So What Should We Do About Drug Addicts?

[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...

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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
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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.

The point of the prescription drug is to help the person get off the illegal drug.

I can't believe you are really this stupid obtuse.

[Wahoo Redux]

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?

SAMSA: Does Mandating Offenders to Treatment Improve Completion Rates?

The participants were enrolled in an intensive outpatient program and were recruited into the study between July 2007 and October 2010. All offenders received weekly therapy sessions using a cognitive problem solving framework and 45% completed the six month treatment program. Interestingly, those who were mandated demonstrated less motivation at treatment entry, yet were more likely to complete treatment compared to those who were not court-ordered to treatment. While controlling for covariates known to be related to treatment completion, the logistic regression analyses demonstrated that court-ordered offenders were over ten times more likely to complete treatment compared to those who entered treatment voluntarily (OR = 10.9, CI = 2.0–59.1, p = .006). These findings demonstrate that stipulated treatment for offenders may be an effective way to increase treatment compliance.

I also found a number of websites that claim court-ordered rehab is as effective as voluntary rehab, but I did not feel like going to Ebscohost and chasing these down. 

This is interesting to me because I went through rehab with two fellas who were court-ordered into the program.  I don't know what happened to them long-term, but neither was particularly resentful that they were there.  In fact, both fellas took it very seriously and worked the program; both were avoiding criminal prosecution, and if you are faced with jail or rehab, rehab looks pretty good.  When we get the point of needing rehabilitation and sobriety, most of us are grateful for the opportunity.  We want out of that lifestyle.

[kaysixteen]

Random points:

1) Is this Canadian drug user org a serious legit organization, or some sort of internet troll thing?   If it is, is there anything comparable on this side of the border?   I say this because, like NAMBLA, this sounds like a bunch of people advocating something that is likely very much opposed by the overwhelming majority of their countries' population (Canadian politics are supposed to be somewhat to the left of ours, but they cannot be that much to the left).  And passing out narcotics free/ at cost, well... let's just say that at least on this side of the border, the *overwhelming majority of Americans would stridently oppose any such idea.  Similarly, I get that the housing crisis here contributes to the opioid epidemic, but giving free housing to able-bodied working-age people who would not work, but rather just indulge in narcotics use in said free housing, well, good luck getting that through Congress too.

2) Someone noted that, in their view, these safe injection sites should simply be places where addicts can shoot up safely, with oversight (presumably), but using drugs they have purchased off-site-- where are they supposed to get the money to purchase said pharmaceuticals, legal or otherwise?

[Parasaurolophus]

Random points:

1) Is this Canadian drug user org a serious legit organization, or some sort of internet troll thing?   If it is, is there anything comparable on this side of the border?   I say this because, like NAMBLA, this sounds like a bunch of people advocating something that is likely very much opposed by the overwhelming majority of their countries' population (Canadian politics are supposed to be somewhat to the left of ours, but they cannot be that much to the left).

I can't tell you about the polling, but I can tell you you might well be quite surprised by how much further left most of the country is, though this of course varies significantly by province and, to an extent, by issue. You should perhaps know that Brtitish Columbia had the first supervised injection site in North America, which was established in 2000; since then, I think we now have around 40 supervised injection sites across the country. It's been a phenomenal success, and is well known internationally. Way back in 2010ish, when the Conservative government was trying to shut downInsite (the supervised injection site), polling showed that just a quarter of the population wanted it shut down; in BC, nearly three-quarters supported its existence. And recently, the federal government decriminalized possession of a small amount of certain hard drugs (opioids, coke, meth) in BC.

[MarathonRunner]

Canadian politics are supposed to be somewhat to the left of ours, but they cannot be that much to the left

You would be surprised then. Most Canadians, from the polls I've seen, support supervised injection sites and a safe supply. The majority support things like methadone programs. Don't have access to links right now, but that's what I recall.

Canadians believe in things like single-payer health care, an adequate social safety net, funding public schools (we pay taxes in Ontario to support the local school board, I"m not sure about other provinces), we pay teachers a decent salary, we don't let insurance decide what medical treatments someone can get physicians or other health care professionals make that decision, and the like, except in Alberta, which is often called Canada's Texas. We also had legal same-sex marriages long before the U.S., allowed women in combat trades in the military long before the U.S., and allow women to serve in every single trade, combat or not, in the military. We have members of the military who are homosexual and transgender, with absolutely no issue. Sadly, with the conservatives being in power in many provincial governments right now, things like our health care system and our social support systems are being torn apart. :(

[marshwiggle]

Canadian politics are supposed to be somewhat to the left of ours, but they cannot be that much to the left

You would be surprised then. Most Canadians, from the polls I've seen, support supervised injection sites and a safe supply. The majority support things like methadone programs. Don't have access to links right now, but that's what I recall.

Canadians believe in things like single-payer health care, an adequate social safety net, funding public schools (we pay taxes in Ontario to support the local school board, I"m not sure about other provinces), we pay teachers a decent salary, we don't let insurance decide what medical treatments someone can get physicians or other health care professionals make that decision, and the like, except in Alberta, which is often called Canada's Texas. We also had legal same-sex marriages long before the U.S., allowed women in combat trades in the military long before the U.S., and allow women to serve in every single trade, combat or not, in the military. We have members of the military who are homosexual and transgender, with absolutely no issue. Sadly, with the conservatives being in power in many provincial governments right now, things like our health care system and our social support systems are being torn apart. :(

Canadians are also less extreme than Americans. Compare the trucker convoy to the Jan. 6 insurrection. The truckers were noisy and obnoxious, and it lasted longer, but there was no bloodshed. Similarly, we didn't have anything like the George Floyd riots. So there's a much smaller militant faction on both ends of the spectrum. And, because we have more than two parties, it's not just an Us vs. Them dynamic. (If you look at provincial elections, it isn't even the same top two parties everywhere; this reflects that the issues are more complex than  just "left vs. right".)

(And, as noted above, things like universal healthcare are strongly supported across the spectrum. Virtually no-one wants an American-type system. A couple of decades ago there was a survey of Canadians' raking of important government services. National defence came second. Healthcare was first.)

[kaysixteen]

A question came to my mind-- is there anything resembling the current American 'opioid epidemic' going on in Canada?  If not, why not?

[Parasaurolophus]

A question came to my mind-- is there anything resembling the current American 'opioid epidemic' going on in Canada?  If not, why not?

Yes. It's a huge problem in British Columbia in particular, especially in Vancouver and its environs.

Prescription opioids were a big driver, as in the US. Some of these effects were and are mitigated by a health system that's not run for profit, however. And by the 40+ supervised injection sites across the country. And the fact that here, Naloxone is available free and over the counter.

As I recall, Canada is the world's second-highest consumer of opioids, after the US (not surprising, really, since shit tends to roll downhill, so to speak; we are a client kingdom, after all). BC has the highest death rate, and it's about half of West Virginia's (the US's highest when last I checked).

[Morden]

BC, Ontario, and Alberta have the highest death rates. Both Ontario and Alberta are far more conservative (and so have fewer supports like safe injection sites) than the lower mainland of BC.
Govt of Canada summary

[dismalist]

It might be useful to distinguish between a baseline share of the population that is addicted and an explosion of deaths upon the opioid "epidemic".

Here are death rates from alcohol and drug misuse 1990 - 2019

Death Rates

Note the explosion in death rates is limited to the United States, with Canada  having about half as rapid a rise, and the other countries shown, having almost no rise. This last is not just due to nice social programs but also to effective law enforcement.

If one worries mainly about the sharp increase in the death rate, there may be a silver bullet available -- Naloxone, an anti-opioid -- now available OTC in the US in the form of a nasal spray [previously prescription IV]. Medicare and medicaid pay for it, as does private insurance. In addition there are many State and charitable enterprises that give this stuff away free. OTC it would cost < $25 per dose. That's incredibly cheap to save a life!

It's also free in Canada, though its availability in pharmacies, including especially the nasal spray, varies by province.

[kaysixteen]

OK, so how is BC different from say, Saskatchewan, that might make BC more likely to go for the smack?  IOW, Sask. is more conservative politically, right, and so likely to be much less amenable to free injection sites, etc.-- or am I missing something?

How is opioid addiction correlated to homelessness in Canada, and how does that differ from here?   Does one see a large quantity of obviously addicted homeless people panhandling, living in tent squatter camps, etc., like we do even in liberal states like mine?

[Parasaurolophus]

OK, so how is BC different from say, Saskatchewan, that might make BC more likely to go for the smack?  IOW, Sask. is more conservative politically, right, and so likely to be much less amenable to free injection sites, etc.-- or am I missing something?

In the Vancouver area (and on Vancouver Island), the temperature barely drops below freezing in the winter, and that, just for a couple weeks. It's a temperate rainforest. In Saskatchewan, by contrast, you're looking at -20 - -40 for months.

People migrate over because it's easier not to die, because it's a major population centre (unlike the prairies), so employment prospects are decent, and yes, because Vancouver was the main hub of the Canadian drug trade. Unfortunately, it's also the second least affordable city to live in in the world.

Does one see a large quantity of obviously addicted homeless people panhandling, living in tent squatter camps, etc., like we do even in liberal states like mine?

Run a Google image search for 'East Hastings'. It's the poster child for homelessness and drug addiction in Vancouver. Imagine 3000+ homeless or addicted people smashed together into a few city blocks.

My entirely unscientific experience is that East Hastings is significantly worse than anywhere I've seen in the US, including anywhere in Hawai'i, Philadelphia, New Orleans, San Francisco, Portland, etc. (One possibility is that the concentration of misery is just higher on East Hastings, and more widely distributed in US cities.) On East Hastings, more people just seem to be having a much harder time of life than the people I've seen and spoken to on American streets. Not that they were having an easy time, by any means.

[Kron3007]

Yeah, if I found myself homeless I would definitely head west.  I can't fathom being homeless in Toronto, Montreal, etc. During the winter, let alone Saskatoon.

Also, when I was young it was pretty common for people to head west after high school to be ski bums or whatever.  A lot of dudes I knew that headed west were into drugs, and many still are from what I can tell.  The west coast seems to be a beacon for a variety of reasons.

I believe this is also true in America though, no?

[Wahoo Redux]

like we do even in liberal states like mine?

Reflexively seeking a sectarian political answer is a little silly, my friend.

The answer, as someone has pointed out, for the large homeless population in some parts of the country is west coast weather.  We have relatively few homeless where we live despite a rabid drug abuse problem, poverty, and crime because the summers are miserably humid and the winters deadly. 

[nebo113]

1) Is this Canadian drug user org a serious legit organization, or some sort of internet troll thing?   If it is, is there anything comparable on this side of the border?   I say this because, like NAMBLA,

I never thought to equate NAMBLA child sex advocates with drug users.  Where in the world do you get these ideas, K16?