Nowhere in these comments have I see anybody take the position that decriminalization is not enough; drugs need to be legalized and regulated.
I have a close friend whose relative is a heroin addict. According to her, a lot of overdoses are due to almost no "heroin" actually being heroin, rather its fentanyl cut to varying degrees of strength. Not knowing what you're taking, and not knowing how strong it is, can lead to a lot of problems. If people knew what they were getting, and it was legal, you could have "functional addicts" that cause little or no societal harm. My friend's relative was a functional addict on and off for 20 years. She held down a job, paid rent, paid taxes, etc. She decided to get clean only when she had a close brush with death thanks to fentanyl.
Think of it this way: My drug of choice is tequila. When I buy a bottle of 80 proof tequila, I buy it from a state licensed store. I have confidence that its 40% alcohol, and that its safe to drink. It is sold by a reputable company with a brand reputation. What we have today with illegal or "decriminalized" drugs is the equivalent of people dying from drinking bathtub gin during prohibition.
>> decriminalization is not enough; drugs need to be legalized and regulated.
This has been an increasingly popular argument here in Portland since decriminalization. It's deployed, generally, in terms of re-criminalizing hard drugs until there's a well thought out framework for safe, regulated legalization.
While I agree in principle [edit: let's say I did agree, but my views on this subject have shifted radically since I voted in favor of decriminalization - and I'll admit I was naive and wrong], I think that while decriminalization without regulation is clearly catastrophic, legalization with regulation would also not be desirable so long as it's confined to one local city, county or state, in the midst of a nationwide fentanyl crisis. Portland simply does not have the capacity or infrastructure to accept further waves of addicts from all over the country who come here to live on the street. Legalization means more regulatory burden, more services for out of town addicts paid by a dwindling local tax base that's quickly being displaced and/or opting to leave.
To do that experiment and do it right, it needs to be nationwide. In any case, Portland can't go it alone anymore.
And remember - we did have a long experiment with legally prescribed opioids, and their widespread availability contributed to the current addiction crisis.
This happens all the time and is in practical use one of the best justifications for regulation.
There must be a more specific term for it I’m forgetting, but it is essentially the tragedy of the commons.
There are many things that are good for society where if one business did them, that business would lose market share or cease to exist, but it is in the public interest that the specific thing be done. Regulation is the proven answer there.
In this case the primary difference is we are talking about regulating cities instead of companies.
I think this is closer to my point, which was that some ideas can only work at scale. That doesn't mean they will work at scale. But having them fail small doesn't prove or disprove anything.
So you come up with a federated database model for your company with 30 employees, and find yourself in dev hell and wasting resources on an expansion that could have been solved with a slightly larger monolith. That means you chose the wrong tool for the local job. It doesn't mean the other tool couldn't be effective for a larger job.
Are the results that bad? Or are the results exactly the same but more visible (i.e. homeless addicts are not just being hidden below the concrete of highway interexchange instead of being able to live in the city center)?
I grew up in Los Angeles in the 80s, a time and place when homelessness was rampant, but your typical homeless person was a slow-to-move 50 year old wino, not a psychotic 20 year old on fentanyl and meth. Leaving aside the difference in the drugs, I think it's worse because: We do have, and have had a lot of people living in underpasses in Portland for the last 30 years. Most of those people are unfortunate locals who fell through the cracks, not the new crop who just showed up from Florida. Underpasses are full, and have been full, for decades. Many of us have tried to help. The increased visibility is a sign of two things: (1) overflow, and (2) much more dangerous chemicals.
"This content is not available in your country/region."
I could only read the title but from what I can come up these people would have overdosed, the only difference with public drug use is they die in front of everyone. What I am concerned is it should actually trigger a response towards helping addicts get access to safer drugs, and finding a way for them to stay functionnal and harmless in our society. Instead people want to try to hide the problem under the carpet but it will not work either.
> And remember - we did have a long experiment with legally prescribed opioids, and their widespread availability contributed to the current addiction crisis.
Well yeah, when you have criminally-encouraged over prescription of highly addictive, fairly dangerous drugs, you’re going to create an addiction crisis, but the actual deaths happening now are due to the unavailability of those same prescription drugs. Before the prescription crackdown and fentanyl prevalence, some people who got addicted turned to heroin, and some of those people ODed, but now nearly every addicted individual only has access to fentanyl-laced street opiates.
Methadone clinics are a decent example of how regulation helps this issue.
Sure, they can help, but wouldn't you say that's treating the symptoms rather than the disease?
>> the actual deaths happening now are due to the unavailability of those same prescription drugs
But you just said the initial reason was "criminally-encouraged over prescription". How do you not trace the deaths now all the way back to that? The thing about opioids is that you develop tolerance. I guess if those people were still getting higher and higher prescribed doses, they would never need to dip into illegal markets where their drugs might be contaminated with fentanyl. But it's hard for me to cut off the search for a root cause of deaths at this latest unavailability. The root cause is the over-prescription in the first place.
Stigmatization serves a role. I'm a smoker - but I know anti-smokers will agree with me, that stigmatizing my behavior prevents more people from starting to do something terrible to their health.
And if that's true, then legalization would be a root cause of the next wave of deaths. It's the addiction that kills; the erstwhile lack of good drugs is just the way it happens to kill some people.
What’s the disease? Is it the body’s down-regulation of opioid receptors? If so, then you’re right. But if it also includes the impact of an active opioid addiction on one’s lifestyle, methadone clinics help treat that, which in turn makes it much easier to address the former.
I think for practical purposes, it’s most helpful to ascribe it to a recent and controllable factor.
Otherwise, you could say that the “no medical benefit” scheduling of cannabis also contributed. Restricting medical pain management options to (with a few exceptions) just opioids when there was an unexplored (medically) class of less addictive, less destructive, physiologically safe medicine, definitely didn’t curb the opioid issue.
I agree that stigmatization is a good thing, but if all tobacco products got taken off shelves overnight, people wouldn’t stop smoking, they’d just have to buy on an unregulated (unsafe) market. Not saying that current regulation is perfect, but at least it can be controlled, which allows the market to move in (hopefully) the right way.
> The thing about opioids is that you develop tolerance.
This isn’t really unique to opioids, and I picture the legalization/regulation being discussed in this thread as more along the lines of existing cannabis programs, though obviously stricter in whatever necessary dimensions.
> It's the addiction that kills
Not necessarily, now at least. Lifestyle, maybe, but plenty of people now are overdosing on fentanyl from just experimenting, not even necessarily with opioids. And yes it is dumb to experiment with unknown street narcotics, but I’d be surprised if you took your first sip of alcohol when you were 21, and it’s the same principle of doing something that feels forbidden (and will make you feel good). And, if it were during prohibition, that sip could have had methanol in it. Now it can’t because of legalization and regulation.
I agree. Any one city that gets out in front will be overwhelmed with a national population of addicts flocking to it. Legalization has to happen nationally.
Imagine if prohibition had ended just in Chicago. Chicago would have been overrun with alcoholics.
> And remember - we did have a long experiment with legally prescribed opioids, and their widespread availability contributed to the current addiction crisis.
That is not what "legalized" means. It's still illegal to have opioids from anywhere other than your own prescription, which means that people without a prescription are basically on their own, have to get it through illegitimate means, and are all the way back to not knowing what they're getting.
If I wanted a supply of, say, LSD, I am not going to accept a doctor telling me how much I can have, when and where I can have it (as in current legalized psilocybin clinics). I want to buy some from the store, take it home, and enjoy it in my own, safe environment, with friends and people I can trust. Is that so hard to ask? It's not like it's any less safe than stuff like alcohol or tobacco, in fact there isn't even any known LD50 yet. The only risk is things being sold as LSD that aren't actually, which is basically the same scenario as the current opioid crisis.
> And remember - we did have a long experiment with legally prescribed opioids, and their widespread availability contributed to the current addiction crisis.
People couldn't just go to a store; trusted family advisors were overprescribing due to intentionally misleading advertising. The addiction crisis is what happens when insurance no longer covers the pills.
I'd say the addiction crisis started when people got addicted. The attendant economic and social crisis then got worse as legal pills became less available. But whether someone gets addicted by way of an overprescribing doctor or by way of picking a bottle of laudinum off the shelf at a liquor store, that person is probably going to become addicted. The question is whether that means they'll have to go looking for potentially dangerous street drugs.
I thought the drug laws in question were, or rather had to be, enacted at the state level. Why does the issue seem to be most pronounced in Portland but not as significant in the rest of Oregon?
What would be different if the experiment was done on a national scale? It seems to me that you would still see the worst impacts confined to a few major cities. I would hypothesize that other factors come into play like lax enforcement/penalties for petty crime, availability of free support services, and general sentiment/tolerance of degeneracy (though it sounds like that is changing.)
It's really, really bad in Eugene, Oregon. And Salem is a mess too. But the Portland metro is by an order of magnitude more populous. It's also desperately underfunded, and it's got a situation in which the populace mostly hates the police, and the police feel the same way back. (Which led to an amazing announcement during early Covid, when people were being assaulted and houses broken into all over the city):
This effect hasn't worn off. And the combination of lawlessness and drug availability in Portland has led to a massive influx of people from every other part of the country that has less tolerance for a combination of open drug use + antisocial behavior. I don't think support services even register as part of the draw. There are no cops here and drugs are everywhere, it's open season on people who own property (still), or just anyone walking down the street with $10 in his pocket.
It's a separate subject whether the Portland police are essentially allowing this because (a) they're pissed off at the DA who won't prosecute anyone they arrest and (b) they're pissed off at the denizens and (c) they can't even hire anyone from Portland itself, since Portlanders hate the police so much. All those are basically true, and they're holding the city hostage by not doing their job.
But this is why it doesn't work on a local level. If half the junkies in Idaho weren't robbing people here to buy fentanyl, they'd have to rob people in Boise. White America did not give a fuck about the effects of street drugs on their loved ones when only Black Americans were enduring the crack epidemic. They only started to care once it affected their neighbors and their kids. Shipping those all off to the one place in the country that allows reckless abuse and has no enforcement is a way of washing their hands of their problems and blaming "liberal cities" like ours.
Yes drugs should be legalized and regulated nationally just like Portugal did. But also we should absolutely unambiguously no excuses house and feed the homeless the end full stop we have plenty of money. It just needs to be redirected to doing something productive other than paying endless assemblies of bureaucrats competing with each other to virtue signal the loudest.
Because the reason people get hooked on to drugs is they have nothing better to do with their lives and they've run out of Hope but that runs straight into the effective altruist and effective acceleration as the gender here so it's not going to happen.
Portugal arrests and jails people for dealing drugs, as well as for public displays of disorder.[0]
>> Police take the person to a police station and weigh the drugs. If the weight exceeds amounts specified for personal use, then the person is charged and tried as a drug trafficker and can receive prison sentences of 1–14 years. Otherwise, the next day, the person appears at the Commission for the Dissuasion of Drug Addiction for an interview by a psychologist or social worker. Next comes an appearance before a three-person panel that will provide guidance about how to stop drug use.
This is the stick which accompanies the carrot. The trouble with decriminalization in Portland is that there's no stick. Sure - make drugs legal, I don't care what people do with their bodies! But make sure they don't become a menace.
Housing the homeless is really a separate topic. I'm all for making sure that no one in this country is ever homeless. The drug culture, however, in Portland is comprised mostly of able young men and women under the age of 30. They're willfully homeless because they've given up the idea of having a life, in favor of the drugs they're on.
You say there are no excuses about housing and feeding the homeless. But facts on the ground are: There is a highly visible group of people who are choosing to be homeless, robbing people and serving their own addiction, and (1) people who are actually homeless not by their own fault are the first victims of this, and (2) the general population here who are extremely caring are absolutely sick of it. The backlash is inevitable, and no amount of moralizing will change that.
I don't believe in "effective altruism" or "acceleration" - I think a 4-day work week or a universal basic income is a recipe for disaster. People need to feel a purpose. Hell, even dogs and horses need a purpose, or they get depressed. Accommodating their worst impulses is worse than doing nothing at all.
Heroin is very different from Tequila, so I don't think it's fair to compare them just because they are both "drugs".
Prior to fentanyl, what was the percentage of high functioning heroin addicts compared to people living on the street? I can't find any research on that question, and I'm somewhat skeptical that your friend is the norm.
> Heroin is very different from Tequila, so I don't think it's fair to compare them just because they are both "drugs".
Very true, alcohol is much worse by most metrics, both in terms of number of addicts, number of deaths/year [1][2] and general damage done to the body. [3][4]. (I'm not trying to be cynical, just stating facts.)
> Prior to fentanyl, what was the percentage of high functioning heroin addicts compared to people living on the street? I can't find any research on that question, and I'm somewhat skeptical that your friend is the norm.
There's no data on self-reported addiction, for obvious reasons, but there is data on overdoses: "Fatalities involving only heroin appear to form a minority of overdose occasions, the presence of other drugs (primarily central nervous system depressants such as alcohol and benzodiazepines) being commonly detected at autopsy." [5]
I've met good people addicted to heroin. They've been through more hell than the rest of us can ever understand, almost entirely because of those times when they couldn't access it. If I could press a button to forever ban them access to any opioid, I'd press that button; they'd get over it in a few months and thank me. But that's impossible. The second best option is to allow them access to a clean, low-cost, prescription of it for the rest of their life.
Those stats aren't per capita. That page says 902,000 Americans use heroin annual and 14,000 die. That is a 1.55% fatality rate. And that is strictly overdoses. Any death to which heroin contributed but isn't an overdose isn't counted.
141,000 Americans die from the effects of alcohol each year. That would include factors such as increased heart attacks, etc. It is not merely looking at deaths from delerium tremens or the like.
Nonetheless, 177 million Americans[1] use alcohol annually. That is a 0.079% fatality rate.
So, the [direct + indirect] deaths from alcohol are 19.6x smaller per user than the direct deaths from heroin. I would wager if you included indirect effects, the difference is 100x or more against heroin.
The per capita number only matter if you believe that legalization would increase the number of heroin addicts. There is no reason to believe that, and any legalization effort should be done to prevent that as much as possible.
I know drug consumption usually go up when legalized, but a regulated heroin market would ideally be under very strict regulation, much stricter then alcohol or weed. It would most likely involve getting a prescription and buying it at a pharmacy. There would probably be strict no advertising and no branding. As well as a strict non-profit requirements for makers and distributes.
>I've met good people addicted to heroin. They've been through more hell than the rest of us can ever understand, almost entirely because of those times when they couldn't access it. If I could press a button to forever ban them access to any opioid, I'd press that button; they'd get over it in a few months and thank me. But that's impossible. The second best option is to allow them access to a clean, low-cost, prescription of it for the rest of their life.
How can you say both of these things? People who try to act like alcohol is worse than Heroin do more harm than good, but you even seem to understand it is worse with your last paragraph.
Of the hundreds of millions of users of alcohol, surely we don't even have to look up a study to find that the percentage of people who "been through more hell than the rest of us can ever understand, almost entirely because of those times when they couldn't access it" is less than Heroin.
> The second best option is to allow them access to a clean, low-cost, prescription of it for the rest of their life
Meaning after a few times of someone finding black market heroin, they can prove addiction - and then get it for low cost on the taxpayers dime, indefinitely and forever. Even better, the heroin addicts with less restraint about only using their supply will know who to beat and steal from to get more.
I'm not saying addicts are inherently bad people. I am saying heroin users are unlikely to have the self-control to stick to their prescribed amount, every day for the rest of their lives. We all have bad days and need something to make them suck less.
> Very true, alcohol is much worse by most metrics, both in terms of number of addicts, number of deaths/year [1][2] and general damage done to the body. [3][4]. (I'm not trying to be cynical, just stating facts.)
That heroin is illegal and prosecuted is going to massively skew the number of people who are likely ever try it or could develop a safe habit around it.
How valid the comparison is between Tequila and Heroine is irrelevant. What is relevant here is harm reduction for the addict. In both cases legalization result in harm reduction. Yes legalized and regulated heroine is still very harmful for an addict, but unregulated and illegal heroine has the potential to be way more harmful then a regulated legal one, potentially deadly. The same logic also applies to illegal and unregulated gin (just to a lesser extent).
And legalized heroin has the potential to create more addicts who would be subjected to the harm of addiction, and their friends and families would be subjected to the harms of seeing their loved ones addicted.
Your argument is tired. There is no such thing as a functional heroin addict. Most don't quit after a 20 year on and off relationship with it. They die and usually cause mayhem in the process - to society, their loved ones, the healthcare system, law enforcement, etc. I'm dealing with a very serious addict in my life right now and how "clean" the drug is makes no difference. They steal and lie non-stop. They cause massive amounts of anxiety and stress to people who love them. They disappear for weeks on end and every time you get a text or call, you think its someone saying they're dead. They treat you like a monster if you don't want to engage with their BS anymore. They claim to want "help" but when push comes to shove, they want to be enabled. After many years of this, you realize that some people simply want to live this lifestyle. The war on drugs was extreme in one direction, and your suggestion, is in the other.
> There is no such thing as a functional heroin addict
I don't have time to really get into the weeds for this discussion, but I can at least do the weaker refutation of this very general claim by way of a counterexample. Professor Carl Hart is one such example that came up in a seminar on substance use disorder during my undergraduate program in integrative neuroscience. [0]
I'm sorry you're dealing with someone who does not have a functional, productive relationship with a substance. What you're describing is true of a lot of things though, not just "hardcore" drugs. If you've lived with or know a gambling/sex addict you know exactly what I'm referring to. How these things hijack our neurology is really complex and it unfortunately boils down to more than "avoid these high risk things". Not sure if you have access to academic journals, but public libraries often can provide access to reputable research on substance use disorder in humans, as well as actual experimentation in animal models such as mice. There are a lot of people whose incentives align with yours for tackling this problem, and the solutions they propose are worth a shot. Clearly the war on drugs has not worked and we agree on that at least. What are we going to try next?
There is a critical difference between heroin, and heroin laced with uknown amounts of a fentanyl analog. The adulterated stuff kills even first time people experimenting with drugs.
Joe Perry & Steven Tyler (Aerosmith's "Toxic Twins") are still here. Clapton lives. So does Led Zeppelin's Jimmy Page.
All those guys would be long dead if there had been fentanyl lacing back in the 70's.
That's a little bit like the football-betting-sequence fallacy -- if I send a thousand letters out, with 50% predicting team A wins and 50% predicting team B wins, and do so successively for 10 weeks, at the end of the 10 weeks a small number of people will have gotten my letters "correctly predicting" the football outcome 10 times in a row. But of course, I didn't know anything about the games.
You can name a few of the richest people ever to do drugs who haven't died -- but how many have? And how many people without resources to pull them back from consequences of an overdose have died versus have used long-term and lived?
(For the record, I think I'm not really on the other side of the larger argument here, but I don't think your argument here is a convincing one.)
I may be wrong, but I thought we were discussing how many regularly-heroin-using people die early, not how many people try heroin once and subsequently become addicted.
Oh I interpreted the thread to be talking about heroine use in general. Could go either way I guess, there's a lot of comments at this point.
Though ime most users don't die. Which is why I support legalization. What I watched happened with my drug phase and others, it was mostly a phase and people just needed time, support and patience to get through to other side. There might be extreme examples ruining it for all, but I saw a lot of people stop after some serious use.
Unfortunately some die because of the policy we have like a few people I knew personally. All uncessarry.
> I'm dealing with a very serious addict in my life right now and how "clean" the drug is makes no difference. They steal and lie non-stop. They cause massive amounts of anxiety and stress to people who love them.
There are plenty of people who fit this description, and heroin isn't the root cause of their problem. It's just a symptom of a deeper problem. For every person like this, there's someone who dabbles with heroin/etc and still goes to work every day and has a healthy relationship with their family.
The source is my personal experience dealing with individuals involved in addiction. No amount of "experts" claiming we need to legalize hardcore drugs is going to change my opinion, thats for sure.
I'll hear the research, but it won't change my mind. I just want them to stop because its killing them. They aren't young. Every time they use is a major rolling of the dice. Many an ER visits have occurred. I don't really care if the drug is legal or not. Same would go with alcohol if that was the poison of choice. And yes, it is an emotional place to make an argument, because its personal, not some stranger you read about on the 4th page of the Tuesday paper OD'ing (which probably isn't even news anymore).
This is the fallacy of scientism. You don't have to do a peer-reviewed research paper to see the truth. Firsthand observation is still the primary way we know the truth. Research depends on observations, not the other way around.
> According to her, a lot of overdoses are due to almost no "heroin" actually being heroin, rather its fentanyl cut to varying degrees of strength.
Anyone knows that who followed current events during the opiod epidemic and read some Wikipedia on it.
And actually, it's not just fentanyl, but fentanyl-like compounds that, even if controlled to the same concentration, have varying degrees of strength.
"The structural variations among fentanyl-related substances can impart profound pharmacological differences between these drugs, especially with respect to potency and efficacy"
You don't know which fentanyl analog is in that heroin dose, and how much of it.
It’s a lot, but not a crazy amount. Chemistry scales combinatorically, so if you find a single nitrogen to put a little e.g. acidic group on you’ve got yourself a couple of hundred possible substituents, many of which may have a similar effect on the body.
In Portland and generally agree. And the people saying alcohol isn’t comparable should look at the stats - death from alcohol is a huge, but normalized and largely invisible issue.
Legalizing will reduce violence, reduce accidental overdoses and poisonings, and give the state regular contact points with users (to hopefully funnel them to assistance). Safe use sites would go some way towards hiding the problem if managed well.
Legalizing will not solve the problem of addiction. It will not solve overdoses (many overdoses are not caused by surprise differences in dose; people often overdose after relapse, or deliberately seek out stronger than usual supplies).
We have to accept that legalizing will solve some problems, but will likely keep killing at least some people.
Housing is another solution to hiding the problem. But housing just hides the drug use problem. It will probably also kill people - people who overdose on the sidewalk are more likely to be narcaned than people using alone.
Free housing + free drugs for opiate addicts would go a long ways towards solving the issue for everyone who isn’t an opiate addict, and probably cheaper than imprisoning or healing addicts.
I’d prefer treatment but the local officials have already proven incapable of that. The county is already very good at handing out needles, smoking kits, and boofing literature, so handing out fetty should be a very light lift administratively.
Housing plus making it legal to use in shared spaces is a good start. E.g some shelters in Seattle have a covered/seating location outside, in sight of the front desk, and residents are encouraged to use there instead of in their rooms so that they can be seen and cared for.
You should watch what is happening in British Colombia, Canada right now.
They have decriminalized possessing less than 2.5 grams of
- Opioids (such as heroin, morphine, and fentanyl)
- Crack and powder cocaine
- Methamphetamine (Meth)
- MDMA (Ecstasy)
It's a trial basis from Jan 31 2023 until Jan 31 2026, so we should get a good amount of data and evidence to see if this leads to better or worse outcomes for people and society as a whole.
Well a lot of reasons people turns to drugs in the USA is because doctors and pharmacists give them strong painkillers way to easily to begin with.
For instance oxycodone and many powerful painkillers are afaik not available as tablets in many countries, only given through IV's and injections in hospitals for serious enough conditions, or under serious constraints like palliative treatments. If you are recovering from an injury and are allowed to leave hospital, all what you should be allowed to take is paracetamol or ibuprofen for a limited time and that's it.
We shouldn't have to enter war against pain. Pain is not necessarily harmful, they are useful signals that can let people assess their recovery and physical state. Trying to avoid pain is trying to avoid reality. It is deemed to fail.
Nobody should take opiods painkillers for minor injuries and ailments, it just doesn't make sense.
to me it seems like you need a strongly enforced social norm that doesn't include all the worst bits of drug abuse (crime, public defecation, graffiti, other public nuisance/problem things) regardless of whether you legalize and regulate or make it extremely illegal. My preference would be for legalize and regulate and social order enforcement because it would cause a lot less misery but I don't see how this works if people are going to be allowed to leave needles everywhere, routinely vandalize and break into cars and buildings, etc. We should have never gotten rid of the enforcement aspect for the bad behavior when we we getting rid of the criminal aspect of the drug use.
Decriminalizing test kits that let you identify the presence of fentanyl in other drugs would be a great start - but those are instead illegal and classified as “paraphernalia”.
That law was already fixed in Portland (and the rest of Oregon). Test strips are still classified as paraphernalia, but there’s a carve out making them legal now.
The only time I've ever been on fentanyl was in a hospital, and the nurse described it to me as the "Michael Jackson drug". I actually enjoyed the gallows humor of the nurses, as I felt it brought down the tension in an otherwise serious environment.
Its very different, in that I can walk in off the street and buy alcohol. As far as I know, there is noplace I can legally buy fentanyl without a prescription.
Indeed! I think the point is that "legalization" and "regulation" can take pretty different forms, not necessarily the for of the substance being generally available.
Not all addictions are the same. Nicotine is extremely addictive but you will never have a total breakdown of your life which is essentially a guarantee with heroin, whether you get it legally or not. There is no such thing as a functional heroin addict (outside of extremely rare cases). Even if they received very pure heroin for free they would be dead within the next decade or two.
> She decided to get clean only when she had a close brush with death thanks to fentanyl.
Under your system she would've never decided to get clean then? Also dying much earlier than she would've had to and probably adding a bunch of burden to the health system. People chastice cigarete smokers for much less.
I'm genuinely curious why you think she should get clean. I fail to see what sort of burden she'd put on the health care system. AFAIK, long term opoid use is less dangerous than cigarette smoking, and the highest danger is of falls.
(https://fpm.ac.uk/opioids-aware-clinical-use-opioids/long-te...)
That's when the user knows what they're taking..
Because the few people I knew in real life that did it died and all the people I know that didn't do it are still alive. One of them was a single mom and left a 12 year old alone.
If you ask that guy who is today an adult, I can tell you he doesn't have second thoughts and would probably punch you in the face if you told him that heroine had no bad effects.
When it comes to dangerous drugs, nothing "works". We have to choose the least-bad policies.
A lot of people, including me, thought the war on drugs was pretty much the worst policy position. Now I'm seeing that there are (perhaps) worse policies. We need to be quantitative and nuanced, not speak in sweeping characterizations.
I think the actual problem is people can’t seem to just use enough to stay functional. Given the legal opportunity to purchase heroin, most people will absolutely overdo it.
There are people with substance abuse problems and addictive behaviour that goes way beyond any particular drug. It's often a condition that needs treatment.
"Given the legal opportunity to purchase X, some people will absolutely overdo it." This goes for some ridiculous things like Pokemon cards or collectible shoes as well. Should we ban those?
I think this is a good point. I've never been high on opiates, but I've heard it described as "an orgasm over your whole body". How are you going to allow everyone that option and expect anyone _not_ to just check-out of reality, reduce all their other living expenses, and just live to get high?
When Bayer created heroin and brought it to market in the late 19th century, is this what happened? I don't know for sure, but I've never read about that having been a problem when it was available over the counter from a reputable brand.
Surely some people became addicted to it (not that different from alcohol, nicotine, fatty sweets, or various prescription drugs), but it didn't destroy society.
The 21st century opioid crisis that’s being unraveled right now with the Sacklers and Purdue pharma would tell a different story. Of course it wasn’t over the counter.
One thing that’s missing in a lot of these discussions is strength and education. What strength was the Bayer drugs vs things available today, and how well informed was the average person that this was a product they could access recreationally.
> 2) What gives you the right to tell people to not do something pleasurable?
this is a really good question and I had to think about it a lot. I think if all other variables were equal, I would have no problem with people doing something pleasurable. In contrast to say, a strict religious fanatic who vociferously preaches against wanking or rock music.
However, I think we can both agree that opiate withdrawals are not pleasurable, nor is the change in an addict's personality when they start putting drugs high and above everything else in life. I think we can also agree that there is a continuity between "pleasurable" and "not pleasurable", and opiates give the user so much pleasure that pales in comparison to anything else. Enough to substantially change their personality, for at least the ones who are susceptible to it (as you pointed out, not everyone becomes instantly addicted). So that's where my case for prohibition comes from.
There's the whole "Rat Park Experiment" that I think deserves a mention. Whether the experiment itself has been debunked (I can't remember) is irrelevant. I think it's worth asking the same question of Portland: is there opportunity here? Can someone get an entry-level job and be happy? If not, why? This is a liberal, government-micromanaged city. Why are things so dismal that people are choosing not to work? (If you wonder why I'm suddenly making this a partisan issue, it's because (1) the government has their hands on all the controls so obviously they could fix things, and (2) people are suggesting regulation of dope, so if the gov can't regulate a simple local economy, why would we think they can suddenly be the new dope dealer?). Why don't they double down on their taxes and fees and manipulate the city such that an entry-level, full-time employee at Dollar General or Taco Bell
can rent his own apartment, raise a family with their spouse, have healthcare, own a car, have a vacation, and a 401k? The reason is because the far left doesn't actually represent the people. They'd rather distract everyone with gender pronouns and anti-racism red-herrings while their own citizens check-out of the late-stage capitalist hellscape their government created for them.
> for at least the ones who are susceptible to it (as you pointed out, not everyone becomes instantly addicted).
And, see, this is the crux. You are banning something for everyone even though only a smaller number seem to be susceptible.
The problem is that this applies to a whole bunch of things: porn, gambling, alcohol, etc. Why heroin and not alcohol which, in many ways, is much worse than heroin?
I agree that the base problem is that life sucks for many people, and we need to fix that. However, that problem is going to be slow in fixing, and we need interim, probably sub-optimal solutions in the meantime.
Wrapping this topic up, I realized something very relevant to PDX I wish I had mentioned originally: the fucking weather. Constantly living under gloomy skies and rain has long-term affects on mental health. I would love to see a graph - controlled for all other variables - of opiate abuse vs avg sunshine.
I had some opium tea when I was in Egypt and let me tell you, it was so cheap, and it felt so good that I would absolutely do it every day if I had the chance.
One or way or another, none of us are getting out of this alive. Not sure where the religious conviction we must save all souls comes from or has any value.
Even if one ascribes to this nihilist POV, it isn't an answer. We see the negative effects on communities, families, and people around addicts. Even if you don't care that people are destroying themselves, when they take out the surrounding area it is a problem we share.
Yeah and humans have seen it for centuries and failed to stop it
Who is to say any progress we make won’t be undid by another pandemic we cannot predict, or some nutter launching the nukes
We have political agents hell bent on war and subjugating undesirables, rather than pushback against them let’s focus on some people who don’t want to live?
Why not ask Oceangate how the war against physics is going. It will always win and erode any social progress we think we made
I don't think that's the goal. The goal is to attempt to reduce harm of something that removes freedom. Try asking a drug addict if they want to keep taking drugs. I suspect you'll be surprised at the answer. Stopping drugs would be like achieving abstinence as the primary form of contraceptive. Both are impossible because they work on the same soup of chemicals, but one has evolved with some form of continuation in mind. The other is a direct injection, orders of magnitude stronger, that just fucks up all the machinery of the brain.
Well we all better stop flying and driving if we’re set out to reduce human suffering.
But hey the toxic mess we leave for the future to suffer through won’t be our problem so shrug
This is the most disingenuous and self righteous thread I’ve ever been involved with. Traditional catechisms and stubbornness will win out against physical reality. RBG fans I guess.
> Well we all better stop flying and driving if we’re set out to reduce human suffering.
If the car has doors your can't unlock, and the plane forced you to fly or you die from withdrawals, both of which follow you around you're whole life honking their horns begging you to get back in, even if you do manage to stop, then your analogy could make sense.
Do you have any experience with addiction?
Having experience with the pain it causes, and not liking the idea of more families being ripped apart/abandoned due to a few milligrams, isn't self righteous as much as sympathetic. I think there's some compromise between complete freedom and "this thing completely removes freedom, so maybe it's a bad idea".
Both times my family wished for euthanization options rather than watch family rot
But patronizing high minds said no; in our society they must suffer until they die
Americans have spent so much time huffing toxic positivity whippets.
All the high minded worship and praise of the economy, tech, feeding notions of American exceptionalism has led us to believe we really can do anything
But we all can’t live forever and have no guarantee the future won’t just screw it all up again
Physics rules, not human philosophy. Reality itself is the root of our misery. There’s no eradicating suffering without eliminating humans; we cannot violate physics and the physical word fosters suffering. Erosion and entropy of all structure.
This forum is sounding way too religious. Thought it was science nerdy when I signed up but it’s just typical “America great!”
You don’t have to watch others rot just because they are alive - you are choosing to stay alive to do so, and can change your mind at any time without imposing on anyone else’s rights.
You seem to argue for ultimate freedom for others as some abstract goal while ignoring how you take from others by existing
You generate waste and increase costs by reducing resources for others
You get in the way of others free agency due to management of your mess
Just by existing you impose yourself on others. Stop pretending physical reality doesn’t apply to you an vacuous political poetry about rights waves away externalized burdens your elder self will foist on the next generation to preserve your perception of rights at the cost of them to perceive what they value for themselves
I’ve been in pain from surgery multiple times, it’s awful. You’d leave dying people in pain to suffer through it versus violate spoken tradition of the dead. Our own experiences mean nothing to you, just adherence to philosophy.
> Well we all better stop flying and driving if we’re set out to reduce human suffering.
No, we're better off regulating safety, setting increasingly strict pollution and mileage standards, and continuing to update laws to eliminate behaviors such as DUI or texting to continue to have those freedoms while limiting externalities.
Humans have absolutely stopped it in places with draconian laws. The use of heroin in Singapore, other parts of south east Asia and parts of the Middle East is essentially zero because they give traffickers the death penalty and jail the few users for a very long time. If you can truly secure your borders and you can’t grow poppy in your country there will be no heroin.
By that logic, we should remove any suicide prevention or other mental health support as well. Allowing, even encouraging, people to suffer when the very nature of their disease destroys their agency should be repugnant to everyone. Religion is a red herring here.
You won’t be saying the same thing when it’s your kid that’s “out of the way”. Making heroin easily accessible means someone that does it a handful of times is truly hooked. Your life is essentially a struggle from that point out.
> you could have "functional addicts" that cause little or no societal harm
Yeah, I don't know about that – plenty of "functional alcoholics" around, sure, but also plenty of not-so-functional alcoholics around, as well as the wife-and-kid-beater alcoholics.
Heroin is not alcohol and doesn't induce aggression in the same way, but it's also a lot more addictive, and especially at low wages getting your daily dose can be a challenge – so "junkies" will not be eliminated outright. I consider it an open question whether they will be reduced – it's very possible (perhaps even plausible), but I certainly wouldn't consider it a forgone conclusion.
> My friend's relative was a functional addict on and off for 20 years.
Dick van Dyke was a chain-smoker until well in to his 70s and he's currently doing well at the age of 97.
These are the sort of things where you really need to look at overall effects and statistics, rather than individual cases.
Hard disagree. Decriminalizing drugs has skyrocketed schizophrenia and homelessness. Drugs should only be legalized in specific, medically necessary situations. Recreational use should be stigmatized and dealers should be handled as Duterte advocated.
The crime of the War on Drugs was that we had double standards, not that we had a War on Drugs.
This sounds like you're advocating a stance where anyone who shows up to a music festival with a bag of weed for their friends should be shot. That's a rather extreme position that seems much worse than the potential harms from the drug itself. Can you go into more detail?
Your argument is a strawman because the people on the streets are not there because they are addicted to weed. China has learnt this the hard way when opium almost destroyed their nation and lead to a century of humiliation, I don't see why the US wants or should repeat the same mistake.
> Recreational use should be stigmatized and dealers should be handled as Duterte advocated.
Are you arguing that no recreational or unsanctioned use of any banned substance should be tolerated?
For context:
- MDMA shows promise treating PTSD. Currently Schedule 1 - total ban
- Psilocybin and other psychedelics reportedly beneficial for end-of-life care, notably in the case of cancer patients. Currently Schedule 1 - total ban
- Marijuana is also still Schedule 1 at the federal level
Schedule 1 is normally also a ban on research but luckily we've seen some improvement in this area. Why? Because the illegal market still exists, and people __do__ discover genuine medical uses for currently banned substances
"Decriminalizing drugs caused the increase in homelessness" seems like a really strong assertion to make considering all the other things that have happened in this same time period.
GP’s coded language (“should be handled as Duterte advocated”) is advocating for summary executions for those committing nonviolent, victimless offenses, carried out between consenting adults.
This is not sensible, nor does it even respect basic human dignity. To elevate it or advocate for it is evil.
I mean, I remember how things were before fentanyl came around (as an outside observer, not as a user) and heroin was a horrible, life-destroying drug addiction back then as well. And I think it was and is convincingly argued that it is much more addictive than alcohol.
Opioids keep the top spot of addictiveness. The second place firmly belongs to nicotine. It's way more addictive than. say, cocaine.
Why not ban nicotine, by the same logic as heroin?
The key difference is that nicotine is a mere stimulant, while heroin alters your perception, it literally changes the way you see good and bad, because it's the ultimate feel-good substance. I have zero qualms about legalizing LSD, psilocybin, ketamine, etc. Likely even cocaine. But legalization of opioids would require a lot of preliminary work, to somehow allow the addicts function in a socially compatible way when badly wanting a dose.
It must be noted that a physiological addiction to opiates does not form from a first dose, and not even from the first ten doses, so infrequent recreational use is possible, given a right psychological preparation. This is similar to alcohol.
Because smokers can hold jobs and are productive members of society. Unlike meth and heroin, nicotine does not make people attack other people, does not make people miss work, does not make people irresponsible.
It's my understanding that street drugs like Heroin were frequently cut to varying, sometimes unpredictable degrees prior to the introduction of fentanyl. So you could still easily misjudge your dose and OD due to the lack of any kind of consistency. Presumably this would also make it even harder to try to taper off the addiction gradually.
Surely we can solve this inability to regulate with even more regulation. Just one more regulation bro... trust me bro. Just a bit more power and money to the government bro. It's all gonna be great! Just give a little bit more in taxes, bro. It's going to be a utopia, you'll see!
Has there been any research into how to measure potency (of fentanyl) and cut it properly? Maybe we could keep the government out of it, and instead give information and supplies to measure the potency correctly? I've heard that one way OD's happen is the substance is not homogeneous, so they can consume half the bag fine, then one dose is super-charged and puts them into OD (because fent can be up to thousands of times stronger than a morphine equivalent). Maybe teach addicts how to dissolve their dope in a liquid and reconstitute it so it's homogeneous in potency? Addicts can be extremely cunning with their drive to get money for dope, so I dont see why they can't use that will power to their advantage. I wonder if they could also get a primitive CPAP machine to keep them breathing if they do OD? IIRC death comes from lack of breathing, not acute toxicity or anything.
Your post is a prime example of the classic engineering approach of efficiently solutioning the immediate technical problem without solving the actual root cause because it's too complex or messy. I mean, CPAP machines for drug addicts because street fentanyl is too potent and inconsistent?
> Has there been any research into how to measure potency (of fentanyl) and cut it properly?
Yes?
When you're having surgery and the anesthesiologist uses a mixture of fentanyl and propofol, such that you safely wake up, they aren't just guessing.
One problem is that what's out on the street isn't necessarily fentanyl in the first place, but any one of hundreds of fentanyl analogs, which all vary in potency. You have no idea whether what you're measuring is fentanyl.
If you "give information and supplies", how do you keep the government out of it? At the very least, the government has to decriminalize what you're doing. Then what; someone has to pay for it. What about liability? If someone dies and it turns out you gave them the supplies, you're liable.
The anesthesiologist doesn't pull out a test strip and check (measure) the purity of the fent they pump the patient with, so you are incorrect. I'm suggesting providing addicts with the tools to measure their own dope's potency so they can avoid OD.
Are many of them going to care? I imagine testing would be useful for pill-takers at festivals, but something that is a daily addiction dominating life seems a different case.
> I imagine testing would be useful for pill-takers at festivals
And many people bring test kits to festivals and raves and clubs and bars already. So this is 100% a proven solution for light recreational party usage.
I agree with skepticism about addicts (especially someone living on the street, etc)
You are talking about harm mitigation, and when options are made available there is very enthusiastic take-up from even street addicts. If you create a safe injection center people will come and use there, so there is medical care. If you distribute drug test kits they will use them. If you offer clean needles they will use them.
We don’t offer them in most places because (a) nobody wants a safe drug use center near them because drug users will come to it and (b) a really despicable and unfortunately common attitude that harm reduction is bad because it keeps drug users alive.
Considering that alcohol is, by far, the most dangerous drug and it's completely legal, I think there's something to be said for your point.
I gotta say though, it's sort of complicated when you're talking about legalizing things that are already legal as prescription drugs (like opiates and benzos). Alcohol is different because it doesn't really have any medical use outside of disinfecting things (it's fairly terrible as an anesthetic or as a tranquilizer), but there's something kind of weird about having former prescription drugs just be legal over the counter. How many people might bypass their doctor and start using strong opiates for pain that might not need it and end up in a bad spot?
I don't think you can go so far as like w/ alcohol where you just show an ID and buy whatever you want, but it does seem like there needs to be some way to ensure the product is safe. Maybe a compromise might be some sort of free testing kits, or something like narcan on hand in a safe space.
Sydney and a large number of other cities about the globe have injecting centres and decades of public reporting on crime, death, etc. in the vicinty of such centres.
They're an interesting middle ground - dedicated medical centres that allow users to inject with clean needles, test drugs for purity, and have narcan and crash carts available for complications.
You arrive, show ID, inject your drugs, chill for 20 minutes or so, and then leave.
The long term results are no increase in crime, reduction in death from overdose and dirty needle infections, HIV, etc, improvement in drug quality (now that the users can readily test quality there's more discernment in the market and a reduction in blatant over cutting bad mixes into the illegal supply).
Public drug use | shooting up is still illegal - this is reduced as there is a centre to go to, etc.
One other benefit is being able to easily and routinely survey drug users and adapt public policy to changing situations on the ground, early detection of changes in illegal supply, etc.
They cost money to run, they save money on reduction in public funds spent on the problems they reduce.
It sounds like the primary benefit is reduced ODs for the drug addicts. Does it do anything to benefit productive members of society? Do libraries go back to to being libraries? Do parks once again serve as a place to relax and recreate with family or friends? Does it clean the sidewalk and make them disability-accessible again? Does it stop the property crimes that are committed to buy drugs?
It's an absurd level of misdirected empathy to redirect such massive parts of the society's collective effort to benefit a few people who had some amount of agency in ruining their own lives.
How it worked in Amsterdam in the 90ies is that the government also started to provide the drugs (Methadon) for the heroin addicts… The addicts were responsible for lots of petty crime in order to fund their habit (stealing car radios, muggings) and this decreased. So this helped make the city a more liveable place, not just for addicts.
Alcohol is only more dangerous because so many more people use alcohol over hard drugs. When you look at the per capita rate, hard drugs kill more people.
Alcohol withdrawal is potentially much more dangerous than withdrawal from most other substances. Withdrawal is always miserable of course, but seizures, blood pressure, elevated pulse, hallucinations, etc. can be fatal in the case of alcohol without treatment. You also have to consider that the first product that alcohol is metabolized into, acetaldehyde, is extremely toxic, attacking multiple organs and also causing lovely things like dna damage.
The thing about most (not all) illegal drugs is most of them have some sort of positive usage outside of abuse. Opiates can be effective for pain, benzodiazepines for acute anxiety, stimulants for ADHD or narcolepsy, etc. Alcohol despite its useful social role (I'm not telling you all to be tee-totallers) is basically just a poison that has a small handful of short term nice effects and a long tail of effects that are a disaster.
Anyway, I question the math in the other post about heroin because it's essentially ignoring the dangers of a bad supply. People do safely take other (prescribed) opiates safely. I imagine that alcohol would be a lot more dangerous if we were back in prohibition times with like bath tub gin.
I have a close friend whose relative is a heroin addict. According to her, a lot of overdoses are due to almost no "heroin" actually being heroin, rather its fentanyl cut to varying degrees of strength. Not knowing what you're taking, and not knowing how strong it is, can lead to a lot of problems. If people knew what they were getting, and it was legal, you could have "functional addicts" that cause little or no societal harm. My friend's relative was a functional addict on and off for 20 years. She held down a job, paid rent, paid taxes, etc. She decided to get clean only when she had a close brush with death thanks to fentanyl.
Think of it this way: My drug of choice is tequila. When I buy a bottle of 80 proof tequila, I buy it from a state licensed store. I have confidence that its 40% alcohol, and that its safe to drink. It is sold by a reputable company with a brand reputation. What we have today with illegal or "decriminalized" drugs is the equivalent of people dying from drinking bathtub gin during prohibition.