So What Should We Do About Drug Addicts?

[Sun_Worshiper]

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.

You think cemeteries are filling up because of marijuana legalization?

[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...

 

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.

Never, ever, ever, pursue two competing goals with a single instrument [Jan Tinbergen]. This is not about raising revenue; it's about saving lives.

[secundem_artem]

Let's face it.  Humans have been looking to get a buzz on since the first Australopithecus stumbled upon some fermenting grapes and accidentally discovered wine.

I've spent a substantial amount of time in Australia which has historically had a quite large problem with heroin addiction.  If the po po finds you with it in your pocket, you will still be arrested, but beyond that, they do have a large harm reduction approach.

For decades, family practice docs with a bit of extra training have been able to prescribe methadone, and later, buprenorphine.  Patients can get their methadone in many local pharmacies for about $5 a day.  Since most addicts are just trying to avoid getting dope sick from withdrawal and are not seeking a high, their prescribed medicine keeps them from having to shoplift or engage in sex work to pay for drugs.  It's quite a good system.

More recently, safe injection rooms have opened.  So if you get a hot dose and nod off, there's someone there to notice and blow some Narcan up your nose.

Here in the Land of Screed and the Home of the Depraved, we insist on seeing this as a legal problem.  I've talked to addicts desperate to get into a methadone program only to find their way blocked by a thousand pages of regulations that make getting treatment impossible.

None of this will work for meth but at least the Aussies have some kind of program in place beyond jail and hoping they find religion.

[kaysixteen]

I have been cogitatin' more on this and will allow that legalization of drugs with a harm reduction focus, providing things like free needles, safe injection spots, etc., will almost certainly reduce OD deaths.  You gots me on that.

Now let's consider the other, less, ahem, positive effects of what is, after all, essentially surrendering to drug addiction.   Addicts (nothing will convince me to avoid use of this descriptive term... I will refrain from using 'junkie' here) will use their safely provided junk in their safely established shoot up spaces, and they will not OD, but they will continue to destroy themselves on the slow burn.  Meanwhile their families, society as a whole, etc., will pay a great price for their addicthood.   Who really thinks that this is a good thing?

[Kron3007]

I have been cogitatin' more on this and will allow that legalization of drugs with a harm reduction focus, providing things like free needles, safe injection spots, etc., will almost certainly reduce OD deaths.  You gots me on that.

Now let's consider the other, less, ahem, positive effects of what is, after all, essentially surrendering to drug addiction.   Addicts (nothing will convince me to avoid use of this descriptive term... I will refrain from using 'junkie' here) will use their safely provided junk in their safely established shoot up spaces, and they will not OD, but they will continue to destroy themselves on the slow burn.  Meanwhile their families, society as a whole, etc., will pay a great price for their addicthood.   Who really thinks that this is a good thing?

It's not giving in to drug addiction if you think it will result in better outcomes and lower impacts.  If there was any evidence that being tough on drugs reduced access, use rates, or negative outcomes, maybe you would have a point, but that is not the case.  Being tough on drugs appeals to the base gut feelings, but it not built on the facts.

What I find more interesting here is that the religious types seem to share your view, despite preaching love and compassion.  What do you think Jesus would do?  This is a real question, how do you think Jesus would approach drug addiction and rehabilitation?

[marshwiggle]

I have been cogitatin' more on this and will allow that legalization of drugs with a harm reduction focus, providing things like free needles, safe injection spots, etc., will almost certainly reduce OD deaths.  You gots me on that.

Now let's consider the other, less, ahem, positive effects of what is, after all, essentially surrendering to drug addiction.   Addicts (nothing will convince me to avoid use of this descriptive term... I will refrain from using 'junkie' here) will use their safely provided junk in their safely established shoot up spaces, and they will not OD, but they will continue to destroy themselves on the slow burn.  Meanwhile their families, society as a whole, etc., will pay a great price for their addicthood.   Who really thinks that this is a good thing?

It's not giving in to drug addiction if you think it will result in better outcomes and lower impacts.  If there was any evidence that being tough on drugs reduced access, use rates, or negative outcomes, maybe you would have a point, but that is not the case.  Being tough on drugs appeals to the base gut feelings, but it not built on the facts.

What I find more interesting here is that the religious types seem to share your view, despite preaching love and compassion.  What do you think Jesus would do?  This is a real question, how do you think Jesus would approach drug addiction and rehabilitation?

First of all, there's a variety of opinion among religious types. Nevertheless, one of the reasons conservative religious types tend to be skeptical of hanging everything on the "harm reduction" approach is that many (most?) of peoples' negative outcomes are the result to at least some extent of their own choices. (In religious language, "sin".) So, beating drug addiction is always  going to require dedicated action of the part of the individual. (There are lots of ex-addicts who make this claim as well.) Much of the "marketing" for the harm reduction approach seems to suggest that keeping people from infection and overdose without any significant effort to get people to quit is sufficient. That, I believe, would be the sticking point for many people.

Compassion for people means helping them to lead the most fulfilling life, which is going to be impossible as long as they are addicted to drugs. Allowing people to live in perpetual limbo, alive but unable to be productive members of their community, isn't the most compassionate response.

[Kron3007]

I have been cogitatin' more on this and will allow that legalization of drugs with a harm reduction focus, providing things like free needles, safe injection spots, etc., will almost certainly reduce OD deaths.  You gots me on that.

Now let's consider the other, less, ahem, positive effects of what is, after all, essentially surrendering to drug addiction.   Addicts (nothing will convince me to avoid use of this descriptive term... I will refrain from using 'junkie' here) will use their safely provided junk in their safely established shoot up spaces, and they will not OD, but they will continue to destroy themselves on the slow burn.  Meanwhile their families, society as a whole, etc., will pay a great price for their addicthood.   Who really thinks that this is a good thing?

It's not giving in to drug addiction if you think it will result in better outcomes and lower impacts.  If there was any evidence that being tough on drugs reduced access, use rates, or negative outcomes, maybe you would have a point, but that is not the case.  Being tough on drugs appeals to the base gut feelings, but it not built on the facts.

What I find more interesting here is that the religious types seem to share your view, despite preaching love and compassion.  What do you think Jesus would do?  This is a real question, how do you think Jesus would approach drug addiction and rehabilitation?

First of all, there's a variety of opinion among religious types. Nevertheless, one of the reasons conservative religious types tend to be skeptical of hanging everything on the "harm reduction" approach is that many (most?) of peoples' negative outcomes are the result to at least some extent of their own choices. (In religious language, "sin".) So, beating drug addiction is always  going to require dedicated action of the part of the individual. (There are lots of ex-addicts who make this claim as well.) Much of the "marketing" for the harm reduction approach seems to suggest that keeping people from infection and overdose without any significant effort to get people to quit is sufficient. That, I believe, would be the sticking point for many people.

Compassion for people means helping them to lead the most fulfilling life, which is going to be impossible as long as they are addicted to drugs. Allowing people to live in perpetual limbo, alive but unable to be productive members of their community, isn't the most compassionate response.

Perhaps the "marketing" needs to improve, but I think you are off base that harm reduction proponents do not want to include effort to help people quit.  In fact, a big component of safe consumption sites is the availability to resources to help people quit.  Helping people quit is really at the core of this approach.

From my perspective people against the harm reduction strategy seem to be less inclined to want to help people quit, they are more interested in punishing people for their choices.  I really doubt sending people to jail contributed to recovery, in fact I believe it does the opposite.

As for compassion, do you really think criminalizing people for drug use is compassionate?  Where is the forgiveness?  Where is the understanding?  You do realize how a drug charge can impact someone's entire future right? 

I really think that if Jesus came down to Earth, he would likely support harm reduction strategies and supporting those that need it no?   
 

[kaysixteen]

Let's use a parallel hypothetical here-- in what definition of 'compassion' would it ever be seen as compassionate to offer free cigarettes to homeless smokers?  And yet cigs do not cause people to become intoxicated, and ruin their lives and those of their families. 

I am sick to death of hearing that we should be waiting for the addict to be 'ready' to get off the junk-- being a narcotics addict (even a weed addict, and certainly anything harder) alters your brain, and in what sense could it be that someone in this state should be considered able to make such a rational choice?

That said, I will be saving my Jesus-like 'compassion' for the families, esp the children, of the addicts, the neighbors in the areas where homeless addicts congregate, etc.

I am also forced to acknowledge that things have changed for me physically.  I am not a tall man (5'7''), but I am a big dude, well north of 200lbs, and traditionally as I have been living here in Rusty City, I have more or less not worried about being physically assaulted by some 150lb hophead.  Because, if so assaulted, I would have been able to thump him, via simple poundage.   But my health, stamina, and strength has declined, and I have to admit that I am now actually afraid when I near or see nearing me, such folks.  I am not sure what I could do about this.

[Kron3007]

Well, if street cigarettes were often laced with cyanide and might kill the homeless smoker, it would be compassionate to give them a safe supply to prevent their death, while using this opportunity to offer them help to quit.  This is the case with street drugs.

In the end, the real question is what leads to the best outcomes.  If you think putting people in jail reduces the number of addicts on the street, I think you are wrong.  The criminalization of drugs only makes the situation worse and is counterproductive.

As for saving your compassion for others and not for all, I don't remember that part of the bible.  Addicts need help, and many of them know it. 

[nebo113]

I am also forced to acknowledge that things have changed for me physically.  I am not a tall man (5'7''), but I am a big dude, well north of 200lbs, and traditionally as I have been living here in Rusty City, I have more or less not worried about being physically assaulted by some 150lb hophead.  Because, if so assaulted, I would have been able to thump him, via simple poundage.   But my health, stamina, and strength has declined, and I have to admit that I am now actually afraid when I near or see nearing me, such folks.  I am not sure what I could do about this.

At the risk of being accused of an ad hominem position, might I suggest that you focus on improving your own health, so you might no longer fear those you pass on the sidewalk and so that you might no longer feel the need to use unpleasant rhetoric in describing them.  (Mods...Delete if you feel I am out of bounds.)

[marshwiggle]

It occurred to me that many of the goals of "safe supply" and "harm reduction" we already have in place for our most common drug - alcohol.

Consider:

• Alcohol can only be bought (or served) by government approved vendors (i.e. safe supply).
• Places that serve alcohol are required to cut people off who have consumed too much (i.e. supervising dosage/overdose prevention) and they are required to take car keys, call a cab, etc. so that people don't drive drunk (i.e. harm reduction).

While those measures of harm reduction have some effect, I've never heard anyone claim that those measures actually directly lead to preventing or curing alcoholism. Based on the experience of 12 step programs, which have about the best track record in the long term for treating alcoholism, ultimately it's necessary for the alcoholic to stop going to bars and stop consuming alcohol completely.

The contrast between what is seen as necessary for alcohol versus other drugs is striking, given that many of the medical and psychological issues around addiction are the same.

[ciao_yall]

It occurred to me that many of the goals of "safe supply" and "harm reduction" we already have in place for our most common drug - alcohol.

Consider:

• Alcohol can only be bought (or served) by government approved vendors (i.e. safe supply).
• Places that serve alcohol are required to cut people off who have consumed too much (i.e. supervising dosage/overdose prevention) and they are required to take car keys, call a cab, etc. so that people don't drive drunk (i.e. harm reduction).

While those measures of harm reduction have some effect, I've never heard anyone claim that those measures actually directly lead to preventing or curing alcoholism. Based on the experience of 12 step programs, which have about the best track record in the long term for treating alcoholism, ultimately it's necessary for the alcoholic to stop going to bars and stop consuming alcohol completely.

The contrast between what is seen as necessary for alcohol versus other drugs is striking, given that many of the medical and psychological issues around addiction are the same.

Well, what if...

• Anyone could brew up bathtub gin, moonshine, with no standards for how much alcohol was in there? High risk of alcohol poisoning or other toxins. Or that they might enjoy being really wasted and seek that out.
• Bars could overserve and the result was someone getting into a car accident, fight, etc? The cut-off laws probably at least keep someone's head clear enough that they might realize "hey, I'm getting a little out of hand here" and at least learn to moderate or cut back in the future.

Also note that the legal drinking age is 21, so at least (theoretically) someone is old enough to handle alcohol when they (theoretically) start drinking.

With illegal drugs, there is no way to control effective dosage, usage, or age of the user.

[marshwiggle]

It occurred to me that many of the goals of "safe supply" and "harm reduction" we already have in place for our most common drug - alcohol.

Consider:

• Alcohol can only be bought (or served) by government approved vendors (i.e. safe supply).
• Places that serve alcohol are required to cut people off who have consumed too much (i.e. supervising dosage/overdose prevention) and they are required to take car keys, call a cab, etc. so that people don't drive drunk (i.e. harm reduction).

While those measures of harm reduction have some effect, I've never heard anyone claim that those measures actually directly lead to preventing or curing alcoholism. Based on the experience of 12 step programs, which have about the best track record in the long term for treating alcoholism, ultimately it's necessary for the alcoholic to stop going to bars and stop consuming alcohol completely.

The contrast between what is seen as necessary for alcohol versus other drugs is striking, given that many of the medical and psychological issues around addiction are the same.

Well, what if...

• Anyone could brew up bathtub gin, moonshine, with no standards for how much alcohol was in there? High risk of alcohol poisoning or other toxins. Or that they might enjoy being really wasted and seek that out.
• Bars could overserve and the result was someone getting into a car accident, fight, etc? The cut-off laws probably at least keep someone's head clear enough that they might realize "hey, I'm getting a little out of hand here" and at least learn to moderate or cut back in the future.

Also note that the legal drinking age is 21, so at least (theoretically) someone is old enough to handle alcohol when they (theoretically) start drinking.

With illegal drugs, there is no way to control effective dosage, usage, or age of the user.

My point about all of that was that there seem to be a lot of assumptions about how "safe supply" and "harm reduction" will automatically get many people off drugs, whereas the experience with alcohol is that no-one suggests those sort of measures are getting people off alcohol. And that's without alcohol being served for free, which is what is promoted for "safe supply". Arguing that somehow free alcohol was part of the way to cure alcoholics would be a very hard case to make based on experience.

[apl68]

I really think that if Jesus came down to Earth, he would likely support harm reduction strategies and supporting those that need it no?   

I don't know.  It's not like I or probably most other Christians who've seriously thought about the issue are set against harm reduction strategies in principle.  I know that my greatest concern with current approaches to harm reduction is that they seem in danger of normalizing and encouraging drug abuse, and making it more socially acceptable.  And that legalization is making them even more readily available than they were already.  Things that have the effect of encouraging more drug use of all sorts are going to lead to more harms, even with more harm reduction efforts in place.  It reminds me of those whose response to the epidemic of gun crime in our nation is to let everybody carry firearms openly so that ordinary citizens can shoot back.  Reducing gun crime by encouraging even more guns is more than a little counterintuitive.  So is reducing our drugs problems by having even more drugs.

Jesus' message is fundamentally one of responsibility and change.  We may like to think of ourselves as good people whose only problem is that we can't catch a decent break and other people don't treat us right.  Maybe we even are good people by most people's definitions, and have had bad breaks and been treated wrong by others.  But no matter how "good" we are or think we are, no matter how much our problems may seem beyond our control, we're still, individually caught up in sin.  We still don't live right, and aren't right before God, and our collective wrongness is why the whole world is as messed up as it is. 

Each and every one of us is part of the problem.  We can't stop being part of the problem through our own effort.  Jesus' teaching calls on us admit as much, stop making excuses, and turn to him to help us get right with God and with each other.  We have to take responsibility, and we have to change.  It's a change that only God can enable, but that doesn't exempt us from responsibility to strive to work with God.

That's why so many Christians take a "no excuses" approach to drug use, however much compassion we may feel and extend toward those who are dealing with them.  We all have something about who we are that we have no excuses for, whether it's sexual immorality, bad ethical choices (which includes things like racism and a lack of compassion toward those in need), selfish attitudes, and the list goes on and on.  None of us has an excuse.  We all have something we need to work on.  Jesus can give us the strength to work on those things.  That includes drug addiction, as the lives of people I know have demonstrated.

What are the right balances and blends involving law enforcement, and drug treatment programs, and harm reduction?  I confess that I don't know.  There aren't any simple and easy answers.  I admit it.  What concerns me about the emerging consensus on drug use is that society and policy are moving toward a simple answer that says "Let's just legalize everything, let everybody do what they feel like doing, and spend billions and billions of dollars trying to clean up the messes."  That's what I fear we see developing, and I fear we're going to have abundant reason as a society to regret it.

[ciao_yall]

It occurred to me that many of the goals of "safe supply" and "harm reduction" we already have in place for our most common drug - alcohol.

Consider:

• Alcohol can only be bought (or served) by government approved vendors (i.e. safe supply).
• Places that serve alcohol are required to cut people off who have consumed too much (i.e. supervising dosage/overdose prevention) and they are required to take car keys, call a cab, etc. so that people don't drive drunk (i.e. harm reduction).

While those measures of harm reduction have some effect, I've never heard anyone claim that those measures actually directly lead to preventing or curing alcoholism. Based on the experience of 12 step programs, which have about the best track record in the long term for treating alcoholism, ultimately it's necessary for the alcoholic to stop going to bars and stop consuming alcohol completely.

The contrast between what is seen as necessary for alcohol versus other drugs is striking, given that many of the medical and psychological issues around addiction are the same.

Well, what if...

• Anyone could brew up bathtub gin, moonshine, with no standards for how much alcohol was in there? High risk of alcohol poisoning or other toxins. Or that they might enjoy being really wasted and seek that out.
• Bars could overserve and the result was someone getting into a car accident, fight, etc? The cut-off laws probably at least keep someone's head clear enough that they might realize "hey, I'm getting a little out of hand here" and at least learn to moderate or cut back in the future.

Also note that the legal drinking age is 21, so at least (theoretically) someone is old enough to handle alcohol when they (theoretically) start drinking.

With illegal drugs, there is no way to control effective dosage, usage, or age of the user.

My point about all of that was that there seem to be a lot of assumptions about how "safe supply" and "harm reduction" will automatically get many people off drugs, whereas the experience with alcohol is that no-one suggests those sort of measures are getting people off alcohol. And that's without alcohol being served for free, which is what is promoted for "safe supply". Arguing that somehow free alcohol was part of the way to cure alcoholics would be a very hard case to make based on experience.

"Harm reduction" is just that. It recognizes that alcohol, tobacco, drugs, etc when misused can cause harm.

The goal is to put in place safeguards such as supply, usage norms, age limits, and punishment for misuse to recognize that while these products exist, they need to be treated with respect.

Prohibition did not work, even though well-meaning people thought that getting rid of alcohol would get rid of all the related social ills they blamed on booze. Actually it was a Puritan, anti-immigrant response to the Irish, Germans, and Italians who showed up on Ellis Island with their favorite firewater, but that's another conversation.

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?