers will be neck deep into crime.

The reason "war on drugs" doesn't work anywhere is because it is not a real war. Governments are mostly investigating, arresting, taking to jury etc. There is no extreme, war like violence, between government and drug cartels. No mass killing. Elimination, as I wrote in another thread. So the government thinks it has "destroyed" a cartel, when in fact it has just "dismantled" it until people at lower layers see vacant positions they can be filling in. Yes, government let WoD as it is, is a multi decade, multi trillion dollar worldwide worthless effort. Take that money and help the sick.

On the other hand, WoD in the slums is a completely different ball game. It is extremely effective because it is violent to infinity. Cartels operate in total monopoly within their territories. No sharing. If you look at the news coming from Rio de Janeiro this week, there is a war going on between a handful of groups interested in a specific region. Those "Fallujah battle" like scenes we see on TV is the tip of the iceberg. It is what can be shown to society. Down there in the ground, when a slum is finally taken over, that when the barbaric mode turns on. The unlucky bastards and their relatives who didn't die in shootings will be subject to beheadings, all limbs amputated, burned/buried alive etc. War. Everyone from the losing cartel is killed and a new monopoly starts.

"Ok, so what if you decriminalize production/distribution to weaken the cartels, giving the population the choice to stay away from all that horror and still buy better quality drugs at a fraction of their cost on the streets and use them without the possibility of being arrested?"

Now, you, third-world government and law enforcement broke the monopoly. And now you are going to face the real war on drugs (no quotes). It's going to be everywhere. The immediate reaction will be something like what happened back in 2006 in Sao Paulo[1].

"Since early Friday May 12, 2006 there have been 299 attacks against public establishments such as police stations, justice forums, buses, etc.; which are allegedly organized by the Primeiro Comando da Capital (PCC) criminal organization."

Yep, 299 attacks in 5 days. Just because some cops killed some key assets from the criminal organization. That is insignificant next to the possible impact of ending the monopoly of their main revenue stream: drugs production and distribution.

They would kill/barbarize people all along government's drug "supply chain". At the factory, at the warehouse... retail shop? I can't even imagine the violence. And, finally, consumers. Bad consumers who made the bad decision to support the monopoly break. Those would be killed at the shop's door so the media could do its job and promote it nationwide.

I also believe cartels would have no trouble in massively robbing premium grade drugs from the government and sell them afterwards. For that, they can use the same .50 cal and TNT used elsewhere to rob banks and armored cars[2]. "They" in this case is not a handful of dudes, but 50.

"The robbers numbered about 50 and came armed with high-caliber weapons, grenades, dynamite..."

So, IMHO, drugs decriminalization may weaken some cartel ops in developed countries, improving quality of life in many ways. No doubt. But that's not necessarily the case in third-world nations where organized crime is big, rich and unthinkably violent.

I wish my government could be as violent as the cartels are and kill everyone. Elimination. Yes. That's the monopoly gameplay. It would trigger something like the 2006 event[1], but then the Army and all law enforcement would fight back nationwide, at all levels. The vacant slots in the cartel structure wouldn't see any backfill.

Of course, no government can do that to its own people these days in modern society. Well, maybe there are some examples here and there, but that doesn't matter, my wish is pure utopia, a crazy fantasy. It won't happen. So let's treat the sick the best way we can. Portugal, parabéns!

Thank you for reading this to the end. It was a long day for me and English, as you obviously know, is not my first language.

[1] https://en.wikipedia.org/wiki/2006_S%C3%A3o_Paulo_violence_o... [2] http://www.latimes.com/world/mexico-americas/la-fg-paraguay-...

>He had no choice. He wanted to play bass with that band and hang out with them

So yes, he had a choice, and took it.

I highly doubt he saw the link being just a kid. It's pretty easy to slide into a situation where peer pressure is stronger than what an unprepared person can cope with. It's the reason why many people consume alcohol or smoke, it should be no surprise that it can be strong enough to get them to do things that are even more against their own interests. The need to belong is a strong one.

I consider myself very lucky not to have this particular trait, but even today (and I'm 52...) there is pressure on me to conform, to drink alcohol for instance. I really am not surprised at all that a younger person longing for a particular kind of company could be pushed to indulge.

So yes, he had a choice, but much further back than where the danger was visible, and to make it seem as if he chose willfully for the life of an addict is not very nice.

"root cause"?

As in no one would use drugs if the cartels didn't exist?

How about removing the revenue from the drug dealing cartels? How much power would they have then?

As a crime capitalizing on perpetuating a disease? How else do you think they would.

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