So What Should We Do About Drug Addicts?

[ciao_yall]

1) 'Harm reduction' is a moral choice, and a bad one, because such actions a) allow addicts to remain addicts, stuck in their addiction, with all the attendant life debiitations appartaining thereto, and b) society (which does have some rights) is stuck with dealing with the addicts, which, even with 'harm reduced', still means these people will be... well.

"Harm reduction" is about meeting people where they are at. For example, there is a needle exchange right outside my condo building once a week.

They give out free needles so users aren't reusing dirty ones and getting infected. They give out sandwiches, snacks, and offers for services.

Maybe it takes a few tries but eventually they do decide to accept services. It's not realistic for the outreach team to expect someone to accept help if they don't know or trust whomever is offering the help. 

I like to say it is the safest evening of the week because only the civilized junkies show up.

[Diogenes]

I keep seeing so many myths pushed here. Nothing is black and white, right? Same thing with this. Again, Reduction is the name of the game. It is not in any way "anything goes" that's a bad strawman argument.

There will never be zero drug and alcohol deaths, just as there with never be zero car or airplane deaths. The point is to put safeguards in place to drop those numbers. Without it, deaths skyrocket, including with the legal drugs like nicotine and alcohol. You can't point at alcohol deaths currently and claim attempts to minimize them failed. What you can do is be a good academic and scientist and do the darn research. Harm Reduction is evidence-based. It works. Prohibition does not.

How do you do the research? Admittedly, it's difficult but you can see natural quasi-experiments like Portugal and in the US the state-by-state cannabis legalization, then compare similar municipalities that still follow prohibition. 

[Diogenes]

Also, the research is clear that the vast majority of people who use even the "hardest" drugs, don't continue into problematic use, and/or grow out of it.

Another case in point is D.A.R.E. a prohibition based education campaign for kids at best did not work. And a couple of studies suggest, made things worse! It may have increased drug use and got kids to try drugs earlier!

[Wahoo Redux]

I speak from firsthand experience and observation.  The biggest problem with getting people off mind-altering-substances (definitely including alcohol, one of the worst drugs there is) is the person with an addiction problem.  Unless we can absolutely guarantee that we can staunch the flow of illegal drugs, which we can't, then people will get their hands on illegal drugs if they really want to.  If addicts (sorry, that is what we are, obviously including myself, labeling or not) cannot get their drug-of-choice, most will default to legal, easily obtained drugs like alcohol or pot. This is true even if you lock them up.  And it is a lot harder to lock up the purveyors of illegal substances than one might think, and very hard to get the kingpins.  It is easy to arrest and convict to the street-level dealers, who are often drug addicts themselves.

In other words, one really needs to volunteer for sobriety and really, really want it to achieve it. I really wanted my life back, so I was motivated. And I had a wide, warm support network of people who were rooting for me.  I don't know how we motivate addicts to overcome their addiction.

[downer]

Most people recover from their addictive behavior on their own, without psychiatric intervention or rehab. There's a strong phenomenon of aging out or maturing out of addiction. Of course, a significant proportion don't, especially when there are other mental illnesses involved.

[Kron3007]

I think the first thing is to stop looking down on people who use drugs, and instead offer support to reduce harm and help them stop when they want to. 

This include legalization to provide a clean safe drug supply chain.  Most people overdosing on fentanyl did not intend to consume it in the first place.  We have thousands of people dying because we are allowing organized crime to supply drugs.  The whole supply chain should be legal and regulated to ensure that people who decide to use drugs are actually consuming what they think they are. 

The reality is that many drugs are not the devil, and are actually much less harmful than many legal options.  A good example is MDMA, which in itself is not that bad, but if you buy it on the street you are likely consuming other, much worse drugs.

After that, there should be no criminalization, and instead those resources should be exclusively put toward outreach to help people. 

One thing that has really surprised me in Canada with legalization of cannabis is the shift in public attitude.  I assumed that the stigma around cannabis was separate from laws and legalization would not change this.  I was wrong, while there is still some stigma, it has decreased dramatically while usage rates have not really changed (maybe some increase in adults, but some decline in youth, which is more important).

 I believe legalization of all drugs would follow a similar path and benefit society.

[kaysixteen]

Ok, let's run  with this:

1) if we engage in a 'harm reduction' (=legalization and providing of safe spaces, free drugs/ paraphernalia , etc., program), how does this action act positively in the lives of the users?

AND

2) how does a harm reduction program help/ act posiitively, on society as a whole?

[Parasaurolophus]

One of the reduced harms is overdose deaths. Another is disease transmission. A third is the number of needles and things lying around. It also acts as a pathway to treatment and builds trust.

Not criminalizing drug use also helps those who are ready to transition out to do so, since they aren't dogged by a criminal record. It's a lot easier to stay clean when you have enough money to stay off the street.

A big part of what's missing, of course, is stable housing. To my mind, there is no good reason for us to accept that anyone should be unhoused unless it's by explicit choice. The homeless population here is only around 4000 people. That's a lot, but not so many that adequately housing them would be prohibitively expensive.

[ciao_yall]

A big part of what's missing, of course, is stable housing. To my mind, there is no good reason for us to accept that anyone should be unhoused unless it's by explicit choice. The homeless population here is only around 4000 people. That's a lot, but not so many that adequately housing them would be prohibitively expensive.

Certainly less expensive than all the hospital emergency rooms, prisons, and social workers that keep them just on the edge of permanent housing. Because if everyone had stable supportive housing who wanted it, well, where would the incentive be to work? /s

[marshwiggle]

One thing that has really surprised me in Canada with legalization of cannabis is the shift in public attitude.  I assumed that the stigma around cannabis was separate from laws and legalization would not change this.  I was wrong, while there is still some stigma, it has decreased dramatically while usage rates have not really changed (maybe some increase in adults, but some decline in youth, which is more important).

On the other side, illegal cannabis hasn't disappeared. In fact, the legal cannbis industry is now claiming they need government support to survive. So mush for legal drugs making illegal drugs unprofitable...

Also, now in our building (where people aren'\t supposed to smoke ANYTHING) we smell pot in the elevators, the parking garage, etc. Legalization of cannabis has made people feel like they have a right to stink up everyone else's atmosphere, even where it's explicitly forbidden.

There's also more date now on the adverse effects of cannabis on brains, especially of teenagers, and its addictive properties.  (before legalization, one of the arguments was that it wasn't addictive like tobacco.)

In many ways, legalizing cannabis has been like Brexit. The reality after the fact hasn't lived up to the hype of the people promoting it.

 

[MarathonRunner]

Having had clients / patients with addiction problems, provide them with safe supply, supply them with easy to access alternatives (methadone for example, but don't make it a burden), provide them with preferably free but at least low cost other treatment options. Incarceration only makes things worse, from clients I've had.

[Kron3007]

One thing that has really surprised me in Canada with legalization of cannabis is the shift in public attitude.  I assumed that the stigma around cannabis was separate from laws and legalization would not change this.  I was wrong, while there is still some stigma, it has decreased dramatically while usage rates have not really changed (maybe some increase in adults, but some decline in youth, which is more important).

On the other side, illegal cannabis hasn't disappeared. In fact, the legal cannbis industry is now claiming they need government support to survive. So mush for legal drugs making illegal drugs unprofitable...

Also, now in our building (where people aren'\t supposed to smoke ANYTHING) we smell pot in the elevators, the parking garage, etc. Legalization of cannabis has made people feel like they have a right to stink up everyone else's atmosphere, even where it's explicitly forbidden.

There's also more date now on the adverse effects of cannabis on brains, especially of teenagers, and its addictive properties.  (before legalization, one of the arguments was that it wasn't addictive like tobacco.)

In many ways, legalizing cannabis has been like Brexit. The reality after the fact hasn't lived up to the hype of the people promoting it.

 

The legal market now accounts for over 50% of total sales, meaning the black market has shrunk by more than half.  That is pretty substantial and represents billions of dollars no longer flowing through back channels.  It will continue to drop and eventually illicit cannabis will be a small percentage of total sales. I really doubt bootleggers just closed shop as soon as alcohol prohibition ended, it likely took many years.  Anyone who thought the black market would disappear overnight was naive.  As for the cannabis industry needing government support, that is really just a matter of too much hype, investment, and expectations that have led to a massive oversupply.  Once some of them go under and stop flooding the market, the industry will balance itself.

Regarding information about the negative effects on brains etc., that is somewhat irrelevant since use in young people has stayed level or declined, and there has only been a moderate increase in older adults (which is also questionable).  If legalization had caused a significant increase in use, especially in the younger group, you may have a point, but since it didnt, it hasn't caused increased harm.   In fact, a lot of this new information has come because of legalization, allowing researchers to more readily conduct the necessary studies and help guide best practices.  Additionally, from what I have seen, legalization of cannabis leads to lower alcohol sales, so even if use did go up the picture is more complex.

As for your building, smells are part of apartment living.  Some people complain about tobacco small, some about boiling cabbage, others about curry.  All potentially valid I suppose, but not really a big deal in the grand scheme.     

Personally, I see cannabis legalization as a huge success and it has proven what many have been saying about the futility and counter-productivity  of the war on drugs for decades.

     

[dismalist]

One thing that has really surprised me in Canada with legalization of cannabis is the shift in public attitude.  I assumed that the stigma around cannabis was separate from laws and legalization would not change this.  I was wrong, while there is still some stigma, it has decreased dramatically while usage rates have not really changed (maybe some increase in adults, but some decline in youth, which is more important).

On the other side, illegal cannabis hasn't disappeared. In fact, the legal cannbis industry is now claiming they need government support to survive. So mush for legal drugs making illegal drugs unprofitable...

Also, now in our building (where people aren'\t supposed to smoke ANYTHING) we smell pot in the elevators, the parking garage, etc. Legalization of cannabis has made people feel like they have a right to stink up everyone else's atmosphere, even where it's explicitly forbidden.

There's also more date now on the adverse effects of cannabis on brains, especially of teenagers, and its addictive properties.  (before legalization, one of the arguments was that it wasn't addictive like tobacco.)

In many ways, legalizing cannabis has been like Brexit. The reality after the fact hasn't lived up to the hype of the people promoting it.

 

Alas, Marsh, the evidence is not what it seems, for it is skin deep. Well over a year ago we had a disquisition about whether legalization would lower the prices of formerly illicit drugs, or raise them. You pointed out that in Canada the price of illegal cannabis was lower than legal cannabis. This threw me off my perch, so I investigated. Your facts are correct, and the same is true in various US States.

What's going on is that nothing has been completely legalized anywhere. Legalization is just a woid. Thus, in various Canadian provinces one needs to jump through hoops to get a license to sell this stuff. Same in New York, where the legal market is disappearing. In the US more broadly, legal dealers have no access to banks. Great help in doing business!

At least as bad is that what's called legalization in many places in merely "decriminalization". That just raises the demand for illicit drugs without cleaning up the quality of the supply. Decriminalization of carrying drugs thus contributes to the rising death rate.

I'm pleasantly surprised how insightful the comments are on this thread. Any defects of the health system in mind, right now doctors are surveilled on their prescription practices for opioids. An addict can't get his stuff under the care of a doctor! Same for pharmacists. At least illicit supply by pharmacies will be pure in content and come with  dosage instructions.

This is no longer just an addiction problem; it's a death rate problem. Legalization would do a lot to lower the death rate.

[apl68]

One thing that has really surprised me in Canada with legalization of cannabis is the shift in public attitude.  I assumed that the stigma around cannabis was separate from laws and legalization would not change this.  I was wrong, while there is still some stigma, it has decreased dramatically while usage rates have not really changed (maybe some increase in adults, but some decline in youth, which is more important).

On the other side, illegal cannabis hasn't disappeared. In fact, the legal cannbis industry is now claiming they need government support to survive. So mush for legal drugs making illegal drugs unprofitable...

Also, now in our building (where people aren'\t supposed to smoke ANYTHING) we smell pot in the elevators, the parking garage, etc. Legalization of cannabis has made people feel like they have a right to stink up everyone else's atmosphere, even where it's explicitly forbidden.

There's also more date now on the adverse effects of cannabis on brains, especially of teenagers, and its addictive properties.  (before legalization, one of the arguments was that it wasn't addictive like tobacco.)

In many ways, legalizing cannabis has been like Brexit. The reality after the fact hasn't lived up to the hype of the people promoting it.

 

As with Brexit, we've only begun to see the unintended harms, which should have been entirely anticipateable.  It's too late now, I'm afraid.  Our societies have drunk deeply of the (heavily spiked) Kool-Aid.  As with so many other bad policy decisions (Afghanistan, bank deregulation, gun deregulation--any number come to mind), we're going to be seeing massive denial and efforts to prove that "no, really, things are moving forward," even as our streets and our cemeteries keep filling up.

[marshwiggle]

One thing that has really surprised me in Canada with legalization of cannabis is the shift in public attitude.  I assumed that the stigma around cannabis was separate from laws and legalization would not change this.  I was wrong, while there is still some stigma, it has decreased dramatically while usage rates have not really changed (maybe some increase in adults, but some decline in youth, which is more important).

On the other side, illegal cannabis hasn't disappeared. In fact, the legal cannbis industry is now claiming they need government support to survive. So mush for legal drugs making illegal drugs unprofitable...

 

Alas, Marsh, the evidence is not what it seems, for it is skin deep. Well over a year ago we had a disquisition about whether legalization would lower the prices of formerly illicit drugs, or raise them. You pointed out that in Canada the price of illegal cannabis was lower than legal cannabis. This threw me off my perch, so I investigated. Your facts are correct, and the same is true in various US States.

What's going on is that nothing has been completely legalized anywhere. Legalization is just a woid. Thus, in various Canadian provinces one needs to jump through hoops to get a license to sell this stuff. Same in New York, where the legal market is disappearing. In the US more broadly, legal dealers have no access to banks. Great help in doing business!

As I understand it, part of the reason legal cannabis is more expensive than illegal cannabis is Canada is that there are strict quality controls imposed by governments that raise the cost of legitimate production.

It is a fascinating test of the mantra "legalize and tax!", since the fact is that it's not so simple- the higher the taxes, the more room for competition from the black market. So the government can try to generate revenue or undercut the black market, but not both.