So What Should We Do About Drug Addicts?

[MarathonRunner]

So I've had patients who are substance users (callling them drug addicts is not the preferred term at all). What to do: if people are in pain provide them adquate pain relief, provide a safe supply, offer programs like methadone treatment, offer counselling, offer in-patient treatment. Above all, treat people with humanity and respect.

Other things harder to implement: provide an adequate social safety net. Reduce racism. In Canada, implement the Calls to Action of the Truth and Reconciliation Commission. Decriminalize drugs.

[dismalist]

So I've had patients who are substance users (callling them drug addicts is not the preferred term at all). What to do: if people are in pain provide them adquate pain relief, provide a safe supply, offer programs like methadone treatment, offer counselling, offer in-patient treatment. Above all, treat people with humanity and respect.

Other things harder to implement: provide an adequate social safety net. Reduce racism. In Canada, implement the Calls to Action of the Truth and Reconciliation Commission. Decriminalize drugs.

Beware weasel words -- legalize drugs, do not merely decriminalize. The latter means that users don't face imprisonment or fines when found with small quantities of "contraband". That increases demand, raising price, but provides no incentive for producers to sell only uncontaminated product. One gets more dangerous stuff.

What's wanted is to call forth a safe supply of drugs. As I said upthread, doctors cannot prescribe opioids in the quantity addicts need. Here, policy is having the opposite effect of that intended.



 

[marshwiggle]

Can someone enjoy a glass of wine, a cigarette, and a quick shot of heroin after work to relax, without waking up in the gutter, chainsmoking, or comatose from an OD?

I'm guessing the people who have that much control over their usage don't need harm reduction facilities; they're able to choose what and when they consume.

So I've had patients who are substance users (callling them drug addicts is not the preferred term at all). What to do: if people are in pain provide them adquate pain relief, provide a safe supply, offer programs like methadone treatment, offer counselling, offer in-patient treatment. Above all, treat people with humanity and respect.

For people with cancer, there are two options: treatment and palliative care. When a person's death is imminent and unavoidable, palliative care is the compassionate choice as it allows them to live their remaining time with minimal pain. However, if their cancer is treatable, and possibly even curable, then offering them palliative care is irresponsible if not downright cruel.  Their best life will be lived if they are cured, rather than just being pain-free for their remaining days. In fact, treatment, be it surgery, chemo, or radiation, is likely to be very uncomfortable, or even painful, in the short term, but with the promise of a vastly better life in the long run.

It's this sense that "offering" treatment to drug users is almost an afterthought that makes me skeptical. It is, by far, the best chance for improved life that most drug users have, but not being up front about this seems as irresponsible as a doctor not telling a patient that their cancer could be treated.

[ciao_yall]

Can someone enjoy a glass of wine, a cigarette, and a quick shot of heroin after work to relax, without waking up in the gutter, chainsmoking, or comatose from an OD?

I'm guessing the people who have that much control over their usage don't need harm reduction facilities; they're able to choose what and when they consume.

The point is that by having controlled substances with structure around them, there is reduced risk of addiction and abuse.

And, for those who slide into abuse, there is a graceful path off besides "cold turkey" and the related distress.

[kaysixteen]

People seem to be deliberately misinterpreting what I have been saying.

I did not say 'lock 'em up'... I did say, 'give em a carrot-and-stick choice between rehab and jail.'   I meant it.   It seems difficult to understand how a bunch of academics could not understand how it is not showing 'compassion' to an addict, by allowing him to remain a drug user.  Really, it does.

Now as to my own heatlh, I suppose there are some things I could be doing that I have not been doing, though I have numerous docs, meds, etc., but one thing I certainly could never do is stop being 55 in favor of again becoming 30.  My own apt bldg is a 50+ unit, and at 55 I am probably 10+ years younger than the average resident here.  Many of these people would have *no hope whatsoever* of defending themselves against hopheads who attempted to commit crimes against them, and would undoubtedly feel great pressure to donate money to aggressive doper panhandlers, etc.  Such indivuduals, therefore, should simply not be allowed to congregate around the building.   It is not being uncompassionate to these folks to say this, largely because it is being compassionate to the elderly folks who live here, to provide them with a safe environment here.   Put simply, sometimes one cannot be 'compassionate' to two people whose interests and behaviors simply contradict each other.

[Kron3007]

Can someone enjoy a glass of wine, a cigarette, and a quick shot of heroin after work to relax, without waking up in the gutter, chainsmoking, or comatose from an OD?

I'm guessing the people who have that much control over their usage don't need harm reduction facilities; they're able to choose what and when they consume.

So I've had patients who are substance users (callling them drug addicts is not the preferred term at all). What to do: if people are in pain provide them adquate pain relief, provide a safe supply, offer programs like methadone treatment, offer counselling, offer in-patient treatment. Above all, treat people with humanity and respect.

For people with cancer, there are two options: treatment and palliative care. When a person's death is imminent and unavoidable, palliative care is the compassionate choice as it allows them to live their remaining time with minimal pain. However, if their cancer is treatable, and possibly even curable, then offering them palliative care is irresponsible if not downright cruel.  Their best life will be lived if they are cured, rather than just being pain-free for their remaining days. In fact, treatment, be it surgery, chemo, or radiation, is likely to be very uncomfortable, or even painful, in the short term, but with the promise of a vastly better life in the long run.

It's this sense that "offering" treatment to drug users is almost an afterthought that makes me skeptical. It is, by far, the best chance for improved life that most drug users have, but not being up front about this seems as irresponsible as a doctor not telling a patient that their cancer could be treated.

So, what is the best way to encourage a drug user to quit or seek help?  Is it being thrown in Jail and forced, or is it more effective to present treatment options in a not judgmental environment?

Your example of alcohol is interesting, but I think it demonstrates the benefits of safe consumption.  We tried prohibition, it didnt work, resulted in more dangerous tainted supply lines, and fueled organized crime.  While having bars dosnt directy help people quit, the fact that drinking is not illegal makes it much easier and more acceptable for people to join AA. 

Regarding free drugs, that is not necessarily the goal.  A legal supply line would not be free, but it would be as safe as possible for the drug in question.  You would be assured the purity and it would prevent overdoses.  It would save lives. 
 

[Kron3007]

People seem to be deliberately misinterpreting what I have been saying.

I did not say 'lock 'em up'... I did say, 'give em a carrot-and-stick choice between rehab and jail.'   I meant it.   It seems difficult to understand how a bunch of academics could not understand how it is not showing 'compassion' to an addict, by allowing him to remain a drug user.  Really, it does.

Now as to my own heatlh, I suppose there are some things I could be doing that I have not been doing, though I have numerous docs, meds, etc., but one thing I certainly could never do is stop being 55 in favor of again becoming 30.  My own apt bldg is a 50+ unit, and at 55 I am probably 10+ years younger than the average resident here.  Many of these people would have *no hope whatsoever* of defending themselves against hopheads who attempted to commit crimes against them, and would undoubtedly feel great pressure to donate money to aggressive doper panhandlers, etc.  Such indivuduals, therefore, should simply not be allowed to congregate around the building.   It is not being uncompassionate to these folks to say this, largely because it is being compassionate to the elderly folks who live here, to provide them with a safe environment here.   Put simply, sometimes one cannot be 'compassionate' to two people whose interests and behaviors simply contradict each other.

What do you believe the long term success rate is for someone that is forced into rehab to avoid jail?  In the end, we should be following data to develop policy that results in the least harm to public health.  I dont think there is any evidence that criminalization is the best approach in any metric.     

[marshwiggle]

Can someone enjoy a glass of wine, a cigarette, and a quick shot of heroin after work to relax, without waking up in the gutter, chainsmoking, or comatose from an OD?

I'm guessing the people who have that much control over their usage don't need harm reduction facilities; they're able to choose what and when they consume.

So I've had patients who are substance users (callling them drug addicts is not the preferred term at all). What to do: if people are in pain provide them adquate pain relief, provide a safe supply, offer programs like methadone treatment, offer counselling, offer in-patient treatment. Above all, treat people with humanity and respect.

For people with cancer, there are two options: treatment and palliative care. When a person's death is imminent and unavoidable, palliative care is the compassionate choice as it allows them to live their remaining time with minimal pain. However, if their cancer is treatable, and possibly even curable, then offering them palliative care is irresponsible if not downright cruel.  Their best life will be lived if they are cured, rather than just being pain-free for their remaining days. In fact, treatment, be it surgery, chemo, or radiation, is likely to be very uncomfortable, or even painful, in the short term, but with the promise of a vastly better life in the long run.

It's this sense that "offering" treatment to drug users is almost an afterthought that makes me skeptical. It is, by far, the best chance for improved life that most drug users have, but not being up front about this seems as irresponsible as a doctor not telling a patient that their cancer could be treated.

So, what is the best way to encourage a drug user to quit or seek help?  Is it being thrown in Jail and forced, or is it more effective to present treatment options in a not judgmental environment?

Not requiring jail time for possession of small quantities doesn't require giving people access to drugs. (And even for alcohol, people can be arrested for "drunk and disorderly" when their conduct puts other people at risk. That should also apply to drug users.)

 

Your example of alcohol is interesting, but I think it demonstrates the benefits of safe consumption.  We tried prohibition, it didnt work, resulted in more dangerous tainted supply lines, and fueled organized crime.  While having bars dosnt directy help people quit, the fact that drinking is not illegal makes it much easier and more acceptable for people to join AA. 

Regarding free drugs, that is not necessarily the goal.  A legal supply line would not be free, but it would be as safe as possible for the drug in question.  You would be assured the purity and it would prevent overdoses.  It would save lives. 
 

So the safe supply advocates would turn someone away if they didn't have the cash for their dose of heroin?

[ciao_yall]

So the safe supply advocates would turn someone away if they didn't have the cash for their dose of heroin?

"Safe supply" sources do not give heroin away for free. Where did you get this idea? The person shows up to a safe injection site with the heroin they have in their possession, no questions asked.

[Kron3007]

Can someone enjoy a glass of wine, a cigarette, and a quick shot of heroin after work to relax, without waking up in the gutter, chainsmoking, or comatose from an OD?

I'm guessing the people who have that much control over their usage don't need harm reduction facilities; they're able to choose what and when they consume.

So I've had patients who are substance users (callling them drug addicts is not the preferred term at all). What to do: if people are in pain provide them adquate pain relief, provide a safe supply, offer programs like methadone treatment, offer counselling, offer in-patient treatment. Above all, treat people with humanity and respect.

For people with cancer, there are two options: treatment and palliative care. When a person's death is imminent and unavoidable, palliative care is the compassionate choice as it allows them to live their remaining time with minimal pain. However, if their cancer is treatable, and possibly even curable, then offering them palliative care is irresponsible if not downright cruel.  Their best life will be lived if they are cured, rather than just being pain-free for their remaining days. In fact, treatment, be it surgery, chemo, or radiation, is likely to be very uncomfortable, or even painful, in the short term, but with the promise of a vastly better life in the long run.

It's this sense that "offering" treatment to drug users is almost an afterthought that makes me skeptical. It is, by far, the best chance for improved life that most drug users have, but not being up front about this seems as irresponsible as a doctor not telling a patient that their cancer could be treated.

So, what is the best way to encourage a drug user to quit or seek help?  Is it being thrown in Jail and forced, or is it more effective to present treatment options in a not judgmental environment?

Not requiring jail time for possession of small quantities doesn't require giving people access to drugs. (And even for alcohol, people can be arrested for "drunk and disorderly" when their conduct puts other people at risk. That should also apply to drug users.)

 

Your example of alcohol is interesting, but I think it demonstrates the benefits of safe consumption.  We tried prohibition, it didnt work, resulted in more dangerous tainted supply lines, and fueled organized crime.  While having bars dosnt directy help people quit, the fact that drinking is not illegal makes it much easier and more acceptable for people to join AA. 

Regarding free drugs, that is not necessarily the goal.  A legal supply line would not be free, but it would be as safe as possible for the drug in question.  You would be assured the purity and it would prevent overdoses.  It would save lives. 
 

So the safe supply advocates would turn someone away if they didn't have the cash for their dose of heroin?

Which is why I support full legalization.  Decriminalization makes sense, but doesn't address some of the core problems.

Just as you mentioned earlier about religious people having many different stances so do people that support safe supply.  In my version, it would be legal and they would need to pay.  I. Addition, there would likely p
Be locations in larger cities for people to use it and access information about rehab etc. 

[MarathonRunner]

Beware weasel words -- legalize drugs, do not merely decriminalize. The latter means that users don't face imprisonment or fines when found with small quantities of "contraband". That increases demand, raising price, but provides no incentive for producers to sell only uncontaminated product. One gets more dangerous stuff.

Fair enough. A lot of the work being done at community health centres is to advocate for at least decriminalization, as that is more palatable to politicians that legalization. But I do agree, legalization would be ideal.

[marshwiggle]

So the safe supply advocates would turn someone away if they didn't have the cash for their dose of heroin?

"Safe supply" sources do not give heroin away for free. Where did you get this idea? The person shows up to a safe injection site with the heroin they have in their possession, no questions asked.

What you're talking about is "safe injection". Safe supply actually involves providing the drugs themselves, produced in (presumably) government-approved facilities.

The Canadian Association of People Who Use Drugs (CAPUD) defines safe supply as "a legal and regulated supply of drugs with mind/body altering properties that traditionally have been accessible only through the illicit drug market." This covers many drugs that are currently illegal, including heroin, fentanyl, cocaine, methamphetamines and MDMA. The goal of safe supply is to enable people who use drugs to access regulated substances from a legal source, rather than toxic versions from illicit markets — ultimately saving lives.

[ciao_yall]

So the safe supply advocates would turn someone away if they didn't have the cash for their dose of heroin?

"Safe supply" sources do not give heroin away for free. Where did you get this idea? The person shows up to a safe injection site with the heroin they have in their possession, no questions asked.

What you're talking about is "safe injection". Safe supply actually involves providing the drugs themselves, produced in (presumably) government-approved facilities.

The Canadian Association of People Who Use Drugs (CAPUD) defines safe supply as "a legal and regulated supply of drugs with mind/body altering properties that traditionally have been accessible only through the illicit drug market." This covers many drugs that are currently illegal, including heroin, fentanyl, cocaine, methamphetamines and MDMA. The goal of safe supply is to enable people who use drugs to access regulated substances from a legal source, rather than toxic versions from illicit markets — ultimately saving lives.

From the article...

=====
So far, safe supply has been happening through a medical model where a person needs to obtain a prescription for a regulated substance from a healthcare provider. This is because, in the context of drug prohibition, a prescription is the only legal way to access many substances with mind/body altering effects. Some of the prescriptions for safe supply are provided within primary care-based programs, which involve ongoing assessments, monitoring and engagement in healthcare and case management services.29 To provide safe supply, hydromorphone can be prescribed as an alternative to illicit opioids such as fentanyl. Hydromorphone is commonly chosen because it is legal, it is covered by most provincial and territorial public drug plans and it is acceptable to people who use opioids.31,32 Other drugs that may be used as safe supply include methylphenidate (a stimulant), diazepam (a benzodiazepine) and diacetylmorphine (heroin).20,26
=====

The government is not making and giving away whatever party drug anyone wants for free.

[marshwiggle]

So the safe supply advocates would turn someone away if they didn't have the cash for their dose of heroin?

"Safe supply" sources do not give heroin away for free. Where did you get this idea? The person shows up to a safe injection site with the heroin they have in their possession, no questions asked.

What you're talking about is "safe injection". Safe supply actually involves providing the drugs themselves, produced in (presumably) government-approved facilities.

The Canadian Association of People Who Use Drugs (CAPUD) defines safe supply as "a legal and regulated supply of drugs with mind/body altering properties that traditionally have been accessible only through the illicit drug market." This covers many drugs that are currently illegal, including heroin, fentanyl, cocaine, methamphetamines and MDMA. The goal of safe supply is to enable people who use drugs to access regulated substances from a legal source, rather than toxic versions from illicit markets — ultimately saving lives.

From the article...

=====
So far, safe supply has been happening through a medical model where a person needs to obtain a prescription for a regulated substance from a healthcare provider. This is because, in the context of drug prohibition, a prescription is the only legal way to access many substances with mind/body altering effects. Some of the prescriptions for safe supply are provided within primary care-based programs, which involve ongoing assessments, monitoring and engagement in healthcare and case management services.29 To provide safe supply, hydromorphone can be prescribed as an alternative to illicit opioids such as fentanyl. Hydromorphone is commonly chosen because it is legal, it is covered by most provincial and territorial public drug plans and it is acceptable to people who use opioids.31,32 Other drugs that may be used as safe supply include methylphenidate (a stimulant), diazepam (a benzodiazepine) and diacetylmorphine (heroin).20,26
=====

The government is not making and giving away whatever party drug anyone wants for free.

No, but they are giving away prescription drugs for free. So cost is no barrier to maintaining a drug habit.

[Parasaurolophus]

No, but they are giving away prescription drugs for free. So cost is no barrier to maintaining a drug habit.

That's fine by me. Much better than the person needing to steal, rob, undertake sex work, or sell drugs to feed their addiction.