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My Sister-In-Law is a counselor at an elementary school in the Chicago area with one other counselor sharing the caseload, she's been working almost a decade.

Before the pandemic, roughly 10% of students at her school came and went through her office seeking mental health treatment. After the pandemic and school reconvened, that number shot up to about 70% of students and has now leveled out around 50% and held steady for the last year. Of course, being a public school district, they couldn't afford to bring on additional caseworkers, so she's having to ration her schedule to see as many students as she can. And the stories she's getting from her kids are often pretty terrible (lots of alcoholism and domestic-violence related issues).

I read stories like this and it's completely unsurprising to see. Between the trauma of the pandemic, endless school shootings and a future that looks increasingly uncertain ecologically and economically, I get it. Who among us honestly wishes they were a kid in this world in this time? I thank my lucky stars every day that I'm not.

I think it’s also become much more acceptable to seek help for mental issues. When I look back at my school days there were a lot of people who had mental problems. Including me. But there was nowhere to go

Bingo. I personally knew of awful situations among classmates (not to speak of my own issues) that they never seeked help for, and I'm sure thats just a tiny fraction of what was going on.

Maybe there was somewhere to go, but therapy and counselors were not part of the culture.

In hindsight if social media in its current state was around when I was a kid I would’ve had a very, very hard time.

Do you know if the proportion of reports of alcoholism and domestic violence is holding steady? I'm interested in separating traumatic environments from the normalisation of seeking help for universal stressors like exam season.

(I do not intend to imply that people don't need help for exam stress)

I disagree. When considering a broader timeline, we live in a time of extraordinary wealth, safety, and ease (especially in the west). It just happens that these things don't necessarily make us happy or even mentally healthy. Media channels constantly pump us with negativity-- fear, jealousy, and hatred of the other. I think most people just need a serious attitude adjustment. Life isn't easy no matter how many luxuries you have. Everything is likely doomed when considering the larger timeline. Suck it up and make your world a better place.

No one's emotional state considers a broader timeline though. Yes outlook and expectation are important to wellbeing but you can't reason or bully yourself into being happy when you aren't.

Whether it's true or not, in this time there is a pervasive feeling of hopelessness and impending doom. These things aren't unique to our time, other people have rightfully felt them. But also we do feel them now, even if you think we shouldn't, even if the data, when looked at in a certain way, indicates we shouldn't. My limbic system just doesn't care.

> Who among us honestly wishes they were a kid in this world in this time?

Is there any time in history that would have been better though?

That last line makes me so sad. It also boils down to where you live. You can live in countries like china or some arab > asian > european countries and have a better life

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How can you start by saying the pandemic screwed them over, and then claim they could have it so much worse so stop complaining?

I hate this attitude, it seems very Gen X to me. The fact that you can point to any arbitrary decade and find somewhere in the world with arguably more volatile circumstances isn't a reason to discourage people from being open about what they're struggling with, especially because during those times, the problems were just different.

Are we regularly under threat from being nuked? Probably not. Are kids still growing up impoverished in violent and/or abusive households? Absolutely.

Even in the last 10 years, prospects for having a relatively stable life have become a lot more grim, for adults, and that has a lot of carryover to kids

I see a lot of posters confidently saying that the solution is obvious and it's [insert their favourite social panacea here]. The level of confidence does not seem related to the amount of evidence presented.

Examples include: more equality; more opportunity; less democracy; reducing gun accidents; less stress; and less teenage parenthood.

Many of these problems have been around for a long time. For example, the US has long been unequal and long been a democracy. Teenage parenthood has actually been falling. The fentanyl epidemic is relatively recent. You cannot explain a change by a constant.

I would support more intellectual humility and attention to the evidence in thinking about this terrible problem.

A simpler explanation is there's just a LOT more fentanyl on the streets now then there use to be. And then, it's very potent and easy for users to overdose. It's easy to make the jump from those two factors to a rapid increase in fentanyl addiction and deaths. If you remove one of those two factors then you reduce the increase in addiction and death. So either reduce the amount of fentanyl on the streets or reduce the risk of overdose. I think Narcan being made OTC recently is an attempt at reducing the risk of overdose ending in death at least.

A lot of these overdoses are because they think they are taking genuine Xanax or Percocet

Many of the Hays County kids who overdosed thought they were taking Xanax or Percocet; instead, the pills turned out to be counterfeits laced with fentanyl. Fentanyl is easier and cheaper to manufacture than natural opioids. It’s also much stronger, and can be unevenly distributed in counterfeit pills, making dosing more difficult

> I think Narcan being made OTC recently is an attempt at reducing the risk of overdose ending in death at least.

Unfortunately, we're starting to face a new monster named Carfentanil, and that monster is Narcan resistant.

That said, the move to make it OTC will definitely reduce the deaths. At risk people, can now keep it readily available. In the cases where there is someone able to call a medic for their friend, and wait for a possibly too late Narcan application, that person will simply be able to administer it immediately.

According to Wiki, carfentanil is ≈10,000 times more powerful than morphine. We're now talking 10s of micrograms for LD50 in humans. Whilst not as a potent a killer as botulinum toxin (a few nanograms), we're dealing with a substance that's essentially unmanageable.

As Wiki mentions, carfentanil is powerful enough to be classed as a chemical weapon. It's time this message was widely broadcast.

Why is there demand for something that is more likely to kill the user? Is it cheaper to produce? Harder to test for? Does it give a stronger high?

Indications are that it's easier to synthesize than morphine. If so, one doesn't run the trafficking risk with local production. Seems also it's cheaper (pushers make more profit).

(If addicts know they're taking carfentanil and risks associated with it then it's indicative of how powerful a hold the drug has over them.)

An article that just went by on Twitter: https://www.nbcnews.com/news/us-news/california-police-union...

Unaccountable policing strikes again, this time by running organized crime importing fentanyl.

> I think Narcan being made OTC recently is an attempt at reducing the risk of overdose ending in death at least

My theory is that this is why there is so much more fentanyl. If you think of a street level hard drug dealer, other than law enforcement, his biggest problem is the churn of his customer base due to overdoses/prison/going clean. The logical consequence of preventing overdoses is that his customer base will have less churn, expand more over time, and be more profitable. The effect of that is that organized crime becomes a bigger business, with all that entails.

I overheard an interesting tinfoil-hat theory about these overdoses, particularly why they seem to come in waves. It goes something like this:

- The best customers are newly minted addicts. They still have jobs, personally property, and friends and family who trust them. They can spend massive amounts of money quickly.

- Over time, these customers lose access to money as they spiral into addiction. They lose their jobs, run out of things to sell, and run out of friends and family to steal from.

- Eventually, they end up breaking into cars, stealing from businesses, mugging people, and committing burglary.

- This increase in crime attracts the attention of the general public and law enforcement.

- Drug dealers, in order to refresh their customer base and start the cycle over, distribute a 'hot' batch of product that kills off many of their customers.

Not sure how sound this theory is, but I thought it was interesting.

Interesting theory, but the last step doesn't make a lot of sense to me. Wouldn't the dealers be happy to take the money, no matter how the users can get it, and just focus on finding new customers?

The idea is that deaths of drug addicts attract less heat than property crimes. Questionable for sure.

I’ve never heard that customers churning out is a problem for dealers. My understanding is that someone ODing is actually good marketing for their product quality and will bring in more customers.

That's old fashioned, from a time when it meant that the heroin wasn't cut with a bunch of inactive stuff.

Nowadays someone ODing means your stuff is cut with fent, which isn't good marketing.

When every dealers known for ODs it stops becoming a concern.

Customer retention rate must necessarily be an implicit property of any business, even drug dealing.

Different businesses are more or less sensitive to different variables

> The logical consequence of preventing overdoses is that his customer base will have less churn, expand more over time, and be more profitable.

street dealers aren't that sophisticated in my experience. If there's competition they just kill each other. They don't have to worry about demand because addiction handles it for them. All the actual street dealers i've encountered ( quite a few in my 20s ) were basically the equivalent of a vending machine.

edit: well i will admit one clever setup i saw in old East Dallas. A drug house started taking copper as payment for drugs because, at the time, copper scrap was very valuable. So like the dealer would take a bunch of copper pipe in trade for drugs. It made for a rash of ridiculous copper thefts, like breaking into and stealing all the wire out of the walls in apartment construction sites.

I'm not describing any sophistication on the part of the dealers; what I'm attempting to describe is more akin to the proliferation of a species in a given ecological niche if more food were introduced. If the drug users die less, the dealers have more customers and make more money, and everything else follows from there.

Narcan only works if there's someone else who can administer it. And that someone else should be sober enough to do it.

I’m in the U.K. and how do you even get this? I’d happily keep it on me but there’s not much info

Edit: oh it’s illegal unless you’re in a very specific position that will likely not save anyone unless it’s very lucky thanks U.K. government. Dickheads.

There are lots of people who believe someone ODing on fentanyl deserves to die.

A lot of people go the brink and come back and live happy lives.

Yes that policy seems dumb. I'm all for everybody being able to buy it. I'm not at all for having to use public funds to pay for it. Let all the saints buy it over the counter with their own money to be the hero, and spare me the tax money.

It used to only work when there was someone to call a medic, and hope they arrived in time. Now, if there's someone to call a medic, then that person can just immediately administer the Narcan. Thus, the point about reducing deaths still stands.

Unfortunately nobody’s confused about the explanation. It’s finding a solution that’s the problem.

People are arguing that more equality, reducing gun accidents and less teenage parenthood will reduce the number of Fentanyl Overdoses?

Might as well ban the sale of Purple Shoes as well, who knows how many lives that could save...

Notice how Barnett has zero empathy when he thought it was just an Austin thing, then did an about face after the subsequent deaths in Kyle.

However I still don’t understand the point of lacing drugs with fentanyl. As a drug dealer you make more money with living clients, right?

For the most part it's not intentionally lacing drugs, it's poor quality control and cross contamination.

No one is intentionally mixing fentanyl and MDMA or cocaine but with poor lab work it's easy to get a bit of the wrong whitish powder and the people selling it down stream have no more idea than their buyers what's really in it.

Affluent recreational drug connoisseurs can use basic chemistry and test kits to be highly confident what they're taking but even they get bit sometimes if reckless and using a new source.

Oh I see. It takes 2mg of fentanyl to kill a person so I bet that much ends up on dirty lab equipment.

Precisely this, yes.

Anecdotal: I have had many exposures to the illicit drug markets in my areas throughout the years. The symptom of many underlying unresolved issues I am sure, but that is not relevant. What I wish to say is that I have seen many pressed counterfeit tablets in my lifetime and have had the luxury and wherewithal to test a majority of them before usage. I have personally never identified fentanyl in a product that was not marketed as an opioid. With illicitly manufactured oxycontin and its ilk you will come across it a majority of the time. But with other things such as MDMA, ketamine and such it's incredibly rare to see. That is not to say it doesn't happen however, there have been instances of things containing fentanyl which had no business doing so. Despite this I echo GP's claim that it's largely due to inadvertant cross contamination than it is some intentional reason. The supply chains for these drugs are very long and windy once they are finalized for consumer use inside the US as well, with many middlemen making a few dollars to facilitate a transaction. Each of those hand-offs is one more opportunity for the new seller to say "I bought X, but could sell much more if I said it was Y", and that ends up killing people occasionally too.

Hypothesis: There is a number of factors at play here that add to the death toll. There is the occasional unintended cross contamination during production. It's also worth noting that individuals who import bulk drugs from overseas for their own sales often order multiple different substances and craft them for sale, further increasing the chance for that contamination during production. There is the fact that fentanyl and a majority of it's analogues are active at shockingly low doses relative to more classical opioids, which makes improper distribution of active ingredients into the final pill mixture highly likely when you consider they are usually not created with the best quality control procedures or equipment. There is the fact that younger users (I would argue they are more experimenters than users per se) of opioid drugs have less physical tolerance to these chemicals. We should also consider that youths also have less practical experience, and not knowing the "lay of the land" with these substances can kill you very easily. And then of course the obvious increase in the average American's listlissness, hopelessness, economic uncertainty, fear of the future and so on. The ground under our feet is shifting and drugs are a temporary respite from that, if harmful long term.

Add to this the fact that we have a very drugs-illiberal society on the whole, whose governments oftentimes think the best way to address this problem is simply banning substances or once in a while executing operations to damage the supply chain, while completely avoiding the idea that perhaps most usage of these substances is symptomatic of a problem and not the problem itself? And you end up with an firehose of drug analogues that can escape easy regulation and restriction juuuuust long enough to gain a foothold in the market and shift the consumer culture of a particular drug. It's not a problem you can legislate your way out of, and it never will be.

All of this is to say I expect US overdoses per capita, the "never-before-seenness" (and by extension lack of medical knowledge surrounding it) of the drug analogues on the market, and the overall appetite for drugs of dependency, all to continue increasing for the forseeable future. I wish it wasn't this way. But like most of the US' modern cultural issues we enjoy arguing about what could offer relief far more than we do finding a bipartisan way to address them.

> With illicitly manufactured oxycontin and its ilk you will come across it a majority of the time. But with other things such as MDMA, ketamine and such it's incredibly rare to see

To anyone reading: Please don't take this at face value. The article itself has a story of someone who OD'ed on fentanyl that was present in their "xanax".

From reading the results from the harm reduction tent at a nearby music festival it's in all the drugs, not just opiates

That is absolutely horrific. I cannot fathom what reasons would compel someone to sell product tainted that way. Especially at a music festival; most of those consumers know their drugs and I imagine would not be the market at which to try selling that kind of shit. The long term money, customer base and word of mouth all benefit more from having non-opiate products sans fentanyl. Even if you're just trying to make a few grand at a music festival. hell, a hit and run business at a music festival with totally inactive products seems a better option than something like dumping fentanyl into (counterfeit) xanax bars.

And yeah, don't take what I say at face value. I'm a nobody on the internet with one story out of billions. Test everything. Every single time.

Just too drive home this point a little deeper. I personally know 2 people who died last year from fentanyl poisoning. One of them thought they were taking MDMA, the other thought they were taking Xanax. Both are terrible, needless deaths but the one who was taking Xanax had actually been prescribed Xanax previously for GAD, but was having trouble getting/affording a doctor to prescribe it to them.

I offer as many condolences to you as my internet connection can carry. Reading that you lost someone who was merely trying to take care of themselves really, really hurts.

I graduated high school in the mid 00's. When I last ran the numbers in 2018, my graduating class of ~250 had lost roughly 4% of its people over the years due to OD.

I deeply want this set of problems to get better, but I cannot convince myself that it will during my lifetime.

The person selling drugs at a festival is extremely far removed from the illicit manufacturer. They almost certainly have no idea the quality of drugs they sell or what’s really in them.

When it comes to festivals, the persons walking about selling hand to hand are some distance removed, the person who decided to sell at Glastonbury (for example) or other festivals aquired supply by the van load, acquired a crew of runners, pushed back against others wanting target the same festival, and is considerably closer to the upstream source and has a damn good idea of the quality of the bulk amount they sourced for that market.

> But like most of the US' modern cultural issues we enjoy arguing about what could offer relief far more than we do finding a bipartisan way to address them.

Puzzling over how we reach bipartisan without ever getting to the agreement part.

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Exactly. Particularly with pressed pills it's almost impossible to know what really in it without a chemistry set, and the people mixing this stuff aren't moonlighting after their day job at the CDC.

Fentanyl costs on the order of $1,000 per kilogram to produce and that’s enough to cut hundreds of thousands of doses of another drug while making them significantly more addictive. It makes other drugs so profitable that the loss in customers is well worth it. There’s a future user born every minute, afterall.

> Notice how Barnett has zero empathy when he thought it was just an Austin thing, then did an about face after the subsequent deaths in Kyle.

I didn't see this in the article. I read that Barnett didn't realize the trend until after a few events - but I didn't see anything indicating a lack of empathy. It's possible to both be emphatic and think an unfortunate event is a one-off caused by external factors, for which a policy change is not necessary.

I don’t think drug dealers are very thoughtful. Whatever makes quick money is fine. And they probably don’t even know what’s in their drugs.

Yeah the rest of the article said that it is cheaper to make than most opioids so I guess it is just the walmartification of illegal drugs: fast and cheap and shoddy.

Illicit fentanyl is mass produced in foreign pharmacy (90% in China), and pretty easy to smuggle in (used to be direct, now via Mexico), making it really cheap. There is also licit fentanyl to consider, which can become illicit due to prescription fraud or theft, but usually its cheap enough to just get illicitly imported fent.

China cracked down on fentanyl manufacture in 2019. “90% in China” is now more like 3%.

Nope. The only thing that has changed since 2019 is that people in China are no longer mailing it directly to the USA anymore (China cracked down on that because America threatened to end preferential mailing rates from China to the USA). Beijing is no longer cooperating with US authorities on stopping fentanyl flow from China:

https://www.wsj.com/articles/fentanyl-crisis-fed-by-flow-of-...

The chemicals are still making it to Mexico from China, that is still easy to track:

https://www.cnn.com/videos/world/2023/03/08/fentanyl-pipelin...

https://www.texasstandard.org/stories/fentanly-drug-path-chi...

Etc...

TLDR; China is still the source for the vast majority of fentanyl in the states (a lot of it is seized in Mexico in containers that come from china, though they get around this by just shipping a lot of it), and no one (including China) is really claiming otherwise since it is just too obvious ATM.

Easier logistics too because of the higher potency. If something is 10x more potent gram for gram, you can take the same revenue while spending 10x less on transportation while simultaneously reducing the chances of getting caught because the volume is so much smaller. Or conversely, for the same risk and transportation costs, make way more money per gram shipped.

Not zero empathy. One's his county (Hays), the other's not (Travis).

> However I still don’t understand the point of lacing drugs with fentanyl. As a drug dealer you make more money with living clients, right?

I don't get that either. Maybe the dealers actually want their clients dead. Or maybe they're incompetent.

They want their clients hooked. A few percent attrition for your SaaS product makes sense if you convert 50% more of your first month subscribers to annual.

The street dealers aren't usually the ones cooking them and therefore don't know what's in them.

but someone is and does?

True, but it's quite possible that people who cook illegal drugs for money often don't care because they get paid by the distributor. At the end of the day, they're just trying to make a living like the rest of us, and they usually don't have to care about what happens to their users because its outside of their feedback loop.

An analog to the tech industry would be the universal frustration with end user data collection vs its continuing proliferation.

Most of us don't like the lack of privacy online and how much data companies capture, and many if not most of us work at companies that aren't capturing end user data. But many if not most of us, do make tools that are sold to companies who do capture an insane amount of user data. Ultimately, we still are often paid, at least indirectly, through privacy-violating user data collection because it's an extremely common web monetization model.

I'd be willing to bet that there more than a few Facebook engineers on this forum who unironically complain about the lack of privacy on the web. But what pays their salaries?

Illegal drugs are a perfect competition market like grain or white label milk. Not really a big opportunity to differentiate with a brand as you can't register a trademark or defend it in court (lol). A minor price advantage brings vendors a magnified sales volume because it is just so cutthroat. See: https://en.wikipedia.org/wiki/2008_Chinese_milk_scandal

> However I still don’t understand the point of lacing drugs with fentanyl. As a drug dealer you make more money with living clients, right?

I always assumed the dealers knew they had terrible cocaine and would lace it with fentanyl to give it more of an effect. The problem is that such a small amount is lethal so it doesn’t get mixed well enough or they just put too much in.

No idea if that’s why.

The only thing that's going to solve this is safe and regulated access to clean drugs. Cut the black market dealers out of the market, and dump all the profits into harm reduction and addiction prevention and treatment resources.

The "tranq" additive that's becoming endemic in streets drugs doesn't respond to narcan either. It's only going to get worse. Wait till carfentanil gets into the supply.

This is what I support too. If you could buy safe, laboratory made & tested cocaine or whatever in the drug store, the overdoses would basically end. We'd still have to deal with people who want to just shoot up in the back of busses in big cities. But we already have that problem. We have a problem with drunk drivers, but we already learned that prohibition didn't work.

We'd have to sell it cheaply enough that the black market wouldn't under cut it. And I can't see this every passing in america. Maybe if every congressman in america had a kid who almost overdosed?

This is the best and quickest solution. It's not without its own problems but they pale in comparison to the situation we currently have.

Too bad more people don't know how or don't have access to darknet markets. They are a panacea for drug safety problems.

Maybe this is the way. Spread knowledge of how to safely order from dark net markets and receive the orders, and saturate high drug use areas with quality and purity testing labs.

The average street drug user won't have capacity to learn how to order from darknet markets and may not have an address to receive it either.

Wealthy, tech literate demographics get their drug of choice safely while the poor or the youth getting drugs from "friends" or dealers keep filling body bags.

DEA's Fentanyl Flow to the United States (pdf)

https://www.dea.gov/sites/default/files/2020-03/DEA_GOV_DIR-...

Yeah, it's an open secret nobody wants to ever talk about in these threads. The fentanyl problems in the United States are essentially a direct social attack by the Chinese on the US. It's basically intentional in every way that matters.

You don't need to invoke conspiracy theories here: the trade is vastly profitable and that's what's driving it. If China cracks down (in reality, not just on paper), production will just shift to India or Vietnam or wherever.

For what it's worth, China as a whole (both the people and the government) remember the Opium Wars quite well and are thus strongly anti-drug: stats are thin on the ground, but by all accounts drug offenses are the top reason for the death penalty. Of course, it only take a few factories to churn out vast quantities of the stuff, and the profits are sufficient to lubricate any officials who might otherwise object.

From the reference you replied to:

> Effective May 1, 2019, China officially controlled all forms of fentanyl as a class of drugs. This fulfilled the commitment that President Xi made during the G-20 Summit. The implementation of the new measure includes investigations of known fentanyl manufacturing areas, stricter control of internet sites advertising fentanyl, stricter enforcement of shipping regulations, and the creation of special teams to investigate leads on fentanyl trafficking. These new restrictions have the potential to severely limit fentanyl production and trafficking from China. This could alter China’s position as a supplier to both the United States and Mexico

Given that the US and China are effectively engaged in a cold war, this "commitment" means virtually nothing. Sure, all commercial production and distribution may have been restricted, but I would bet that would not stop their military or intelligence organizations from continuing to engage in this form of social warfare. The CIA has done much worse with less at stake.

agreed, their lack of commitment in stopping any kind of ransomware attacks that come out of china speaks the same sentiment

What's crazy is that the big government solution to this was to build a wall at the US-Mexico border.

Mexican drug cartels are leading suppliers of cocaine, heroin, meth...

There is no wall high enough to even make those things pause for a second.

Big business will not be stopped by a wall.

What should they do?

I've been sitting here reading this whole thread wondering the same thing.

I don't really know how I would go about it, but I think the only solution is to make people not want to turn to the drugs in the first place.

Make poor people less poor? Make people feel better about their lives and prospects?

I guess I would spend a heap of money working out what makes people turn to the drugs and try and help them solve those problems some other way.

> Make poor people less poor? Make people feel better about their lives and prospects?

I think those are two unrelated issues. There's many places in the world where people have substantially less than in the US but have much higher life satisfaction and extremely lower rates of drug addiction.

Many young people are dying of accidental fentanyl poisoning because they get counterfeit sleeping pills or whatever from their friends. Sure we should absolutely reduce the factors that cause people to turn to drugs. But some people are always going to have insomnia. Some people are always going to want to alter their mental state.

https://peterattiamd.com/anthonyhipolito/

I've taken drugs my whole adult live and never witnessed a faulty product except badly grown weed.

There are rules for safe drug use. There are test kits (today, back then they were expensive) and most countries gladly have drug checking places as well.

The issue aren't the drugs but the culture and knowledge around it.

Your personal experience is meaningless. Mexican drug cartels are literally producing faulty product today. Watch the interview that I linked above. Counterfeit prescription pills randomly contain fatal doses of fentanyl due to poor quality control.

There is no "culture" here. It's just some kid getting a pill from a friend at school. They're not going to check it for safety.

15 year olds are not going to go to some narc in a suit to check if the smart pills they bought on tiktok are legit or not.

Not sure how drug checkings looks where you are but this is exactly what 15yo me and his peers did.

My modest proposal is to make drugs OTC for adults. Regulate the supply and most of the problems disappear. The war on drugs has failed, we need to abandon it in the west. People want to get high, not die. Give them the ability to manage their addiction with dignity and safety.

No. The opioid crisis is completely manufactured in the USA by US drug companies such as Purdue Pharma. China is just profiting off it. Your xenophobic conspiracy theory is laughable.

This report is a bit old. Since then, China no longer manufactures fentanyl (for the most part), and does not ship fentanyl precursors to the USA.

So the flows look much different now. The precursors are shipped to Mexico, where fentanyl is produced in small labs, often trained by Chinese associates, and then shipped to the USA.

> produced in small labs, often trained by Chinese associates, and then shipped to the USA.

Same thing, more steps, more plausible deniability. What's the diff?

Well for one, if China stops supplying Mexico, and the USA stops all illicit deliveries of anything from China…

That won’t solve our problem because Mexico will buy chemical precursors from Brazil, India, or any of the large chemical companies in Mexico. The labs are already there (invested capital) and the chemicals (marginal costs) aren’t specialized.

So the “solution” has changed if you want prohibition. I mean, we’ve tried prohibition for 70+ years now. It doesn’t work. But we can keep trying!

> So the “solution” has changed if you want prohibition. I mean, we’ve tried prohibition for 70+ years now. It doesn’t work. But we can keep trying!

I'm not sure that our dabbling with legalization is a panacea either. Maybe we should aggressively try both at the same time. Extremely harsh punishment for dealers, decriminalization for users, well funded treatment for anybody who wants it.

I think the only solution is for the US to conquer the other half of Mexico that it didn't annex in the 19th century. Feasibility: uncertain.

The article places a lot of blame on the state of Texas:

> Directing blame at Mexico is also a way to avoid looking at how Texas fails children.

But also includes anecdotes like:

> When Noah awoke from his coma, he was tearful and apologetic. He thought only a few hours had passed; it had been four days. Janel and her husband called treatment centers, but none would take Noah without his consent, and he insisted that he didn’t have a problem. Even so, Janel was hopeful; that summer was one of the best they’d had as a family. Noah was dating a sweet girl, and when he wasn’t with her he seemed happy enough to hang around the house doing TikTok cooking challenges. Then, the first week of school, sixteen days after Janel gave birth to another son, Noah overdosed at his girlfriend’s house.

It seems to me that if a child overdoses, but refuses to accept their parents demand to seek treatment, they should be denied privileges - forbidden from spending time with unapproved friends, denied a cell phone, denied allowance, etc. This case (and a few others) seem to be clear cut cases where a parent could have forced compliance, but choose not to - I can't imagine any kid choosing no friends and no cell phone to avoid going to one hour per week of narcotics anonymous.

That was my dad’s strategy and I overdosed three times in high school, 20 years ago. We don’t talk anymore.

A large part of the problem was not having my own social group from being grounded for a full year when I wasn’t getting all my homework done.

Am I to understand you blame your father for overdosing 3 times?

Largely, yes. Every aspect of my life was heavily controlled and I had very little freedom to choose how I spent any of my time or efforts. I was still a child then, not an adult. I’ve had no problems with addiction since becoming an adult and being in control of my own life.

Would you blame yourself if your 3-year old overdosed on Tylenol he grabbed from your medicine cabinet? Would you blame yourself if your 17-year old daughter chose to commit suicide by grabbing a bottle of Tylenol from your medicine cabinet?

Were I your father I would blame myself, without a doubt. But that doesn't mean it's not strange to me that you blame him.

draconian parenting in a free society leads to incredibly bad outcomes. the parents undermine their own authority and the child doesn't know any better but to rebel. this is why parenting is hard, you need to walk a fine line between 'friend' and 'jailer'.

a lot of immigrants have a tough time with this general concept - they have no idea what it's like growing up in the US, none whatsoever. it produces wildly bi-modal outcomes. the ones that end up on the bottom of the curve are left scratching their heads, because they're ego-driven/stubborn or stupid, or both. and plenty of the outwardly successful kids have issues later on.

also the reason i'm not going to have kids. i don't think i could handle it, and this isn't the sort of thing you get another shot at.

Can I ask - if you had the choice between attending treatment or being grounded, why did you choose to be grounded?

None of my family or friends were aware of my drug use at any point. That choice was not presented to me.

Furthermore, rehab would not have fixed my conditions that led to addiction. I turned 18, my father moved out, I immediately found better things to do with my time now that I was free to plan my own day. And I never struggled with addiction again.

I don’t think rehab would have helped, because it couldn’t solve my actual problem.

I'm glad you're doing better these days, but it's not at all clear to me how your experience relates to my original comment. In that comment, I suggested that parents should use the restriction of privileges to incentivize a non-compliant child to get the appropriate treatment for a substance abuse disorder. You indicated that your father restricted your privileges for such a long time it had a negative impact on your development but that your father was not aware of your substance abuse disorder. Then, the restrictions couldn't have been to incentivize you to get treatment. So how was your dad's strategy similar to my suggestion?

I'm glad you're doing better these days. As a father to very young kids, I'm curious to learn what I can from your experience. Was your father controlling you in a misguided but well-meaning attempt to shield you from "bad" stuff? Or was it more malicious? I don't plan to be the second type, but if your dad was also trying his best, how does a parent balance preventing obvious bad things from happening but also give enough freedom to not stifle the kid?

In my experience, you cannot force or punish someone out of problematic substance abuse. If it was that easy, we'd already have the solution. These kids are engaging in this behavior for one reason or another and the solution isn't to make them feel worse about it than they already do.

I was required to attend alcoholics anonymous for three months to continue in university after passing out from intoxication on the quad. Hearing those stories led me to stop experimenting with new drugs and reduce my drinking - I didn't want to become those people. I don't know that such cautionary tales would necessarily have helped this child, but they might have.

Let's not forget that attending substance abuse classes is the recommend medical treatment for substance abuse, a medical problem. Doctors wouldn't recommend it if it didn't work sometimes. Imagine if the story was about a broken leg instead of substance abuse and the child similarly said they didn't feel like anything was wrong with their leg, and so it similarly went untreated.

> I was required to attend alcoholics anonymous for three months to continue in university after passing out from intoxication on the quad.

That's quite different from consuming synthetic opioids in elementary / middle school. The former is fairly common at colleges and universities in the west. I'm glad that you were able to dodge that bullet though.

> I don't know that such cautionary tales would necessarily have helped this child, but they might have

They certainly didn't for me. Adolescents aren't necessarily known for their ability to accurately weigh long term consequences when making decisions.

> is the recommend medical treatment for substance abuse, a medical problem

AA and NA would like to disagree. Spirituality is the central component of these programs.

> Imagine if the story was about a broken leg instead of substance abuse and the child similarly said they didn't feel like anything was wrong with their leg, and so it similarly went untreated

A broken leg would be painful enough to spur anyone to seek treatment. Consequences from substance abuse and experimenting with drugs often don't manifest as quickly or as obviously.

The bottom line is that putting further shame on a person who is abusing substances, often leads to the further abuse of substances. This was the case with myself, and most people I encountered throughout my trips to AA / NA meetings, rehabs and a halfway house. I didn't start getting better until I began loving myself enough to stop wanting to slowly kill myself. Punishing or shaming a child who is suffering or simply comitting a mistake, is most certainly not the key to ending their suffering or helping them to realize their misstep.

That could as easily have backfired, especially because AA is religious and has cultish vibes. A young person who drinks that much might well end up deciding to say fuck this and drink even more.

We know there are better and more effective ways (Sinclair method, or even just reading The easy way to stop drinking), but they don't have the cultural heft that AA has.

Physical dependence on these guys is substantially stronger than alcohol. Takes days to get off, and then constant cravings.

You really think "you're grounded" would have helped in this situation?

It's not always easy dealing with teenagers you know. That's why you have to treat them like little adults when they're younger, all the way from when they're toddlers really. Children don't usually focus on the long term, so you have to make them see the long term.

“forced compliance” is not a reliable strategy.

https://archive.ph/IhGh9

I don’t get how the DEA is able to cause an ADHD medication shortage by limiting supply and yet at the same time pharma companies are allowed to just manufacture as much fentanyl and other opioids as much as they want.

The illegal fent isn't coming from legit pharma companies.

Well by definition the illegal fentanyl isn’t coming from legal drug companies. But believing it has always been illegal fentanyl seems somewhat ahistorical. It wasn’t that long ago that Purdue Pharma, the Sackler Family, and other pharma companies settled for billions of dollars for their role in the opioid epidemic. It hasn’t always been cartels and China.

It isn't being illegally diverted from legitimate supply, for example. The street fent comes from a wholly criminal supply chain.

The prescription opioid "epidemic" re: Purdue et al was exclusively or virtually exclusively non-fentanyl opioids.

Seems odd to me we just smoothly slid from the prescription opioid crisis to non-prescription, illegal fentanyl. I’m not saying it’s some big conspiracy where pharma is secretly selling to cartels or anything. It just seems like a weird coincidence. E.g. did the crack down on prescription opioids lead to a large backlog of unused precursor chemicals and feedstocks that could end up in the criminal supply chain?

The crackdown on pill mills lead to a huge increase in demand for black market opioids, which was initially met by heroin and later fent. I think criminal fent manufacturing just happened to develop in that time period but market forces can’t be ignored.

The fentanyl is mostly made in Mexico these days[1], I don't think the pharma companies could compete on price...

1: https://www.bbc.com/news/world-us-canada-64047688

More details posted by another user earlier https://www.dea.gov/sites/default/files/2020-03/DEA_GOV_DIR-...

Most of the chemicals comes from China and is manufactured in Mexico then comes over the southern border into the US.

https://trone.house.gov/2023/01/08/chinas-role-in-illicit-fe...

Sure it’s coming over the border by Americans. Why isn’t this an issue down in Cameron or Hidalgo counties?

It's controlled by the cartels, the mules who actually bring it over can be anybody; whoever the cartels feel comfortable with.

You are missing the point. Out of all the counties in Texas — why is it that Hays county has the biggest problem. Hays county is just south of Austin, in central texas.

Sure it could be cartels, it could also be snowbirds bringing meds from Mexico to people in the north. You and I don’t have conclusive evidence of either.

>why is it that Hays county has the biggest problem

No idea. I'm certain it won't be limited to that county for long. I assume the cartels are selling it to somebody who is then selling it at the schools or at a local hangout that the students go to.

>You and I don’t have conclusive evidence of either.

Trone said “99 percent of the fentanyl is coming from precursor drugs from China, and then it’s manufactured by two cartels, the Jalisco and Sinaloa Cartels, and they’re the ones that are bringing it across the border,” adding that it’s important to stop it from the source.

This is from the government report I linked up above. That's what I was going on. That seems fairly conclusive evidence if you trust the report.

As an aside, further down the linked article this is stated:

Fentanyl is coming from Mexico, but it is most commonly brought through ports of entry, by U.S. citizens.

They don't cite any evidence, so I'm not sure where they came up with that, but it directly contradicts the government report I linked.

Used to come in straight from China through the mail. It's chemical warfare

I don't like this propensity to blame china for everything.

If your ordered a dangerous substance, and it arrives clearly labeled, they've done their job.

If you are putting it where you shouldn't, it's on you.

Given what the West did to China in the Opium wars, we would do well to teach history better.

They say those who don't learn history are doomed to repeat it. Well here we are and it seems the CCP's learned from the past. Have we?

@ClumsyPilot https://www.justice.gov/usao-ndca/pr/san-jose-police-union-e...

impressive!

What are you talking about blaming China? It's a fact. The CCP was (is) involved with/accepting of producing fentanyl and sending it to the US. Yeah, people wanted it and they got it. I see nothing wrong with that other than the potential for cross contamination or mislabeling if someone messes up on an order.

Please read about the opium wars. You have no idea what kind of force you're encouraging passivity to.

Fentanyl is an opioid, most of which is produce by china which is currently trying to play the opium wars in reverse while most westerners pretend there is no precedent to what is going on.

It’s funny/sad to ask the pro-drug crowd if I can get my prescription medication without going through a doctor. People flip out.

Only took me 2 years to get a prescription for a common but off label use for one medication.

> prescription medication without going through a doctor.

What does it mean?

I think the OP is pointing out his observation that the folks who argue for drug decriminalization are also the ones most likely to be offended by the idea that medicinal drugs, like an antibiotic, be obtainable without a prescription.

The stories the cartel guys told in federal prison about what they made people do to get their supply still makes my skin crawl. If you support keeping drugs illegal you support teenagers (that society has decided aren't responsible enough to buy alcohol) being subjected to the worst things cartel guys can up with to be 'entertained'. Period. If you want to keep this garbage illegal you support and are OK with a level of abuse that you can not shake once you hear about it.

Best book on addiction, period https://drgabormate.com/book/in-the-realm-of-hungry-ghosts/

I never understood why you'd supply a drug that kills your customer base.

I gist I get is that cheaper-to-produce counterfeit pills laced with Fentanyl are causing accidental overdosing because people think they're taking something else.

And the bogus pills are wildly inconsistent in the dose they deliver.

Before I'd only heard the complete bullshit from Fox News that Fentanyl laced Halloween candy will kill your children if they even touch it.

It's not that dealers know their drugs will definitely kill customers, it's that they don't know what's in what they're selling and they're smart enough to know not to ask questions of their suppliers.

I bought a THC vape cartridge in a non-legal state several years ago, right around the time when there was a spike in hospitalizations and deaths around fake THC carts. My guy promised me that it came from Colorado, but I googled the brand name from the packaging and quickly discovered that it was counterfeit packaging that anyone could buy on Alibaba. Maybe my guy knew that it was fake, maybe he didn't. But that's the crux the black market, unless it comes from the earth, you can't really know what it is you're getting.

> It's not that dealers know their drugs will definitely kill customers, it's that they don't know what's in what they're selling and they're smart enough to know not to ask questions of their suppliers.

Same difference. Why do the suppliers think it's smart to poison their product?

They may not use this logic but it’s churn rate vs. customer lifetime value.

When your product is consumed by people who are at one point or another in the process of killing themselves, it’s all churn all the time.

Dealing opiates is a high volume, high frequency business. If cutting x or y with fentanyl both saves significant money and even helps you extract some more transactions from the customer before they OD for the last time, it’s a business advantage.

The market for junkies seeking out “high quality opiates” is vanishingly small. People get hooked on fentanyl, literally want it, and then it’s game over.

Basically death is where the high growth is.

I wish I had used the term addicts and not junkies.

How many times do people have to ask this. There's poor quality control of illicit drug production.

So it's fentanyl residue spilling from actual fentanyl-for-sale, into other product?

If so, that's a very clear explanation I actually haven't seen stated so simply before.

Basically, yes. It's fentanyl residue in some level of the chain after multiple steps of purchase-cut-resell.

At some layer of the long winding black market route, people will be cutting drugs with any sort of lacing to increase profits, they might be dealing with multiple different kinds of drugs in high volume and use fentanyl to cut their heroin/opiates to get more potency out of less product. When using some tool that wasn't cleaned properly and still has residues of fentanyl (which has a ridiculous high ratio of potency vs dosage) it ends up getting mixed into other drugs.

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A lot of people thought those Alibaba brands were real. By the way, it was vitamin E used to cut the carts that caused the lung problems, for those who don't know.

> I never understood why you'd supply a drug that kills your customer base.

I was a private yacht chef for 6 years. One yacht guest was the biggest condescending jerk so I made him what he said was the best food he has ever had in his life and thought I was putting in the extra effort to impress him. Diplomacy is telling someone to go to hell and make them look forward to the trip. When I liked guests they ate much more plain simple food. If I serve the most perfect Foie Gras, Beef Wellington, and Creme Brulee to a person am I breaking the law? Heart disease the biggest killer in the United States. I haven't worked on a yacht in over a decade and I'm still very close with one family I worked for, for whom I cooked very healthy food. I have joked during that time the reason I cooked healthy plain food for them was that I liked the job security knowing they will be around for a while. One of the many reasons I became a software engineer instead of working in restaurants was guilt feeling like a drug dealer while I ate healthy food which I cooked for myself and friends. Don't get high on your own supply.

The connection between food and heart disease is not nearly as strong as you seem to think. Heart disease is multi-factorial, with genetics and (lack of) exercise also playing a big part. You could stuff someone full of foie gras for an entire yacht trip and they're likely to be just fine.

My understanding is that people aren't intentionally buying fentanyl. They're buying "heroin" or "oxycodone" which is really just a tiny bit of fentanyl with something else to make the dose look right.

Since fentanyl is so strong, it's pretty easy to screw up the cutting and people end up dying occasionally.

Not only heroin or oxy, nor even opiates. It can come from cross-contamination, a seller might cut their heroin stash with fentanyl, let's say they use a scale to try to dose it, they don't clean the scale properly and then use it to weight some cocaine. Done, you have cocaine mixed with fentanyl.

The sheer density helps get it through the border. Smuggling less dense drugs is just more expensive. And opioid addicts aren't especially rational about risk / health to begin with.

London disagrees, cocaine is regularly found in Parliament and in the City.

I'm not sure cocaine is a good example, seeing as how a backpack full of cocaine is worth $360,000+

What does that show disagreement with?

Where is the disagreement?

That’s a fallacy that took me a long time to get over. People do not behave rationally. It is as simple as that. I can argue logically if everyone thinks logically and treats their fellow human being with decency respect and concern, we would all be better off. They will simply laugh at me as gullible and naive while stealing me blind.

I dont think it’s intentional.

With heroin, you can eyeball an appropriate dose even if it’s 100% pure.

You cant do that with fentanyl.

You’re giving a lot of credit to drug dealers. All the ones I’ve ever known had to no clue what they were selling and as long as you paid they didn’t care what happened to you. If they were regular functioning humans then they wouldn’t be drug dealers.

I would really like to hear from the kids about why this is happening. Any explanation from anyone other than them is just conjecture. We won’t understand this until they start speaking for themselves.

While not a bad impetus, young people tend to be talented at identifying the proximate cause but may not have any idea what the root cause is.

It can take time to get the full picture, even for people directly involved.

My sense is that the use of drugs by teens occurs mainly due to:

- ease of availability

- teens being too trusting of other teens

- teens having too much time on their hands and not enough vision of the long term

Parents have a lot to do with this, naturally, but of course some of these teens have only one parent, and others have two working parents, and there's only so many hours in the day.

- teens are immature and ignorant

Well drugs feel really fucking good, and living as a teenager these days does not.

I happen to live in Kyle and also have the experience of attending rehab twice (2016 and 2019). I was never into pills, although I would gladly take them if they were being offered by a friend at a party, or there was a prescription lying around the house. Thankfully I got my shit together and don't engage in that type of destructive behavior anymore. Some of the comments and replies posted in this thread seem quite out of touch with reality though...

I spoke to a few folks I attended rehab / lived in a halfway house with, and those who had been using fentanyl said that nothing compared - subs, heroin, morphine, you name it. The first time I went to rehab, the majority of people there were there for pain pills and heroin. The second time around, almost all the opiate users were using or had at least tried fentanyl.

The problem with subs and methadone, is that it gets into your bones and both substances are addictive in themselves. Trading one addiction for another, even if less harmful, never works out well. Drugs being illegal isn't the problem here - I used to think that if the US followed in the steps of Portugal, the country would be much better off - we're talking school age kids here though. They're not thinking about legal consequences nor are they going to seek out help. They're going to try something out of boredom, some sort of mental state or because their friends are doing it, and with fentanyl many are going to end up dead.

It's easy to understand why kids are becoming increasingly despondent and increasingly turning to drugs for an escape. They don't have a chance to grow up before the weighty issues of the world are thrust upon their shoulders. Between social media, the news cycle, and the education system in our country - they're being done no favors. When they can't handle the load anymore, they often have no one to turn to as their parents are busy working to sustain a family. It's going to require a reckoning (for all of humanity) of what is truly valuable in life - chasing a dollar or being present.

Reading the headlines, seeing the billboards, hearing the stories on the radio while driving is all pretty surreal. I'm not sure what the solution to the problem is, other than making sure one's children know that they are loved and being the best parent one can. I know for me, fear is what caused me to use and that fear manifested itself in many forms - mostly a dissatisfaction with reality. I pretty much had to reshape my entire perspective regarding my existence and reason for being, before I found a way to move past my substance abuse issues. I'm not sure how you help a child realize there's more to life than what can be perceived with our five senses, and that every life is worth infinitely more than a pill or a fun time, but I suppose I get to figure this out with my own son.

I hope that we can all show one another a little more love in this world, and that we can also stop being sold on so much fear.

I had an oxycodone addiction in high school 20 years ago. Quite a few other students I knew did as well.

Many of them sought help for it. I did not - I quit cold turkey after my third mild overdose. I had access to a nearly unlimited amount (>400 pills) left over from an earlier surgery.

For me opiates were a very effective relief against terrible emotional pain. I think just being there for your son a lot, including him in your activities as much as you can, treating him like an adult that you accept, will go a long way to immunizing him against addiction.

It’s important that your son feel it’s safe to bring his shameful actions to you for hands-off advice and support.

That last sentence is definitely not how I felt growing up - not because I had bad parents - but because their parents were pros at shaming them and they didn't realize they were carrying on that legacy. I hope to break that cycle. Thanks for summing it up so succinctly.

I've been prescribed oxy a couple of times for minor injuries. I cannot function on oxy so I've never taken more than one or two of them. If a doctor offers me oxy, I flat out refuse.

Oxycodone should never be a default medication. Suffering through the pain of recovery from an injury or surgery is better than what I understand the suffering from oxy is.

I think that culture of medicine in the US where if you are injured or sick docs have to give you something to relieve all pain, at the cost of feeling totally numb or be a zombie, is totally wrong.

Obviously pain medication needs to exist but they don't have to be that powerful. It is normal feel pain through recovery and puts good markers on your own improvement process. How are people supposed to listen to their body signals if we numb everything?

For me I was not a fan of opiates when I was in intense physical pain while recovering from surgery. I stopped early and that’s why I had so much left over.

However, it was an ideal drug for emotional pain in later years and I was extremely functional on it. Much more functional than I was sober.

I will never get it. Oxy does nothing good for me and I would never want it. The two times I accepted a prescription for it I tossed it all.

> I had access to a nearly unlimited amount (>400 pills) left over from an earlier surgery

What the actual fuck? Was this some kind of surgery with long term pain that needed to managed (over a year?) and you slowly built up excess pills, or was this really the quantity that some doctors were prescribing (hence the lawsuits)?

> Drugs being illegal isn't the problem here

Drugs being illegal is a huge part of the problem here. Because it's manufactured with essentially no QC, fentanyl dosage varies hugely from pill to pill, it's being sold as other drugs or adulterated into other drugs, etc etc.

If adults could get their drugs legally, it would almost entirely eliminate demand for illegal fentanyl and thus prevent it from making it into the hands of kids. Sure, some pills would still be diverted/stolen etc by kids, but at least it would eliminate the class of problems where pill #1 gets you high and pill #2 in the same batch kills you

> If adults could get their drugs legally, it would almost entirely eliminate demand for illegal fentanyl and thus prevent it from making it into the hands of kids

There's already a wide variety of substances kids can legally get their hands on to get high with. Some are available for purchase at your local gas station, and are much cheaper than a Percocet. The drugs are being sold TO kids in this county, it's not a case of kids getting it from their parents. There are dealers in the schools selling the fentanyl and advertising it as other opiates. These dealers aren't getting it from their parents either, they're getting it from suppliers who are bringing it in from Mexico.

> Because it's manufactured with essentially no QC, fentanyl dosage varies hugely from pill to pill, it's being sold as other drugs or adulterated into other drugs

The fentanyl isn't being manufactured in the US and thus is not subject to any US drug regulation or quality control. It wouldn't eliminate the class of problems you're suggesting either as it's being purposefully pumped into the US. Drug users are always looking for the next best high - they don't stop because something is legal. It's eventually going to stop working for them anyway because, tolerance.

You're muddling up things. Yes, gas stations sell sketchy 'legal highs', but those are an entirely separate category of drugs from synthetic opiates like fentanyl. Dealers in schools selling hard drugs exist because the cartels have the economies of scale to produce and smuggle opiates in huge quantities, which their adult customers consume in huge quantities and pay (in aggregate) huge amounts for. If that adult demand goes away because they can get their hard drugs legally and safely elsewhere (the Swiss model), it is no longer profitable to peddle fentanyl in junior high bathrooms in exchange for a teen's lunch money.

> Yes, gas stations sell sketchy 'legal highs', but those are an entirely separate category of drugs from synthetic opiates like fentanyl

I never claimed they weren't. My point was that if it was just about kids wanting to get high, they could easily find one elsewhere, for cheaper and most likely it would be easier to obtain.

> Dealers in schools selling hard drugs exist because the cartels have the economies of scale to produce and smuggle opiates in huge quantities, which their adult customers consume in huge quantities and pay (in aggregate) huge amounts for

I don't disagree with this point.

> If that adult demand goes away because they can get their hard drugs legally and safely elsewhere (the Swiss model), it is no longer profitable to peddle fentanyl in junior high bathrooms in exchange for a teen's lunch money

I'm pretty sure people living in Portugal / Switzerland aren't legally buying synthetic opioids like fentanyl, and even if they are - the investment into social programs like substance abuse treatment, education and mental health, dwarfs whatever the US invests in these areas. Decriminalizing / legalizing all drugs or the manufacture and distribution of said drugs, is not going to solve the opioid epidemic in the US.

Drug addiction and death are profitable and there is much incentive for policy makers to preserve the status quo. The lack of social programs and infrastructure is arguably a larger hurdle we'd need to overcome before legalization would bear any fruits. Not every country is a Switzerland or Portugal and you can't just lift and shift and guarantee success. Even the countries that have implemented these types of policies have experienced increases in opioid use: https://www.thelancet.com/journals/lanepe/article/PIIS2666-7...

gas station? whip its and morning glory seeds and nutmeg? nothing getting sold in gas station is like an oxy. come on...

https://www.forbes.com/sites/tylerroush/2023/03/24/growing-d...

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For so many years, I always wanted to have a kid. But life had its own plans.

Now, I am glad I don't have a kid. This world is ruthless - and I speak with the sword of layoffs hanging on my neck because that's how the system is designed.

The world has always been ruthless and humanity has somehow persevered.

People have persevered in the most abject conditions, it doesn't mean it's a noble thing to make more people go through it.

The problem to me at least seems obvious; Politicians (and especially a certain side) have been using children as political fodder and a lot of these problems have started coming to roost.

Kids are given less hope for their careers and futures. They have to deal with constant training fearing that one of their classmates could pick up a gun and kill their friends or teachers. Parents (and especially the more toxic kind) encroach more on schools, handcuffing them from providing aid, taking away books, telling them exactly how to behave even when such behavior causes no problems. Schools get less funding for teachers and support staff so when kids have issues or need help they struggle to do so. Then there's the increasing squeeze that lower and middle class parents see where even if they are supportive and love their kids, their daily lives get a little bit worse every day.

It shouldn't be a surprise that they're anxious messes. But fixing it requires recognizing that America is broken.

If you are a drug user, a parent, someone who works with kids, or maybe just want to be a hero someday: you can and should keep a box of Narcan in your house. You can even receive it for free at some pharmacies (just ask), or by filling out this form: https://redcap.uthscsa.edu/REDCap/surveys/?s=8NDKCYKXJW . Also there is a link at the bottom of that page for a site full of resources so you can learn how to administer it, recognize signs of overdose, etc. I know this isn't the solution to the overall problem, but it is one way to make a difference.

Getting this [1] into the hands of all the kids out there seems like a good start. And of course getting the "yeah, just use it if you're even a little worried your friend can't breath anymore; it won't make things worse"

"Don't take drugs" is a good start but reminding kids that they're playing in hardcore mode only goes so far -- even the good ones get unlucky or make bad decisions...

[1] https://thehill.com/newsletters/health-care/3924952-fda-appr...

This is one of those cases where I think we should treat the symptom (first) rather than the problem.

Teach them basic pharmacology, dosage calculations, and give access to free test kits to know how strong the stuff they're about take is.

This doesn't solve any societal problems at a grander scale, it doesn't improve the mental health of teenagers, and it won't eliminate overdose deaths entirely...

But it will save the lives of some children who haven't had a chance to really live their life in the first place. It will give them time to look for help they didn't know they needed.

this is fucking fentanyl

how are you going to get children to measure micrograms

It’s usually going to be diluted in something if my spouse’s experience with this subject still holds true.

From there you’re measuring concentration, which opens a host of options from community labs to minimal test kits.

yes

children measuring the concentration of something that can kill if you breathe around it wrong

i think you're on to something

Coming from SEA I always wondering why the west don't ban the drugs.

Yes, illegal drug abuse is still an issue here, but it's nowhere close to major contributor of death and crime.

We’ve tried. For 70+ years. Prohibition has caused more problems here than it’s solved…as it’s solved basically no problems.

For a large variety of reasons, the Singapore model doesn’t work here. It doesn’t even work across all of SEA. The Philippines have banned drugs for a long time, but they still have 2-3 million people who regularly use illegal drugs. 4% of Thais have used illegal drugs in the past year, and both countries have very strict laws about drug trafficking.

Most modern SEA country don't have those issue: Singapore, Taiwan, Hong Kong, Macao, Japan, South Korea.

They all had severe drug problem in the 20th century. They all have drugs get you an express ticket to firing squad, and all of them don't have major drug problem today.

As for Philippine, they are close to failed state since 80s. Drugs lords are rampant, Duterte despite being frowned upon many philippines like him since he's only man are willing to do something about it.

We have not tried in the way southeast Asia does. Agree or disagree, drug laws in the west have never been as strict as southeast Asia. In Singapore, drugs are an immediate trip to the gallows. We've never had that here.

Phillipines has experimented with allowing anyone to murder anyone else they suspect of using drugs. That hasn’t significantly decreased the rate of illegal drug use in the country. This is despite making payments to people to summarily execute drug addicts. Thousands have been executed across the Phillipines. Drug use still about the same.

The “SEA Solution” isn’t even a universal solution across SEA!

I mean FFS we found out we were completely wrong about the prohibition on marijuana here in the USA. and Alcohol. What’s next? MDMA?

Vigilantism is not the rule of law no matter whether it's government sanctioned or not.

I'm late to this discussion and don't expect anyone to read my comment. If America is so great why aren't we able to find the labs producing fentanyl and bomb them back to rare earth mineral. No empire in the past would of accepted such an attack and that's what it is. If it was a 50/50 if vodka killed you we would murder and imprison until it wasn't.

China is creating all of it and doing Opium wars 2.0 on the US. All the fentanyl precursors are sent from China to Mexico and Chinese Chemist train cartel goons to make fent and press pills.

The place to bomb would be Mexican border states and I’m not sure anyone wants about Iraq 2.0 in our back yard. An ex Mexican police/reporter I saw on podcast claimed the US military was the only one who could stop it.

https://youtu.be/GHxM8cX_OdA

Fentanyl lab: https://youtu.be/jZFjV9BRyNw

The labs are smaller now and operate very lean so if one gets busted they have 5 others.

Yes its messy but we are fully capable of cursing any bloodline that produces poison for consumption for the next 100 years and we should. Red or Blue we should all be together on this. Drugs are a tough issue but fentanyl and the grift that involves murder of the most vulnerable is disgusting.

Trying to bomb your problems away is why some of us are neither red nor blue. The human cost of a literal war would be so so high, and mostly incurred on bystanders and children who have nothing to do with this. We have no right to inflict that horror, even to stop our own catastrophe, which it's debatable it would even do.

USA doesn't go to real war over citizen security interests. It only goes for business interests.

"We're going to solve the problem of people dying by killing a lot more people" is such a morally bankrupt idea, as well as not working.

> If it was a 50/50 if vodka killed you we would murder and imprison until it wasn't.

I urge you to look at what actually happened in the US prohibition era.

Are there any surprising demographic tilts to the populations fentanyl is hitting? (Particularly among the young.)

It's a huge problem here on the east coast especially in semi-rural areas (think like networks of small very poor towns and small cities). The general consensus I've gathered is that it's predominantly young white men, often very poor, who are struggling with adverse conditions in terms of gainful employment/education opportunities etc. As previously solid economies are crumbling around them.

That puts a rather large hole in one of the popular narratives.

which one? I'm not familiar with the other narratives

The one about them being an inherently privileged group of oppressors.

fentanyl addicts are oppressing people these days? I hadn't heard that..

Really? That's the only narrative I've heard.

I wonder how much of that is ADHD based as we have 7 variants of ADHD among 3 neurotransmitter groups; Dopamine, Serotonin, and GABA which would imply its not recessive 7 percent alone for dopamine but closer to 21 percent of population.

My bias, I have type 2 ADHD.

No one cares are drug users.. till they break into your house or car for valuables.

This sort of issue is a community problem but the West is so geared to the individual I don't see this being solved.

Drug users are people's children first. Parents suffer the most.

When fentanyl properly "arrives" here (Ireland) its going to be a fucking bloodbath, and our government will wring their hands and go "there's nothing we could have done".

I mean, it (fentanyl) exists here, but is relatively rare for now.

We have large numbers of opiate users, most of whom are not the "homeless drug addicts" you would expect (though we have fucking loads of those).

We also have a massive number of people hooked on benzos and similar drugs, which here are almost all "legit contents, but dodgily branded generics from Asia".

Again, the vast majority of these addicts you wouldn't notice/know about.

From the data I've seen, in the US and Canada, both opiates and benzos are supplanted by fentanyl - fake benzos that are actually fentanyl, fent sold as oxys, sold as heroin, etc

The quality of heroin here tends to be pretty low, so whenever a stronger batch arrives there's often a number of deaths or near fatal overdoses.

Once fentanyl starts showing up in any significant amounts, there's probably going to be a fucking massive spike in overdoses.

The opiate problem here is only getting worse too, the governments been sitting on its hands and various plans to try deal with it besides just arresting people have languished in committees/planning for as long as I can remember.

Pretty much daily when out walking in a residential area I come across discarded syringes, the frequency of which increases the closer you get to the city center.

I regularly see users nodding off or shooting up in public, and that's just the visible ones. Seen a fair few OD's too, called ambo for a couple.

Narcan and similar aren't really accessible here - our health service has made a lot of noise about an access program, but the iron grip of the regulator won't simply make it OTC for private persons to purchase without paperwork.

Supervised injection rooms and such have also stalled out entirely due to nobody wanting one near them. Which is a bit daft.

If you walk around central Dublin, Temple Bar, etc, you will see dozens of people openly using "hard" drugs on the street. That is where the addicts are. So building a facility there makes sense, right? The local businessmen disagree, due to magical thinking that if its built somewhere else, the addicts will move. They won't.

I'm almost glad that the worst we have to contend with (for now) is the crack epidemic finally hitting our shores.

We have an open border that allows anyone and anything to be imported in to the US. TX bears the brunt of it due to its proximity.

Spicy thread

What is the most effective method to teach children that drugs are bad?

Wait, fentanyl testing strips are illegal in Texas? What?

> “Illicit drugs are flowing into the country at an alarming rate because of Biden’s open border,” the Republican National Committee tweeted, in February. Texas Governor Greg Abbott cited the rise in youth fentanyl deaths as a justification for building a state-funded border wall.

lol politicized everything. clueless people making statements, nothing good will ever happen. what can you do but laugh at this point to cope?

It's not politicization if it's true.

It can’t be false because it contains no facts.

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i wish there was a way to disable the effects of opioids on the brain. Then you could give an addict a shot and their drugs become worthless to them. Like a vaccine for the chemical reaction of opioids or something.

You are basically proposing lobotomy, which was tried.

Opium Wars payback.

85% of excess deaths in NYC are now drugs. That includes deaths from homocide, suicide, cars, everything - 85% of those are drugs.

https://nytimes.com/2023/02/20/nyregion/sudden-deaths-overdo...

It's the most serious issue facing the country, and we have 0 idea what to do. It's 30 9/11s a year worth of death and misery. https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/...

0 idea what to do? Switzerland [1] has implemented a successful strategy that revolves around one key point: treating the drug problem as healthcare instead of criminality. The "War on Drugs" is the most ineffective strategy when it comes to dealing with addiction.

[1]: https://www.opensocietyfoundations.org/publications/mountain...

Did you read the report? Policing is still a major part of the Swiss approach to drug prevention (one of the four pillars) and though they try to use fines as a penalty instead of imprisonment, imprisonment for drug use still happens as well:

> It is notable that by many measures, policing did not decline with the advent of the four-pillars policy. As Figure 2 shows, policing continued to be very active well after the drug policy changes occurred, though the bulk of arrests since the early 1990s have been related to cannabis use by young persons (Reuter and Schnoz 2009). Relatively few of these arrests, however, led to incarceration and many resulted in administrative fines not registered on a person’s criminal record (Ibid.; Killias 2009).

In some parts of the US, the police have entered the war on drugs on the side of drugs. https://www.nbcnews.com/news/us-news/california-police-union...

Is it that simple though? There are probably other factors that make people in the US more prone to drug addiction (e.g. poverty, lack of opportunities...).

I’m unsure of the situation in other countries but getting adequate treatment for substance use disorder in the U.S. is terribly difficult (nearly impossible for some) and faith-based 12 step programs such as AA/NA dominate the landscape and effectively replace mental healthcare in many situations. The poor utilize 12-steps because it’s free social support which is great, but for-profits do the same thing (because it’s very cheap to just implement 12 step thinking) and rehab patients are often handed a “big book” (AA/NA’s main text) well before they get a psych evaluation, if they get one at all

In short, substance use disorder is treated as a primary condition here, there’s a massive high-profit industry built around it and specifically treating it using faith-based 12 step methodology so a lot of mentally ill people who use drugs never receive proper treatment

Bingo.

I remember telling my mother in the 90s that my 'substance abuse' was a symptom, not the problem itself. I was self medicating. No one wanted to hear it.

In the time since, it often feels like we've gotten worse at recognizing this. Meanwhile, proper treatment for mental health issues continues to be difficult to find (many if not the majority of so-called professionals are anything but), as well as increasingly expensive and inconvenient. To say nothing of how much of psychiatry has devolved into pinning you to a DSM category and throwing drugs at you in as short of a session as possible-- "come back in 2 months and we'll just as quickly throw some different drugs at you if those aren't working"... rinse and repeat ad infinitum. Anyone struggling to get through each day is not going to be well served by this.

We need at least 10x more therapists willing to spend time with patients and address their many intertwined issues, using logical, rational, evidence based methods. Right now, I don't see how we even start to get there from here.

12 step can be a lifeline for people at the end of their rope who have no other options, but it also inevitably fails anyone who doesn't buy into the narrative about a higher power. [I would argue it fails even those who do, as it teaches powerlessness.] Some may benefit from such an extreme approach, but it is deeply, deeply flawed. The main strength it does have is connecting you with other people and being very accessible. But we can & should do better.

>12 step can be a lifeline for people at the end of their rope who have no other options, but it also inevitably fails anyone who doesn't buy into the narrative about a higher power. [I would argue it fails even those who do, as it teaches powerlessness.] Some may benefit from such an extreme approach, but it is deeply, deeply flawed. The main strength it does have is connecting you with other people and being very accessible. But we can & should do better.

oh indeed. I found myself in the rooms of AA/NA at the age of 19, still very foolish in my youth, confused, pretty desperate. Even in that state I had such a hard time buying into just the first few steps. it all seemed so utterly nonsensical to me and I realized believing in god was a prerequisite I could never meet. for those unfamiliar with the 12 steps of alcoholic anonymous this is how they begin...

1. We admitted we were powerless over alcohol—that our lives had become unmanageable.

2. Came to believe that a Power greater than ourselves could restore us to sanity.

3. Made a decision to turn our will and our lives over to the care of God as we understood Him.

Note that I don’t have a dog in this fight as I’m no longer in AA, but I have to nitpick: “a power greater than yourself” can be a pretty big umbrella, especially depending on the meetings you attend.

It doesn’t have to mean “God”, and it certainly doesn’t have to be the Judeo-Christian definition of God. It just has to mean “something other than yourself”. It can be the meetings themselves, the cute dog you saw in the dog park the other day who let you rub his belly, the Flying Spaghetti Monster, or whatever.

The idea behind it is that, if your best thinking brought you to rock bottom, and you’ve tried everything you could think of to stop drinking without success, then maybe it’s time to let something else take the wheel.

Again, let me stress that I don’t have an opinion on this one way or the other, I am simply correcting the record here. It wasn’t for me, and I certainly don’t think AA/NA has a monopoly on sobriety. But I had 5 good years of being clean and sober before going back out, and when I finally did start drinking again, it was in a MUCH healthier way. It also helped a lot of good friends, and I’m grateful for that.

While this is in theory true, and as much as the literature of AA attempts to separate itself from Christianity or any other religion, the reality is that the 12 steps of Alcoholics Anonymous were derived from the 4 steps of the Oxford Group- an Evangelical Christian organization. The word god is constantly thrown around in meetings and throughout the literature and, make no mistake, that is a Christian god they are talking about. Christian prayers are fairly common in meetings as well, especially the Lord’s Prayer- and 12-step meetings are typically held in churches.

> the 12 steps of Alcoholics Anonymous were derived from the 4 steps of the Oxford Group

This is true. It's also true that AA broke off from the Oxford Group ("kicked out", according to Lois W, the wife of founder Bill W) for being too agnostic. Apparently it was pretty dramatic- see "AA Started In Riots" by Roger C. for more. [1]

> The word god is constantly thrown around in meetings and throughout the literature and, make no mistake, that is a Christian god they are talking about.

The meetings I went to were quite secular. I'm vehemently agnostic, and I never once felt like the people there were proselytizing to me. If they had, I would have left real quickly and not gone back.

Most of the meetings I went to were in SF, LA, NYC, Shanghai, etc.), making it easier to find secular meetings that were run by people like me. Someone living in small-town America might have a different experience from mine. Hopefully with the advent of Zoom meetings, this is now less of an issue, but I can’t say since I left AA before Zoom became a thing.

Each meeting is meant to be independent from the others, and each has its own bent. You'll find meetings for Christians but also meetings for atheists, just like you'll find mens' meetings, womens' meetings, young peoples' meetings, etc.

> 12-step meetings are typically held in churches.

I've been to meetings in church basements and Sunday school rooms, but I've also been to meetings at American Legion halls, recreation fields, City Halls, even the basement of a donut shop.

Consider the cost of running a meeting. Literally their only revenue source is donations from attendees. Giving a donation might be hard for someone who has just hit rock bottom, and it can be expensive to rent a room for use as an Alano Club. Churches might be more likely to cut AA groups a break on the rent.

I don't want to be accused of promotion by either HN or AA, so I won't link to them, but secular AA meetings are plentiful and pretty easy to Google. Secularism is part of AA’s "12 Traditions", as well. [2]

All that said, if AA still feels too religious for someone, there are other groups out there which don’t make use of the “higher power” concept in any capacity. Again, I maintain that AA doesn’t have a monopoly on sobriety.

1. https://aaagnostica.org/2013/12/08/aa-started-in-riots

2. https://www.aa.org/the-twelve-traditions

My background is I used to run a national harm reduction org and I’ve also spent countless nights and mornings in AA and NA meetings in cities and towns throughout the country- places like Baltimore, Miami/Dade County, Tucson, Santa Ana, Denver/Boulder, Newport Beach and nearby suburbs of all these places

That’s great you were able to access secular meetings in SF/LA/NYC, but the reality for most Americans is that those meetings you attended might as well not exist, they are elusive, infrequent, and make up a tiny percentage of the total meetings online or otherwise

Having said all that. and while we are nitpicking- it’s probably worth mentioning that “secular” meetings still have 12 steps and still involve handing your will and life over to a higher power of some more palatable flavor (such as “the program”)- so definitionally we are still talking about faith-based treatment. This will never work out well for atheists and that’s the point me and others are making.

Those places, let's not forget, deliver care often with a motive of indoctrination in to religion.

It really is taking advantage of people who are vulnerable. Sickening that that's what is on offer in a "developed" nation.

That's not even getting to the fact that the leading cause of death in children and teenagers is guns[1]

I can't really understand it.

[1]: https://eu.statesman.com/story/news/politics/politifact/2022...

This is blatantly false. It’s stated very plainly in the traditions spoken every meeting that the 12-based programs don’t align with any sect denomination or religion.

The programs are faith based and widely supported by medical professionals. Plenty of folks have problems with anything being faith based, but unfortunately there aren’t better alternatives for alcoholics and addicts.

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This is offensive and a blatant violation of the HN rules.

12-step programs are definitively unrelated to any religion and well respected by the professional medical community. Various religious institutions around the world host the meetings altruistically, and it has no influence on the fundamental content and purpose of the 12-step programs.

God is mentioned in 4 of the AA 12 steps, as an example. Spirituality/Him or a "higher power" referenced in 7 of them.

Don't get me started on the others.

It may be respected by the US medical community (and we know how uncommercial and trust worthy that is!) elsewhere we go by science backed systems that aren't just relapse setups.

The US health care system has some of the worst statistics in developed nations for prescription addiction, post natal death, infant mortality, death during pregnancy and lots more. Forgive me for thinking you are infact, willfully ignorant. That's my opinion and I can hold it.

The psudo-psychology nonsense these schemes peddle is nothing short of 1800s "you've got ghosts in your blood" nonsense.

I'm an ex addict.

Your mention of the dismal US healthcare system is ad hominem and irrelevant.

12-step programs are empirically superior to any alternative; established by comprehensive literature review [1]. Your “science-backed” implication is utterly false.

12-step literature repeatedly, to exhaustion, emphasizes that the spiritual nature of the program is as the person understands it.

[1] https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...

>12-step programs are empirically superior to any alternative ...

You'll want to reread your study there. For most of the criteria they measured, the conclusion was that AA performed as well as other interventions. Not better. It certainly doesn't establish AA as the superior treatment. The author's conclusion seems to be that it might be about as good and it's free.

My point is valid, and its validity is confirmed in the first sentence of the conclusions.

Ah, now I can reply. It wasn't letting me for a while there. Probably because you repeatedly edited your comment.

The study you linked says that for a certain measure, it works better according to a grand total of two studies they looked at. For the rest, the conclusion was that AA performed as well as other interventions. It's also a review study, which can sometimes be helpful, but often cannot draw clear conclusions due to the studies being reviewed not necessarily measuring the same parameters. They also rejected about half the papers they found due to apparent bias.

It's certainly not the kind of paper that establishes something as settled science and even at that, it doesn't say what you claim it does.

The deeper a comment is the longer you have to wait to reply. I’ll improve your day by telling you that you can always click on a comment’s time stamp to reply immediately :)

The purpose of my comment was refuting that 12-step programs aren’t science-backed, which is blatantly false. As you’ve stated, the entirety of literature on the subject shows that it’s at least as good.

> 12-step literature repeatedly, to exhaustion, emphasizes that the spiritual nature of the program is as the person understands it.

That has no place in the treatment of psychological issues such as addiction. It'd be like trying to pray your way out of schizophrenia or use meditation to get rid of a tumor. Or like asking a pastor to cure your ...

Actually, Americans do that a lot. I saw a senator asking parents to pray that no more school shooting happen (there have been 19 in 2023 alone in America[1]).

Keep praying, but a better strategy might be actual addiction treatment and stopping people carrying guns. Anything else is just enabling suffering. Other governments have worked this out. It isn't a mystery anymore. It doesn't require prayer or spirituality or faith.

[1]: https://en.wikipedia.org/wiki/List_of_school_shootings_in_th...

You’ve changed the target of the argument far enough that I’ll consider my purpose achieved.

Really?

> Those places, let's not forget, deliver care often with a motive of indoctrination in to religion. It really is taking advantage of people who are vulnerable.

Because I think i've provided more to backup my claim than your "nuh-huh!" replies. You changed target from _my_ claim they are used for indoctrination to their validity in science.

Both refutations are dubious at best, it seems you have taken a position and are sticking to it, out of dogma. A bit like those who blindly follow religion.

Like those people, I don't debate with them. It is pointless. Have a good day.

I haven’t shifted my target since my first comment, and you have failed to argue against it. You have instead raised “America has problems” straw men and posited that 12-step philosophy is wrong.

Pointing out your false statement that there’s no science behind 12-step programs was in direct defense of my original comment/argument’s claim about them being recommended/supported by the medical community. My previous source only denotes 12-step programs as “at least as good” instead of “superior”, but labeling a literature review as “dubious at best” implies science denial that would make this a worthless discussion.

My “nuh-huh” reply regarding your use of the word indoctrination was in fact citing the AA preamble read every meeting: “AA is not allied with any sect, denomination, politics, organization, or institution … neither endorses nor opposes any causes”.

AA is technically a religion (in the US at least). In the positive sense, indoctrination is a correct word to use regarding what goes on in meetings. The common negative sense in which you’re aggressively using the word, implying hidden agendas/motives, is entirely false. Saying 12-step programs act directly opposite to the stated preamble would be a conspiracy theory also making this discussion worthless.

The research you cite doesn’t refute criticism of the poor state of US healthcare. It also doesn’t refute the criticism being presented here, that treating the issue as an individual failing doesn’t work for everyone and we need more collective “whole community” approaches, such as decriminalisation, ending the war on drugs rhetoric, serious pushback against excessive force use on cognitively impaired individuals under the influence of drugs who are cooperative but having difficulty complying… and basically an all around general effort to try and stop me the stigmatisation of “drug users” as scum… Because worldwide, on average: most of us drink alcohol or coffee at least occasionally and many do so with regularity; many smoke cigarettes or cigars or hookah’s; some overuse pain medication unnecessarily to keep up with gym routine when they should let their body heal; some smoke weed and others mix the active ingredients into food and drinks for the same sorts of desired reaction; there’s a thriving trade in male sexual enhancement pills which range from unnecessary viagra prescriptions to illegal imports from overseas vendors of otherwise normal pharmaceutical products to “herbal” supplements illegally laced with pharmaceutical grade ingredients not listed on the packaging if the packaging even has a list of ingredients at all; there’s a statically significant number of people who use amyl nitrate for sexual purposes; there’s many people with various medical conditions, such as Narcolepsy and ADHD where the prescription is pharmaceutical grade amphetamines, and they go about their days routinely consuming medicine that were they not prescribed it, would categorically make them under present attitudes towards drug use “drug addicts with serious dependence issues”, I’ve more than once heard a story to the effect of “I thought I was addicted to dex, even tried rehab, turns out I just had ADHD”; there’s people with anxiety and other psychiatric disorders who are prescribed things like benzodiazepines which again have thriving off label use by people without prescriptions when they’re able to get them…

We as a species have embraced the idea that you can live “better through chemistry” and that’s not going away because it has roots so deep they stretch back to tribal practices and into prehistory. The idea that there’s a magical list of drugs that are ok and not ok and you should punish people that like the not ok ones, is stupid fairy tail morality and translates about as well to the real world as prohibition of alcohol did in America, except this has worked longer because we exported around the world via treaties and we made a smaller group of people than “everyone who likes to drink alcohol” into the villains of our fairy tale narrative. There are obviously going to be things that should be illegal and laws will need to exist and be enforced, my point is that by encouraging the fairytale morality we’ve had generations of people concentrating power into the hands of groups of people we all have blatantly seem abusing it, and that’s not just about the police it’s about the organised crime and their victims. The whole system is in a slow spiral and it will not get better until we break they pattern.

And as for the researchers you cited , they were pretty specifically comparing focused treatment programs that are aimed at the individual not at any sort of social interventions like changing drug policy at the state/national level.

You're absolutely right.

I was a cocaine addict. It turned out, I had ADHD. Through science and evidence led medicine, I was treated for ADHD and this gave me the foundation to leave cocaine behind.

I'm pretty sure the self-shaming, placebo based 12-steps programme wouldn't have led to an ADHD diagnosis that actual therapy with a qualified psychiatrist found.

Modern medicine is amazing. Using group support sessions whose framework was invented before we knew any better as the primary source of addiction treatment is like refusing to use cars because a horse and cart do the same job.

America's obsession with puritan, white Christian conservative values keeps it in the dark ages (in terms of mental/physical health) and no amount of psudoliberalism will counter that.

What's the point in telling yourself it's the "greatest country on earth" if your population are one of the most unhealthy?

sirsinsalot says <">That's not even getting to the fact that the leading cause of death in children and teenagers is guns[1] I can't really understand it.

[1]: https://eu.statesman.com/story/news/politics/politifact/2022..."<

No surprise, because the URL contradicts what you say. If omitting certain age ranges is your idea of the truth, please say so up front.

> Rockefeller and Johns Hopkins researchers said that when analyzing the leading causes of death among "children," infants are typically not included because of certain fatal conditions unique to children under a year old.

Yes OK, excluding those under a year old. So guns are the leading cause of death in America for those between 1 and 18 years old.

Is that OK now? Defensible now? Did that undermine my entire point? Or are you nit picking to detract from the toxic state of the country?

This comment implies that faith-based 12-step programs aren’t proper treatment, and that is false. Any medical professional will tell you that there’s no alternative that produces better results. The problem is abysmal: both faith-based and non-faith-based approaches perform poorly, but 12-step programs are the industry standard because they are the best we have.

Personally I think the non-faith-based centers only exist as a result of severe religious trauma. I’ve met plenty of 12-step alcoholics who make jokes about how bad things like SMART recovery are. It’s a trope on recovery meme sites.

Thankfully times are starting to change, with places like http://boulder.care prescribing Subutex as an easier rung to reach while climbing the ladder on addressing opiate use disorder (OUD).

yeah Bicycle and Ophelia are a few other U.S. suboxone telehealth startups that seem to be doing good work as well (if anyone is interested, it's worth checking each of these out as their coverage varies in terms of which states, last I checked)

Portugal did this in the 90's and they where poorer than the US for sure.

It's a cultural/religious problem if you ask me.

Portugal is pretty devoutly Catholic.

It’s a cultural problem.

That means nothing as I assume the GP was alluding to Puritan values instead of Catholic ones.

That’s precisely what I meant. Both have religion in spades - but only one has a toxic culture around it. It probably helps that Portugal was a neighbour to religious lunatics for much of its existence, and even had a few deeply unpopular monarchs who invited the inquisition in. It’s still there in the cultural memory - they take god seriously, but the idea of religious persecution and the involvement of church in state is pretty much anathema to the average Portuguese.

Evangelicals are not Puritans, nor is there a theological ancestry from modern evangelical christianity to Puritanism.

Vladimir wants to paint a specific picture, dig?

I think he meant evangelicals who push "personal responsibility" and other similar values.

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I suspect their welfare state is/was still better than the US's though.

Honestly, I agree. I think that the American experiment is failing. The school shootings, the insane death toll from reckless driving, the drugs - people are desperate and disconnected.

Religion and civic groups are basically gone, with no replacement. We're in these weird atomized suburban bubbles. Seems bad.

Lack of healthcare coverage and over-prescription of opioids are both factors as well.

People are self-medicating due to not getting the pain medication they need because they lack healthcare. Or they have untreated mental issues. or, if they do have healthcare, they might very well get prescribed super addictive drugs over a long period of time.

>because they lack healthcare.

I'm convinced the "crackdown" on pills is what led to where we are today. Many doctors won't prescribe pain medication because they're afraid to lose their license or have a DEA raid. People find what they want in heroin and now fentanyl. Why we keep fighting the drug war this way is beyond me.

>if they do have healthcare, they might very well get prescribed super addictive drugs over a long period of time.

I think this is also why we are here today.

* lack of cheap and easy to access mental health resources

* physical health resources are tied to work-provided health insurance, and are often not great

* lack of the above two lead to easy fixes, like prescribing opioids aggressively

* aggressive anti-drug laws that put more people away than attempting to treat them

* no real safety net if any of the above screw up, driving many to poverty, jail, addiction, etc. $30 of pills might be the only joy or relief from their shitty situation, so pop em if you got em.

Having healthcare accessible in general would at least be a step towards a greater public wealth for individuals. Even a little less poverty has got to do some good.

This is from 2010 before fentanyl was really a thing. Like the article stated, people are dying off of cheap pressed pills made from combos of Chinese imported RCs mixed with fentanyl.

These pills are MUCH cheaper/widely available than the non-"counterfeit" opioids. And much more likely to spontaneously kill you vs how people more traditionally overdosed. Addicts aren't the only ones ODing.

The "war on drugs" is probably a good thing as far as this goes because making opioids more widely available is not really what we should want in society. I think greater availability of other "party" drugs like ketamine in Europe could maybe help some, but I'm not sure how much.

A culture of widely available test strips + narcan + fentanyl education should be the minimum we should be doing. We definitely shouldn't be trying delusional attempts at limiting narcan availability. Ex:

https://idahocapitalsun.com/2023/03/28/idaho-lawmakers-vote-...

I see the US healthcare system more as a cause for the opiod epidemic, not the solution.

Please do not compare a very small country with a very small and integrated population, which is also very rich to the USA. It does not make any sense.

Are you saying that the US can't learn anything from Switzerland's experience? Why does the US size and population preclude it from treating drug problems as healthcare issues?

This is SF, Portland, Seattle, Vancouver strategy - and the cities look like images from the Opium Wars. And least China had the sense to fight back - The West is in terminal decline.

No, here's the top states in 2015 and those cities aren't in them. The reason you said those cities is the same reason fox focuses on crime in nyc, republican propaganda

West Virginia: 41.5 per 100,000 people

New Hampshire: 34.3 per 100,000 people

Kentucky: 29.9 per 100,000 people

Ohio: 29.9 per 100,000 people

Rhode Island: 28.2 per 100,000 people

Pennsylvania: 26.3 per 100,000 people

Massachusetts: 25.7 per 100,000 people

New Mexico: 25.3 per 100,000 people

Utah: 23.4 per 100,000 people

San Francisco is 75 per 100K. (620 last year, population is 800K)

It's not in the top 10 cities of overdoses per 2020 data that I posted on another reply.

Those are the top states, but it's possible that the cities he mentioned are the top cities.

https://drexel.edu/uhc/resources/briefs/BCHC%20Drug%20Overdo...

No, San Francisco is at number 11 on the top 10 in 2020. The rest are below that.Why didn't he mention any of the top 10? Why does foxnews discuss crime in San Francisco and NY so much?

They absolutely talk about Baltimore as being a failed city:

https://www.foxnews.com/search-results/search?q=Baltimore

Same with every other city on that list:

https://www.foxnews.com/search-results/search?q=Philadelphia

etc

Sorry - I didn't mean to make this a blue team vs red team thing. I think you missed the point.

Then explain why you choose those three cities? Why did you only mention cities?

Opiod overdoses have devastated rural areas. https://www.usda.gov/topics/opioids

What was your point if not propoganda? Just to let us know drug abuse is bad? Is this new information? Your comment doesn't offer interesting information, a solution, not even a personal experience. That's why I think it's right wing propaganda.

Just like foxnews you repeat something over and over in order to imprint it on the ding dongs who base their knowledge off hearsay instead of facts.

"Oh look a post about something bad that happens everywhere but I can increase the association level with cities run by democrats in order to justify my political support. Because if the opposition is suffering worse than me then I'm not wrong in who I support...even if it's not true"

Because I live in San Francisco and it went to hell over the course of 12 years - and those cities that I travel too look like they are going down the same path.

But I will concede your point. The whole West is circling the toilet bowl but as you point out some areas a little faster than others.

"The west is circling the toilet bowl".

Compared to what?

My point was that you were spewing republican propoganda either willingly or unintellionally

frequency and airtime?

Chicago, sf Vancouver are densely populated and high population. Number of cases of gun violence or drug overdose will also be high. But they are not the top cities % wise

On the contrary, we have medication (buprenorphene) that is remarkably effective for opioid addiction. France liberalized access to it and overdose deaths fell 80% between 1994 and 2002.

Suboxone is handed out like candy in downtown Toronto and East Hastings Vancouver to any addict who wants it and is willing to show up at a pharmacy daily until they build trust with a doctor to get it on long term prescriptions.

This is part of the solution which is sorely lacking in many US states but it’s not some catch-all solution to drugs. It’s basically a better version of Methadone which has been available widely in the US since the 1980s.

I recently watched Sid and Nancy about Sid Vicious and him and his girlfriend are getting Methadone at a pharmacy in 1980s NYC before he later relapsed and offed himself.

https://www.imdb.com/title/tt0091954/

It’s important no doubt but moving beyond the prohibition drug war approach (which is failing in places going hard as it is weak like Canada) to dealing with this requires a serious reckoning and public investment that we aren’t ready to accept yet but will be imposed on us whether we like it or not.

> It’s important no doubt but moving beyond the prohibition drug war approach (which is failing in places going hard as it is weak like Canada)to dealing with this requires a serious reckoning and public investment that we aren’t ready to accept yet but will be imposed on us whether we like it or not.

There are lots of contradictions here. Voters don't understand how they can be asked to liberalize hard drug use (and even decriminalize dealing) on the one hand, and are asked for billions of dollars for drug addiction treatment on the other. In Seattle, we have a particularly bad mess, where the biggest thing now is trying to fentanyl smoking off of public buses and light rail. They are even talking about studying the dangers of second hand fentanyl smoke to bus drivers.

Hopefully we can learn something from our neighbors up north, but frankly it doesn't seem to be that much better in Vancouver.

> Voters don't understand how they can be asked to liberalize hard drug use (and even decriminalize dealing) on the one hand, and are asked for billions of dollars for drug addiction treatment on the other.

It's easy to communicate this: We spend billions to incarcerate people for drug crimes, and then send them out with a criminal record that pushes them right back toward drug use. OR we spend fewer billions on drug addiction treatment and housing. It's not confusing or contradictory at all.

People who end up in prison don't get help, and people who get help don't end up in prison.

"Voters" wouldn't be confused if certain interests didn't keep them confused. It's profitable to keep housing scarce and prisons full. Until we start prioritizing sick people over profiteers we won't fix this problem.

No, you seem to be confused as to what voters actually want. Sure we could do drug treatment for less money and more social benefit, but how does that punish the baddies? If we give them free treatment and forgiveness, what does that say about me? I was good and they did the bad thing, and yet you want to throw a feast for your prodigal son. Taxes are high enough already, too high to give money to those fallen souls.

Or something like that. At least the first half. Most of us here are engineers, scientists, and tech leaders who can see how disruption can make a better system. But a lot of people see the opioid crisis not as health crisis but as a moral dilemma.

No, this is Seattle, we don’t want baddies to be punished. We want buses that don’t smell like burnt peanut butter. We want parks without tents, libraries without naked guys running around in crisis, and we’d like it all for some property tax rate that is less than 2%/year. It would also be nice if our grocery stores didn’t shut down due to shoplifting excesses, but that’s a stretch goal.

> Sure we could do drug treatment for less money and more social benefit, but how does that punish the baddies? If we give them free treatment and forgiveness, what does that say about me? I was good and they did the bad thing, and yet you want to throw a feast for your prodigal son. Taxes are high enough already, too high to give money to those fallen souls.

It's ironic that Christianity says they should do exactly that.

I don't think it says that. The younger son comes back and yes, a one-off feast is thrown, and the son's betrayal is completely forgiven, but the dad tells the older son that everything he has is his. He doesn't say, "Give your brother some more cash".

I don't have a strong position on drug laws, as I don't live in a city that's devastated by drug use. I just wanted to weigh in on the meaning of that parable.

I argue that in this context money spent on a one time feast can be interpreted as money spent on drug rehab. Rehab after all is meant to be a process, even if lengthy, that results in one no longer being dependent and hopefully not relapsing. Rehab is not a process of feeding the vice (unless there are various corporate interests and the process is perverted).

The point is to contrast retribution and discrimination with rehabilitation and empathy. Christianity very much endorses the latter option at least as long as the other is part of the in-group.

But maybe the in-group and out-group separation is very much the point of these laws since the war on drugs (started by Nixon) is a direct continuation of slavery after peonage was ended by FDR during WWII.

> the war on drugs (started by Nixon) is a direct continuation of slavery after peonage was ended by FDR during WWII

Do you have any justification for this? It seems an utterly bizarre take on the face of it.

If you mean the first part then here is a quote from John Ehrlichman, the White House Counsel and Assistant to the President for Domestic Affairs under President Richard Nixon:

> “You want to know what this was really all about?” he asked with the bluntness of a man who, after public disgrace and a stretch in federal prison, had little left to protect. “The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people. You understand what I’m saying? We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.”

Family members of Ehrlichman reject the veracity of the quote but I see no reason to since it is not about himself, it is about Nixon and his policies. There are some more voices questioning whether he was lying but even those voices admit Nixon was racist. I think it matters not whether introducing those laws had racism as a primary purpose, or whether they "coincidentally" aligned with a hidden agenda. Prohibition might not have had the purpose of creating a mafia network but failure to foresee that and failure to promptly react when the negative side effects of a law become apparent still matter. Prohibition in the US lasted 13 years, the US war on drugs is ongoing since the 70 even after other countries like Portugal demonstrated it is cheaper and more efficient to focus on rehabilitation.

If you mean the second part, see FDR's Circular 3591 from 1941-12-12. September 1942 is when the last slave in the US was freed. Nixon was elected a few decades later.

Feel free to explain which part is an utterly bizarre take.

> which part is an utterly bizarre take

I don't know which is; it just appears that way. It would be that the war on drugs was a continuation of slavery, which I don't think you've mentioned

Slavery is an extreme form of discrimination where the out-group is deemed subhuman. And discrimination is something the US has struggled with since the very beginning. It is the very notion that some people deserve to be restricted more and protected less by the law than other people. The notion that the out-group should be dehumanized and therefore it deserves whatever misery it finds itself in. This is a social illness. All that changed in the US are the names and sizes of the in-group and of the out-groups. But the illness is still there in the minds of the people.

It's a continuation in the sense that it is a manifestation of the same social illness.

> Slavery is an extreme form of discrimination where the out-group is deemed subhuman.

Ugh, no, don't argue in favor of my beliefs this badly. We know what slavery is, and creative redefinitions only make you sound dishonest. Slavery, real slavery, still exists in the US, and we don't have to make up weird definitions to say that.

Slavery still exists in the US, legally. The thirteenth amendment says:

"Neither slavery nor involuntary servitude, except as a punishment for crime whereof the party shall have been duly convicted, shall exist within the United States, or any place subject to their jurisdiction." (Emphasis mine).

This is a massive loophole, and one which has been taken full advantage of. By criminalizing things which shouldn't be criminalized, and then enforcing those laws unequally, you can effectively enslave a large portion of whatever group you want to.

In some cases such as Angola prison, the prisoners/slaves are literally forced to pick cotton for no pay. In other cases, the prisoners/slaves are paid some small amount: this is better for optics, but these same prisons easily recover the money by vending basic necessities at gouged prices: if you pay a seamstress $1/hour and then charge her $10 for a tampon at commissary, that's not pay. Prisoners can't shop elsewhere and can't work elsewhere.

And to be clear: the work isn't voluntary. Refusal to work is punished with solitary confinement and sensory deprivation--and that's if they bother to comply with the law instead of just beating prisoners who don't work or paying another prisoner to shank them. With little oversight, there's little stopping prisons from doing this.

In addition to lack of oversight allowing abuses of power, it also allows unsafe work conditions. Prisoners/slaves are unable to report unsafe conditions to anyone, and when unsafe conditions occur, there's no incentive to fix them.

Prison slavery is used by a variety of industries. JCPenney and KMart use prison slavery to manufacture clothes, IBM uses prison slavery to assemble circuitry, Wendy's and McDonald's use prison slavery to process foods.

I was not aware of all you wrote. I guess thanks for picking up the ball when I dropped it.

As an eastern European, for whom high school had almost nothing to say about American history (other than WWII) and afterwards I originally learned the usually parroted variant only to later correct the knowledge I had, I am baffled again and again every time when learning new things about the putrid fractal that is slavery in the US. I was never even that curious in the first place.

I did hear about the prison industrial complex but I had no idea about the "Angola" and how close this gets to slavery called by a different name. Reading about it now. I believed that while for profit prisons were inhuman, prisoners were not used for forced labor. I always kinda assumed that meant that prisons received so much money from the state they even made a profit.

That major western brands make use of it feels nauseating. I believed this was stuff we were criticizing China for.

Well the key word is “Baddies” we need to stop looking at drug addicts as “bad” but merely sick.

The actual “baddies” would lose their funding if you cure the junkies. The problem is the system as it is is profitable for other more socially acceptable “baddies” who stand to lose out. e.g sacklers

"we need to stop looking at drug addicts as “bad” but merely sick."

The root of the sickness often extends far beyond the individual into society. That's what many people don't want to look at or acknowledge. They insist on casting blame on the victim, and keep creating more victims.

To be honest I think you’re being to kind to the they. Yes there are some people who act out of being misinformed, or fear but there are cyclical people that pump this point of view specially for profit. Look at the sea change now in the US that pharma sent to far and people finally realised a lot of the “drugs bad” schtik was merely PR

The chapter in Erewhon from 1872 is interesting. In this strange utopia/dystopia the sick are punished like criminals and the criminals are treated with compassion as if they were sick. Particularly relevant for considering how drug addicts are treated.

https://standardebooks.org/ebooks/samuel-butler/erewhon/text...

He is pointing out the voters perspective which is valid and rarely reflected on social media since it is innately selfish.

At it's core this is a social issue that is swept under the rug for decades since the real solutions requires harsh reform that will likely destroy careers for pursuing it.

Drugs are a strong form of control, not just for the peddlers but to appease the masses from their painful reality, something that certain branches might like with AI and stuff reducing the usefulness of labor.

And the reason for that is the drug users as criminals narrative has been promoted by a combination of well meaning misinformed people and mere neerdowell grifters.

The solution is to promote this alternative narrative, something which is happening now thanks in part to successful activism and better education, but also an increasing wariness on the part of the public on the true motives behind public drug policy. I don’t think it’s a pure coincidence that this is all happening at the tail end of the opioid pandemic!

> but how does that punish the baddies?

I hope we (as humanity) will get over punishment for the sake of punishment. It is a power tool to steer people away from harmful behavior and I don't think we can stop using it altogether anytime soon but it should be used to the extent it actually changes people's behavior - longer sentences not necessary better in this regard than shorter ones in combination with some re-integration program. And if we can prevent antisocial behavior without punishment why not at least try?

In prison or dead means they aren't on the streets and people don't have to face or interact with the problem. I would guess that many voters are much happier with "out of sight, out of mind"

Also not a risk to you. Most drug addicts are not the kind of people you want around. There are highly functioning ones, but it often exacerbates mental health issues.

Not sure prohibition is the correct approach but let's not strawman the other side of the argument.

> Most drug addicts are not the kind of people you want around.

True, but how much time does the average non-addict spend in drug rehabs? Both prisons and rehab facilities isolate addicts from the general population.

How does "we need to spend billions to get these people" translate into "people shouldn't be responsible for their choices?" Because if they aren't responsible for their choices, I am?

It isn't even less money, we passed that mark a long time ago. The average junkie in Seattle costs King County around $100k/year (w/o making any progress on their addiction), while we can put them in prison for around half that. This isn't about saving money anymore, its about throwing money into a bottomless pit and seeing nothing improving at all.

A lot of those "junkies" started off as normal people with pain, who were targeted by perdue, until they became heavily addicted to opiods and eventually turned to heroin or fentanyl.

We, as a society, as responsible for this situation, because we allowed a company to turn hundreds of thousands of people into drug addicts, and let all of the company executives walk away without any repercussions.

We have two options, both of which are bottomless pits:

1. Do nothing, and pay the costs associated with drug addicts being left untreated (shelters, prisons, run down portions of cities, lowered property values) 2. Treat people

One of those options may cost a lot, but it also improves everyone's lives. I don't understand why this choice is so hard for some folks.

Before even deciding between those choices, we should at least stop the problem continuing, by preventing so many prescriptions for opioids being given out to people in pain. The government should prosecute the likes of Purdue for their aggressive targeting of people in pain.

It won't happen though, because of regulatory capture, and general lobbying / corruption.

That problem is mostly already stopped. It is now much more difficult for doctors to prescribe opioid painkillers, to the extent that patients who legitimately have serious chronic pain are turning to buying illegal drugs because they can't get what they need through the healthcare system anymore.

People in serious pain want relief. They ask for relief.

If you were a doctor would your response to a patient in unbearable pain be, “Sorry, can’t help you”?

Washington state successfully sued Purdue for millions of dollars over their contribution to opioid dependency. It hasn't made the tabloids because it's an example of government doing things right that doesn't sell well to people who want to complain about regulatory capture and corruption.

If we don't choose option 2, we're choosing option 1.

We need to address the source and the problem at the same time. Regulatory capture doesn't really apply here, but lobbying (which is synonymous with corruption at this point) definitely does. Fixing the citizen's united issue would be a proper start at addressing the lobbying problem.

There's also the Singapore approach, which is where we don't tolerate any of this insanity.

Really curious where those numbers come from. Do you have a link you can share?

https://www.city-journal.org/seattle-homelessness

> At the same time, according to the Puget Sound Business Journal, the Seattle metro area spends more than $1 billion fighting homelessness every year. That’s nearly $100,000 for every homeless man, woman, and child in King County, yet the crisis seems only to have deepened, with more addiction, more crime, and more tent encampments in residential neighborhoods. By any measure, the city’s efforts are not working.

For incarceration costs:

https://www.doc.wa.gov/docs/publications/reports/200-AR001.p...

About $110/day (so $40,150/year)

I'm familiar with stats like this for other cities, but in my experience, it's common for those statistics to be misinterpreted.

Often these funds go towards housing people so they are no longer homeless, so you might have X people who are currently homeless, but Y people relying on that $1B to remain housed.

Because of that, it's inaccurate to divide $1B by X and then claim that's how much going towards individuals who are still homeless anyway, when it is more accurate to divide that figure by X+Y.

This stat isn't even being misinterpreted, it's being lied about. The $1billion is an imaginary number that includes theoretical lost tourism revenue, a pretense at annual spending of the capital costs for buildings used by welfare services, etc.

What that, obscenely slanted, first link doesn't mention, is that each year around 10k homeless people in Seattle get off the streets.

It isn't like that money is being flushed down a hole, results are being had on an individual basis, but for reasons that are nationwide in scope, the overall problem (# of homeless people on the streets of Seattle) isn't getting any better.

National problems require national solutions, but half the senate is perfectly happy to offload the cost of social ills onto coastal metros.

The chronic homeless cases (the ones that can’t recover quickly) eat up around 80% of that money, so it still isn’t that far off. The low hanging fruit cases just need housing, and aren’t going to destroy or use it to make meth, they don’t require anywhere bear $100k/year in services.

Oh, look, you are getting your info exactly where I guessed. Not that impressive, it's always easier to identify the source of made up facts.

>> Seattle metro area spends more than $1 billion fighting homelessness every year.

Think about how monumentally worse the problem might be if they didn't spend that money. There are very likely tens of thousands more people who would be homeless if not for government support/programs. Just imagine how many people would be on the streets in a week if EI and disability income streams were cut.

Does every homeless in Seattle is a fentanyl addict ?

No, only the ones that are acting nuts on the streets, the ones you are more likely notice more and the ones that aren’t helped without a lot of resources.

Yikes, Chris Rufo...

How inefficient is this system, actually? I doubt one homeless man in seattle can cost 2 times as much as I earn per year. What are you spending all these dollars on? A free visit to a prostitute every week? Oh, I forgot, thats illegal in the US...

They come from Christopher Rufo, a terrible person who is funded by creationist right wingers and these days is spending his time working with DeSantis to whip up fear of Critical Race Theory in schools.

Prison is actually extremely expensive and unsustainable

The person you replied to specifically said prison is half the cost of alternative services to drug addicts. Your refutation would be worth something if you had figures, as they have subsequently posted a link to back up their position.

Except that posted link does not back up their position. The money went to housing for the homeless, not to "alternative services to drug addicts". The author's entire point or claim in that article is Seattle is wasting money on affordable housing because the driver of homelessness isn't housing costs, but rather other factors like domestic violence, drug abuse, etc.

In fact, the author encourages services to drug addicts near the end:

> With a secure emergency shelter system like that in San Diego, the county and city governments can reroute existing resources and “flood the zone” with on-site treatment options for the homeless. For addiction services, we should prioritize recovery programs and terminate policies like safe-injection sites that draw addicts from other cities.

> Because if they aren't responsible for their choices, I am?

I think you're assuming for some reason that these folks are just having fun.

A solid majority of these people were abused as children, which at least from those I've met certainly wasn't their own choice.

Interesting and low price you are putting there on a humans life.

It sounds like King County has an inefficient system. Bit of a rant here.

Tying success to "progress on their addiction" is also puritan brainworms, sorry.

A lot of US stuff seems to rely on punitive monitoring and "you relapsed, back to square one" nonsense, like a game of snakes and ladders. But with a body count.

Some people will never recover. Some will. Some will take fucking ages.

Being an addict and being a mostly functional, productive member of society are not mutually exclusive.

The actual ways to start fixing this problem are unfortunately, rather unpalatable to voters despite being cheaper in the long run.

Here's the thing. Heroin is dirt cheap to make at a controlled quality - its used in hospitals as diamorphine for end of life care, and some other uses.

State supply of heroin to heroin addicts is a policy that has been tested in the UK, Switzerland, Netherlands, and elsewhere at various points and it fucking works.

Decriminalization of possession with referral to addiction services is a policy that has worked phenomenally in Portugal.

Housing-first policies have worked out fantastically in Finland.

Putting supervised/safe injection rooms and needle exchanges in areas where addicts actually are (as opposed to where they are not) also works to reduce issues like people nodding off on the street, smoking up on buses, needles being discarded everywhere, etc.

Another point to note: the vast majority of addicts don't want to be addicts.

Those who do get off the drugs often relapse.

A vanishingly small minority don't want to get off the stuff.

Safe consumption spaces with state supply, clean needles/pipes/works, etc can effectively act as onboarding for users to engage with further services and progress along their journey to reintegration into society.

Get people into those spaces. Get them into supported housing.

Become their drug supplier, so they are no longer engaging in criminality or at risk of contaminated supply.

Don't make "being sober" a requirement for progression.

Aim to get them into "own door" independent housing with engagement with social services.

Help them find paid jobs and start supporting themselves, reintegrating into society.

Offer rehab/treatment, suboxone, etc.

Basically, TL;DR - offer them dignity and agency, and you will see far greater success.

End rant.

California has been at the vanguard of reducing prison population, and decriminalizing drug use, and so far the results look disastrous. That’s not a policy that needs any confusion to be unappealing.

Aren't other states exporting those they don't want to California?

People are mobile. They go where they need to be to survive. Texan prisons will give you an open bus ticket on discharge, people head west for services, charity, and a better chance of not going back to prison.

> a better chance of not going back to prison

but mostly a better chance of not going back to the sending state's prison.

> California has been at the vanguard of reducing prison population

California’s prison population has been stable since 2017.

13 of 35 state-owned facilities operate beyond capacity.

Source: https://www.ppic.org/publication/californias-prison-populati...

Is it a disaster throughout the state or only in some metros?

I've heard San Diego is more or less totally normal. SF is a fucking disaster.

I am very confused on why the US can't stop drugs entering the nation.

Really? Singapore finds kilograms of smuggled heroin every month or so inside the country, not at border checks.

And it’s an island country with only a single airport, a couple ports and 2 bridges into the country and the death penalty for smuggling. They throw a ton of resources at trying to stop it from coming in in the first place.

If they cant stop it, i dont know how a country like the US with thousands of miles of undefended borders can.

If Singapore is only finding kilograms of smuggled heroin every month, then they are very, very successful even for a single city. Hell, thats an extraordinary achievement. Likely the best in the whole world I think by a wide margin.

The U.S. is failing to stop multiple TONNES of drugs. (actually >100 tonnes if you look at DEA extrapolated figures). Border policy is clearly non-existent.

How much is Singapore NOT finding?

"Singapore has one of the lowest rates of drug abuse in the world: 30 opiates abusers per 100,000 people, compared with 600 in the United States"

You're missing the point. If even Singapore, where the problem of opiates being imported should be way easier to solve; if even they can't actually fix their problem and get that number to zero, what hope does the US have of fixing the problem? The US would end up spending trillions on border control and not actually fix the problem either, with less than nothing to show for it - several orders of magnitude increase in cost and wait times aren't going to be good for business or the county, and would end up costing us more money in lost business on top of the money spent on pointless expensive border upgrades, like a wall thats easily defeated.

"if even they can't actually fix their problem and get that number to zero"

This is silly nonsense. There is no crime that can be made to zero. There is definitely crime that can be severely mitigated. You are throwing the towel on border security. Please don't make up stupid figures like trillions of dollars. Our border security budget is a fraction of the "Ukrainian War" budget. Exceed that first and you are free to complain.

You don't understand the scope of the problem and want to throw money down the drain in the name of border security. In order to meaningfully make a dent in the problem, given the size of the US-Canada and US-Mexico borders, and the East and West coastlines, and all of the international airports, and not just shift the problem around from one location to another, all of the border needs to be made more secure. I have no idea why you keep bringing up Ukraine either. You know we're shipping military hardware to them and not pallets of dollar bills right? What are we going to do instead of help Ukraine with that? Line up artillery shells on the border with Mexico and somehow that'll help the war on drugs? Talk about silly nonsense!

Understand the scope of the problem first and you'll be free to think about how to meaningfully address the border situation.

I know the amount the U.S govt is spending on border security vs the amount of money being spent on Ukrainian aid. One dwarves the other by a full order of magnitude - showing exactly where the real priorities lie - NOT for the U.S. citizen.

No need for additional drug scanners at our ports or a border wall to reduce cartel trafficking. Who cares if tens-of-thousands of bright teenagers die of drugs being sent across the southern border ? We need Ukraine to crush Russia. RAWR.

"You know we're shipping military hardware to them and not pallets of dollar bills right?"

Ah.. but you are quite mistaken there. We are not just shipping military hardware. There is $30 billion in financial aid alone - and even far more being planned this year. Wow - thats more generous than many U.S. states receive for disasters.

You clearly have no idea how much money is spent on border security, given that the DHS budget is $50 billion, the Coast Guard another $10-15 billion, etc. every year.

Source? Government estimates?

This claim was from WAPO https://www.washingtonpost.com/opinions/singapore-is-winning... written by the Singapore ambassador.

But I believe he claims rightly, since the statistics match for Singapore's population and drug abusers. Please note that Singapore also considers cannabis as drug abuse.

Report: https://www.cnb.gov.sg/docs/default-source/drug-situation-re...

Singapore has a reputation to uphold so unlike US numbers that tend to be high, i assume Singapore is taking the low end.

Not to say opioid abuse is less, but its way more than youd think considering the governments stance.

The U.S. checks something like 1% of the cargo entering it’s shores.

Sure, the US could check 50% of it. But are you willing to pay 10-20% more in the cost of everything due to the subsequent inflation?

Hah, if the U.S. spent a tiny fraction of the money being spent on the Ukraine war on border security, one would get far better outcomes. No fear of inflation at all of-course - to print endless money to wage more war. But spending on the border ? Oooh - that's bad!

Tiny fraction of few billions. Are you talking about THOUSANDS of dollars?

Oh please.

"The United States has appropriated approximately $115 billion in emergency funding to support Ukraine since February 24, 2022."

The Trump border wall cost is $12 billion. I think ~1/9th is a tiny fraction right ? I don't mean milli-fractions or micro-fractions, just tiny.

And btw, that $115 billion towards Ukraine is expected to grow quite a bit further in 2023/24. Who knows - it might become a milli-fraction or micro-fraction eventually.

> "The United States has appropriated approximately $115 billion in emergency funding to support Ukraine since February 24, 2022."

Ukraine received about $7b in 2022.

$12b does not look like a tiny fraction of $7b.

Can you please provide the source for your just $7 billion figure ? I am not sure where you quoting from.

A fairly conservative source is here:

Bilateral aid to Ukraine between January 24, 2022, and January 15, 2023 https://www.cfr.org/article/how-much-aid-has-us-sent-ukraine... .

This by itself $76.8 billion in committed aid and does not include all U.S. spending related to the war. And newer appropriations made just after Jan 2023

The non-conservative estimate: https://www.crfb.org/blogs/congress-approved-113-billion-aid... which adds upto $113 billion in 2022.

I looked at the first graph in the first article returned by Google:

https://usafacts.org/articles/how-much-money-has-the-us-give...

So ? You are looking at one sub-component of the aid in flight in 2022 encapsulated in one bill. Your link itself takes the upper value of the allocated aid: "The nation has allocated $114.9 billion in aid over the last year, contained in four separate bills".

Please do that for border security in the U.S. Like Ukraine, there is utterly NO need to transfer all the money in ONE big bang - can do the same in chunks. As long as the "border aid" is allocated in chunks - we can have better drug scanners at ports, more personnel and patrols, more funds to care for actual migrants (as opposed to drug camels), investigative teams to track down drug-routes and personnel involved, etc

Except "The United States has appropriated approximately $115 billion" is a horseshit lie. The vast majority of the money that news casters tell you we "spent" on Ukraine was spent in the previous decades, designing, testing, and building the war machines that we put into storage since then, waiting for the soviets attacked. These are machines that have already been paid off, and would otherwise take money to get rid off.

The M113s we sent to Ukraine, we have been trying to dump them on ANYONE who will take them because shipping them across the world is literally cheaper than cutting them up and making them not a weapon anymore. The stryker program is done, and the vehicles will be replaced. We don't want to keep any of these vehicles, because unlike Russia, we think using 20 year old machines to fight a modern war would be extremely embarrassing and pathetic.

We haven't spent a hundred billion dollars helping Ukraine. We spent trillions of dollars over the past many decades buying stuff to kill the soviets and blow up the desert and we have nothing better to do with them. We literally have thousands of Abrams and Bradleys sitting all over the world, being worked on every week to keep them in tip top shape, that we would rather replace before we think we have to fight China.

Russia's best is being torched by our TABLE SCRAPS.

Quit parroting the narrative of people trying to deceive you.

controlling the border is a hot button political issue in the US. It comes up constantly in election season. The right wants more the left therefore wants less.

It would be better if the state's were allowed to do more on their own borders but it's a federal thing and therefore impossible. Texas has the money and will to do a lot of border enforcement on its own but it's prohibited by law.

A lot of opiates are produced in the US.

The legal ones are produced in the USA. The illegal ones are mainly produced in China.

This is minor compared to the hundreds of tonnes of drugs (possibly thousands) crossing the border of which only a small portion are seized.

https://www.cbp.gov/newsroom/stats/drug-seizure-statistics

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It's pretty deliberate failure to understand, in my opinion, driven by a core belief that bad things happen to bad people and they need to be punished out of it, not helped. The goal for many people is absolutely not reducing deaths, or even getting rid of fentanyl smoke on buses. It is expelling fentanyl users from society and expecting that will stop new users appearing. That's why they don't want to spend money on treatment or services. They think enabling the existence and recovery of existing users will encourage more.

> or even getting rid of fentanyl smoke on buses.

The burnt peanut butter smell is pretty rancid. Voters, even in Seattle, only have a finite amount of empathy to spare on this problem, and it has mostly been expended.

> It is expelling fentanyl users from society and expecting that will stop new users appearing. That's why they don't want to spend money on treatment or services. They think enabling the existence and recovery of existing users will encourage more.

We (King County at least) spend around $100k/junkie per year on services. And that still isn't considered enough. So should we double our property taxes or something to spend even more money on this problem?

> They think enabling the existence and recovery of existing users will encourage more.

If Seattle is the only place these people can get help across the whole country, that would definitely occur. You can't fight a national problem with local resources and not expect distortions (people are mobile).

I'm not arguing fentanyl smoke is nice. I'm arguing that people, apparently including you, refuse to do any of the well understood and successful things that would get rid of fentanyl smoke on buses because you don't want to make help available.

> around $100k/junkie per year

Absolute nonsense. We spend nothing of the sort. We are not even pretending to approach it. Sounds like you're getting your hot takes from Christopher Rufo misinterpreting the Puget Sound Business Journal speculation a couple years ago.

The lies spread by Rufo and his ilk certainly contribute to the unwillingness to do anything, by making people confidently delusional about what currently exists.

I am constantly amazed at Americans who seem to think that XYZ is an intractable problem with no solution, without bothering to even look outside their borders and notice the fact that almost no other country seems to have the same problem, or at least the same problem at a similar scale as the US.

Vancouver is right next door, they have similar problems. Maybe they deal with it slightly better, but the scale is the same.

This is a national problem and needs to be addressed (and funded) as such.

The war on drugs has failed miserably (for it's ostensible purpose (to "protect" us from dangerous drugs).

We need to legalize and regulate them all, and make their abuse a medical issue rather than a criminal issue.

For those that have no desire or ability to quit, we can put them in camps and hand out dope to keep them sedated and "safe" from questionable supplies. If they want to get clean, they can have the support to do that but otherwise are effectively interned on work farms.

This is the cheapest, safest, and most humane way of dealing with this problem.

You still fantasize about a world where everything and everyone is ”clean”.

That will never exist but you will destroy the humanity of yourself and others in an attempt to delude yourself.

Nah, getting dangerous people off the street is its own reward.

If they could get high without causing problems I couldn't care.

Exactly. Way cheaper than jail too.

I have lots of fantasies but that ain't one of them. The gist of my point is that there's going to be a subset of the population that is "broken" and is unable to function as a "productive member of society".

We are going to spend money on them one way or the other; my way would be far more effective than how it happens today (both in cost and in actual remediation).

How would this destroy my (and others) humanity? It's currently challenged by watching people live in tents, shit on the sidewalk, and pass out in public on dope. How is my suggestion worse?

> "They think enabling the existence and recovery of existing users will encourage more."

It's also a timing issue. I think a lot of people that are currently in the "just get rid of them" camp would have been in the "let's help them rehabilitate" camp when the problem was in small or controlled scale.

But we are way passed that. It's a downright epidemic and needs to be dealt with in more drastic and immediate terms for some of us. I'm not going to wait 5 years while my children are innocent and in school and wandering around for the problem to get better. I want my neighborhood safe and clean and innocent for them now. This is why suburbs popped up on some level. People just want to be left alone and in relative calm and clean surroundings.

Gated white communities still exist, if you want a drastic immediate change then move there.

Portlander chiming in here. I think it's almost universally accepted now that decriminalization was a stupid idea - and I myself voted for it at the time. I absolutely would still vote for anything that improved the availability of treatment for addiction, regardless of cost. But I think what we've learned is that every carrot needs a stick. And where there's excess supply, demand will catch up. All of which means, go after supply and possession again until this is under control.

>go after supply and possession again

that achieved 0 results in 40+ years of drug warfare with millions dead and the rise of international cartels who are as powerful as nation states.

This is not the way, complete legalization is the only way to break the power of cartels.

"Legalization" is absolutely worse. Millions of dead sooner and with more collateral damage.

You don't have to legalize the drug, simply giving it to existing junkies for free by prescription for a while would allow you to break the cartels. Also, actually do break the cartels like Ecuador is doing, with life sentences or death.

The problem with the methods we've used is that we've used them piecemeal and inconsistently.

Once the pushers are gone you force the junkies into rehab. Then when there's no epidemic you could actually legalize to prevent a black market from returning.

> "Legalization" is absolutely worse. Millions of dead sooner and with more collateral damage.

Portugal tried. In 2001, they decriminalized the possession of all drugs for personal use and started treating drug possession as a medical issue instead of a criminal issue. Ever since, Portugals rate of drug addiction and drug death is below the EU average. The policy is considered a success. It reduced harm for the addicted and at the same time, reduced the social costs of drug addiction. The rate of HIV, Hepatitis infection and other side effects of drug addiction dropped significantly.

See https://transformdrugs.org/blog/drug-decriminalisation-in-po...

Now, they didn’t just legalize drugs, but put the money they saved on the enforcement side into rehab, clean needle and other flanking programs, essentially “giving” it to the addicts. This may seem unpalatable to many, but the outcome is a win for everyone.

Portugal didn't decriminalize anything. They still pick you up against your will and detain you for years while not giving you drugs and forcing you to work. The only semblance of decriminalization is that if you cooperate and don't try to escape they don't give you a criminal record.

They use the criminal justice system and the underlying crime of public use and unsafe intoxication to force you into rehab, which is the very definition of criminalized.

It's decriminalized. That's literally the word. It's still illegal to possess controlled substances, but not a crime right away.

There's a published list [1] of illegal substances and what quantities constitute as "personal use" (like 25g of weed or 5g of hash - translated in "individual doses"). More than that you can be trialed for drug dealing, which is a fair trade-off.

Yes it's still illegal to possess any of these substances, but what happens is that if you're below the "criminal" threshold, you get a doctor/shrink appointment and usually pay a small fine (around 25 euros). Nothing gets written to your criminal record. Repeated offenders might have more several penalties like community service.

Recently there's been a surge in homelessness and harder drug consumption, analog to the rest of Europe, due to a huge housing crisis, very stagnant salaries and overall poor quality of life here (in Portugal).

[1]: https://dre.pt/dre/legislacao-consolidada/decreto-lei/1993-5...

That's not how it's used in North America and thus it's not the impression our pundits are trying to give when they use it to reference you.

Here, decriminalized is uncontrolled. You can buy your fentanyl in front of a cop and do it in public. Cops can't arrest you for it. There is a maximum amount but it's huge! Pot is still limited though, and you can be arrested for having more than an ounce but you can't be arrested for carrying enough fentanyl to kill an entire building of people.

This has been done so that there's no way to force people into rehab, so they're a continual source of income for the taxpayer funded "charities" that provide for them.

This is not true. That's exactly how it is used in North America.

Do you have any links to back up those claims? Every single article about Portugal's drug situation I've seen seems to disagree with you.

As a part-time resident of two major drug cities I've been looking for that article. I just have to read between the lines and contrast it with the results we get from the same words.

It should be obvious when reading a story about Portugal that they couldn't get the junkie to stay in rehab voluntarily, so obviously they don't mean "no potential of a criminal charge at all".

Whereas in Vancouver they specifically changed the rules so you can buy and do drugs in front of the police, pass out and almost die - get revived and smoke more drugs, and have no charges, no special detainment, nothing.

"I have no source or evidence so just keep taking my word at face value"

My source is my eyes. I drove through the local drug camp recently and saw a dealer dealing within a stone's throw from police in their car, and junkies passed out just steps from him. There's a ton of evidence, but you could search for it if you really wanted and you didn't.

What I haven't found is a single short and simple article that explains for ... people like you, that what Vancouver/Seattle/Portland/SF and Portugal mean by decriminalization is not the same.

Your eyes have no value in this conversation. If you can only back up your claims with "trust me bro", they are irrelevant.

What issue do you have that makes you incapable of searching for references and yet still able to whine about that incapability online? And what are you actually looking for a reference for? That there are drug encampments? That some cities have literally made it legal to buy and sell Fentanyl?

You have been told something exists, that's 95% of the way there. Now go to a search engine and type 'vancouver drug decriminalization' and 'Portugal drug treatment' and read about the issue.

You're trying so very hard to use me to justify your ignorance and to be insulting in the process.

I googled the phrase 'Portugal drug treatment' and found out what I was suspecting from the start - which is, everything I saw previously was correct and they indeed decriminalized all drugs up to certain weight and still jail dealers. This goes against the claims that you previously made that they did not have a decriminalization, and the next one about criminal record also doesn't make any sense in this context - what would the criminal record be, a gram of weed?

Okay, now that you did some work and have questions I can help.

> what would the criminal record be

Public intoxication, possession, etc.

> everything I saw previously was correct and they indeed decriminalized all drugs

They haven't decriminalized public usage. You can have your small amount of drugs if you do it in private and are discrete.

> This goes against the claims that you previously made that they did not have a decriminalization

It's a system of not giving you a criminal record by using the mere threat of the criminal justice system for force you to voluntarily enter rehab. So you have to do what they say but then they don't label you a criminal and they sort of pretend you went into treatment on your own.

In the words of the guy who invented and runs their system:

"There are a lot of myths around the Portuguese model that, for instance, we just liberalize you do whatever you want, nobody cares ... It's important to say that using drugs in Portugal is still prohibited under the law ... If somebody in Portugal starts injecting heroin in public [...] he would be arrested and conducted to the police station. The substances would be apprehended. If they have more than the amount that is calculated on the basis of personal use he undergoes criminal procedures as before. If he has less than that amount he would be intimated to present himself to the commission. It's not a court, it's not a formal institution, but he will be confronted to discuss his drug use with professionals. It's mandatory, with a little bit of muscle you have them in front of you. We can try to understand what is happening with this person. For each hundren people that is conducted through those commissions, ten of them are problematic users." -- João Goulão - National drug coordinator for Portugal - https://twitter.com/ShellenbergerMD/status/16412220666858455...

This next part is where you have to read between the lines a bit. They don't come right out and say that they can't arrest junkies for junking in public - you have to understand that they wouldn't pass a bylaw to make it happen if they didn't need to which means that in the rest of the cities they would not arrest and move them proactively.

Here's a typical article about Vancouver BC's decriminalization - https://archive.is/f2Q0k

"Police forces across British Columbia are finalizing training on new drug laws that will limit or entirely cease their interactions with people who use drugs as the province becomes the first in Canada to decriminalize simple possession."

"While many police departments have in recent years moved away from arresting and recommending charges for possession alone, officers will now also stop confiscating illegal drugs"

"at least one city is preparing to introduce a new bylaw that would re-engage police if people use in certain public spaces."

From which we learn that 1) they won't be able to arrest at all for drug possession, 2) they won't even be able to confiscate dangerous drugs, 3) they won't even arrest people for public use (unless cities pass a bylaw overriding the province.)

In Portugal they will arrest, and will confiscate, and will use legal powers (if you push them to it) to detain you. In Vancouver they can not arrest, can not confiscate, and will not engage the criminal justice system at all.

Portugal is saving lives by using the courts, Vancouver is getting worse with every loosening. Seattle and SF are roughly the same as Vancouver.

Vancouver for years and years under a half way "decriminalization" did still confiscate drugs and all the while everything became worse.

Only now as of January 31, 2023 are police in Vancouver supposed to stop confiscating drugs. we're only 3 months into this new era.

Only sometimes, like when someone ODed or tried to sell right in public. And of course that didn't do much if any good overall because Vancouver didn't do anything else that Portugal does - like limiting the almost endless supply of cheap fentanyl. Even when they seized drugs it was a mere matter of minutes and a few dollars to get more.

Vancouver/BC didn't have decent recovery programs, and not enough capacity even in the bad programs, and critically - no legal capacity to force someone into them even if they did. People can be detained for up to 72hrs and "dried out" but that merely lets some of the detox pass, it's not at all related to kicking the drug and recovering from addiction. Even when they want to be clean the city usually houses them in a drug hotel where peer pressure drags them back in.

Arrest and seizure are valid tactics, Portugal proves it, despite Vancouver failing to apply them properly as part of a holistic program.

what about a state monopoly, like alcohol in Sweden?

[0] https://en.wikipedia.org/wiki/Systembolaget

What's wrong with just having the FDA ensure the purity and selling it in the locked condoms cabinet at walmart?

Purdue showed how well that approach works out with the even more restricted Oxycontin.

Did they? It seems the problems started when they started cracking down and people had to resort to street heroin, and later fentanyl to get pain relief. If there were an easy, legal way to get oxycontin, I bet the majority of the problems of people dying from fake oxycontin laced with fentanyl would go away overnight.

Purdue had a financial interest in selling more Oxycontin. They knowingly pushed doctors to prescribe the medication in a manner that encouraged addiction. They knowingly misled patients and doctors as to how addictive the medication was.

Cutting the supply off without any alternatives absolutely caused harm. However, that only serves as evidence that safe and legal means of procurement are better than illegal ones.

If there had been a network of state dispensaries to provide safe regulated doses and support, over-prescription could have been stopped without leaving the victims to fend for themselves.

There's a segment of junkies who don't want drug treatment, just to get high at all costs. I spend almost daily talking to people that are professionals in this area (not a junky myself, just related to medical providers) and it's an everyday occurrence that people will come in, completely trick the medical providers for a daily or whatever short-term fix they're allowed with minimal privileges, and then use it to supplant their black market addiction. You can let them pursue their dream at black market prices while they bust into cars and inject god knows what of random purity. I'd much rather they just be able to buy it for $0.10 at walmart and beg for a dime outside the gas station, and know exactly what they're getting.

I'm not disagreeing about access to treatment, but just to be clear I don't see much intersectionality there with stopping the black market. For so many of them it becomes "sweet I can buy my black market shit, plus get whatever the addiction center place offers me on top of that."

So then they're able to stockpile and hoard it and then what? they get this stash and then are able to exist in a land of plenty when previously there was famine. it's like money. if you don't have any, things are really rough. but if you have enough that you're swimming in it? well then you're able to step aside from earthly concerns like making rent, and can choose to invest it in causes you choose. For a junkie who's drug life is feast or famine, having default access to what they need and feeling safe allows them to move on with their lives and get past their addiction and into jobs and return to regular life and be contributing members of society.

No, because the drugs are only given out in the context of dying in the street. There's absolutely no provision for people who are addicted through accident, for instance, to achieve some safe supply while tapering off to avoid the street.

And the government has decided that drug users are on palliative care, that they're never expected to improve, so they can be given drugs that are likely to end or destroy their life without any concern for recovery. That sounds 'caring' but in areas without this assumption they actually do rescue many people from this death, making the 'caring' cities into uncaring hellholes for the addicted - where they go to die on the streets of a preventable death.

There is no fear of 'famine' because the people who are being given drugs are being given drugs for the rest of their life. There's no fear of running out because even if the government stopped the supply the street drugs are only a few dollars.

What these excess drugs do is 1) increase the amount of drugs the person is taking and/or 2) get sold outside of the drug cities, both of which increase the scope of the problem.

Also, druggies don't need money because they can just take whatever they want from stores and at most will be forced to give the item back. They're given food and shelter and drugs and can steal any luxury under $1000. (Not that they'd be punished above that, but the stores aren't required to sit and accept it - they can apply reasonable force to recover their goods.)

> "sweet I can buy my black market shit, plus get whatever the addiction center place offers me on top of that."

That's the best outcome. In Canada the legal drugs they gave the junkies ended up being sold by mail to other parts of the country.

Diverted drugs become black market drugs. I'm sure the Mexicans are getting ultra pure fentanyl or being trained to make the pure shit from precursors. Somehow most of it ends up being stomped on by the time it reaches the consumer. That is to say just because it was pure when the junky got it, doesn't mean it was accurately represented to the end user or altered along the way. Black market diversion from treatment facilities seems non-ideal.

The problem is the stomping isn't uniform. Whatever's being used as an adulterant, the end product has chunks of adulterant, and chunks of fentanyl, and this is what ends up killing people, because they end up with a life ending sliver of fentanyl from the heterogeneous mixture of drugs.

Killing a few people with your supply is an actual sales tactic called 'Hot Shotting' (a term for a lethal dose). When dealers cut and package for delivery they'll make a few extra strong and give them to well-known junkies who will then overdose and potentially die, in the process proving who's selling strong drugs. "That must be good stuff, Kevin died from it and they barely revived Sue."

Not only are street drugs inherently unsafe, the dealers view their customers as so expendable they're willing to kill them for advertising.

To fix this we've got to switch to government supply, but only when we simultaneously wipe out the illegal supply and suppliers, so that we don't simply compound the problem. Our interventions are like antibiotics. They lose their power over time when misused. They're best employed heavily in a cocktail and used fully.

what's wrong with selling cigarettes to 7 year olds? Same thing, isn't it?

There's also nothing illegal about a 7 year old jumping into a rushing river or buying unregulated "research" chemicals on the internet. Same thing, isn't it?

The way 7 year olds are kept out of rushing rivers, or consuming black market dope, is they have a parent, guardian, foster caretaker, someone looking after them. It's illegal to neglect a child. Sending a 7 year old to buy you cigarettes arguably isn't neglect, letting them smoke cigarettes or research chemicals probably is.

If someone wants to snort up a pile of rat poison, or fentanyl who am I to stop them. Let them buy Pfizer mega-OD-fentanyl-express they saw advertised on the Citybus for $0.10, and let the cartels get crushed by legal competition who have everything to lose by doing drive-bys in residential neighborhoods.

What makes a pharma company inherently any better than a cartel? Is this just an argument to buy American?

Is it just decriminalized, or is there safe supply in Portland also?

Because without a steady, safe supply, people are still going to continue overdosing.

Yes. We need complete legalization and regulation. People who want opioids need to be able to get a known product, and people who don't want opioids need to know that their product doesn't contain any.

People who want opiates are people who can't wait to die.

[edit] I like your username btw... I actually said that to someone tonight... a man, a plan, a canal; Panama. The couple stared at me until I said "palindrome" and then I'm pretty sure they thought I was crazy.

You do realize that there are clinical uses for opiates right?

Possession here without intent to sell is now decriminalized for all drugs, and larger amounts are considered misdemeanors. I do think "legalization" would be better - where the supply was safe and regulated. There's also the simple fact that being one of the few places in a country full of addicts to advance decriminalization has made us a destination for people who want to die on the street with a pipe and a needle, so we've had a massive influx from the rest of the country that we are not equipped to handle. But layered over that is the cartel system that runs the human trafficking and the mass theft that perpetuates a lot of the human misery here now.

Easier access to drugs sounds humane but it's exactly the opposite.

Then it's unfortunate to hear you regret voting for decriminalization and think it'd be better to go back to punishing people harshly for drug use and distribution. I think decriminalization is the first step, only because it's hard to push for safe supply in addition to decriminalization, but we should all be pushing for safe supply now as well, and the proceeds of that going to funding rehab programs, as well as other overall QoL improvements for people.

Legalization + safe supply might not reduce the occurrence of people using (or at least not right away), but it will provide better overall outcomes for society. If we address the systemic issues which cause so much suffering (which is why we're seeing so much addiction), and also provide treatment options, people will be more inclined to seek out those options.

I assume you're familiar with the Rat Park findings? (https://en.wikipedia.org/wiki/Rat_Park)

Or take your head our of your ass, stop enacting half-hearted measures like decriminalization and completely legalize the supply.

Your prime issue is corruption, not drug use

i don't get why decriminalization keeps getting pushed by people

my cynical take, entrenched people have something to gain by the grey area decriminalization offers.

My point of view is that locking people up for drug use:

* Hasn't reduced drug use

* Makes them more likely to continue their drug use

* Often leads to the use of harder drugs

* Is expensive

* Provides funding to cartels

* Causes violence

Decriminalising, or legalising drug use removes one of the main motivators of gang formation/violence while allowing the state to focus on helping addicts recover and contribute to society. The money spent on enforcement can now be spent on treatment, reducing the need for further funding rather than increasing it.

i agree, i think the grey area decriminalization is pointless, full legalization is the way to go with safe regulated drugs

There is another option, which is to leave the users alone and go hard after the suppliers.

That is an option yes. It could reduce the likelihood that addicts end up in a cycle of incarceration and more extreme drug use. However, without a legal supply, I don't believe it would have any effect towards curtailing gang violence or their funding.

Personally, I believe the legal supply should be delivered by the state. With a focus on providing monitored, unadulterated doses of the safest alternative and a program aimed at weaning the user off in a sustainable manner.

yup. they get to virtue signal and also quicken the death of the addicts. It's pure emasculated Portland passive aggression.

> There are lots of contradictions here. Voters don't understand how they can be asked to liberalize hard drug use (and even decriminalize dealing) on the one hand, and are asked for billions of dollars for drug addiction treatment on the other.

And understandably so. It's a textbook example of privatizing the profits, and socializing the costs.

It's not enough to tax drugs. Certain products are so harmful, and their harmful use so profitable, that allowing any kind of private profit from it at all is a disaster. (Yes, the most prominent of those are tobacco, alcohol and gambling).

Worse, addiction treatment is really expensive and not very effective - even the best addiction treatment programs have high relapse rates. Even the relatively cheap programs that only seek to limit the damage addicts do to themselves and others, can only be defended on humanitarian grounds, not economic ones.

Yes, we need to help addicts. Yes, including in purely harm-reduction ways. But we're deluding ourselves if we think this is a solution at all, let alone one we can afford if we let private economic interests profit from addiction without obstacles.

> Voters don't understand how they can be asked to liberalize hard drug use (and even decriminalize dealing) on the one hand, and are asked for billions of dollars for drug addiction treatment on the other

We are increasingly spending more on drug treatment. The current approach has failed and <x> are dead. It's time to change our approach, and a radical change is needed for this massive problem.

> Voters don't understand how they can be asked to liberalize hard drug use (and even decriminalize dealing) on the one hand, and are asked for billions of dollars for drug addiction treatment on the other.

That depends on the voters.

In the 90s Switzerland experienced a significant change in its drug policy.

One of the pillars (arguably the most important) is harm reduction. At that time hardcore addicts could get heroin prescribed and paid for by health insurance. Getting into the program was not simple, but for those that were hopelessly addicted and not able to kick the habit it was fundamentally successful.

The policy is still in place and was confirmed with significant majorities by the voters in multiple referendums.

A lot of those voters seem more interested in just letting """bad people""" die.

Why can't they understand this? Criminal enforcement and crime are apparently a major concern among voters.

They are just the victim of right wing propaganda

Buprenorphine is allowed in all US states and the FDA recently said even family doctors can initiate therapy.

And British Colombia is have record numbers of fatal overdoses, so while a tool, its not a solution to the crisis.

It’s not always just about what is “allowed in US states” but making it easy for addicts who need a solution to be locally accessible vs just as easily going on the corner with $10 for another high. I was purposefully being colourful saying Suboxone was handed out like candy in Canada but it probably needs to be to compete with the wide availability of Fentanyl and other drugs.

I should also note that being in favour of harm reduction doesn’t mean tolerating Portland style appeasement of crime and public …craziness. The baby is often thrown out with the bath water with this stuff and it doesn’t have to be that way. But that overreaction goes both ways in terms of dealing with the drug problem.

Yeah this a key point. Buprenorphine availability is very inconsistent in practice throughout the US. I'm not just talking about rural Kansas here either, it can be a struggle in every state and many major metro areas. Especially if you have all the associated problems one might expect (no car, no money for a copay, other health problems, etc).

Additionally, the actual treatment provided varies considerably between doctors. Do they give the patient enough to avoid severe withdrawal? Do they allow the patient to stay on buprenorphine long term if needed? How do they handle relapses? What sort of counseling or therapy do they provide (if any)? Do they take insurance?

Buprenorphine is available through telemedicine (even before Covid).

https://www.statnews.com/2022/03/07/doctors-companies-push-t...

I wont argue there are some barrier, but it’s not hard to get anywhere in the US.

Your link says that it was not available by telemedicine before covid, and it may not be any more once covid rules end.

Can't see any way an official programme can compete on convenience with 24/7 street corner illegal supplies.

Seriously. The world would not end if you could buy Vyvanse and Targiniq over the counter. Just let people have the safest version of these substances and move on. Most aren’t seeking help.

I don't disagree. I just don't think it's practical to put a 24/7 pharmacy on every block.

Why do they need to be on every block? If there's no "it's a crime" markup, drugs are really cheap, and illegal supply chains can't really compete with Walgreens and CVS supply chains sending out semi-trucks full of product from distribution centers.

Don't just do one thing at once. Arrest and charge everyone related to drug trafficking at the same time as forcing every public user of hard drugs to report for testing when picking up their daily dose and enforce it with ankle bracelets.

Then because you're not just putting a bandaid on it you have the funds available to actually get people off the street (and not just into shitty drug hotels) which is one of the biggest obstacles to getting sober.

The change to allow anyone to prescribe it is very recent, prior to that it was extremely limited, and most providers will still not prescribe it for a variety of reasons, ranging from not understanding it to addiction stigma to fear of the DEA.

The sad fact is that most people who would benefit from it simply do not have access to it.

I'd make suboxone available OTC, no questions asked.

Low cost, or even just free if you register as an addict.

Same for naloxone/narcan/whatever "overdose stopper" autoinjectors. Which, I'm reliably told, are the opposite of a good time.

Suboxone is not a drug you can really abuse in any fun way, and a lot of folks won't engage "formally" with addiction services due to stigma, paranoia, worries about their medical records being tainted forever, etc.

The addicts you see on the streets are just the tip of the iceberg. Much like alcoholism, the vast majority of users are "hidden".

There are multiples more users who are still functioning within society, holding down jobs, etc.

Addicts will find a way. Buprenorphine is the most abused opioid in Finland. Which by the way has the most youth drug deaths in Europe[1]. Granted it's usually Subutex (just buprenorphine) rather than Suboxone (buprenorphine + naloxone) but there's not much difference unless you're using intravenously because buprenorphine has such a high binding affinity.

I agree that there's a huge problem with opiates and am in favor of legalizing everything, but it's good to realize that buprenorphine is not a magic candy that fixes everything - you're just replacing an addiction to a deadly feel-good opiate with an addiction to a slightly less feel-good opiate with a larger therapeutic index.

[1]: https://www.euronews.com/2023/03/16/why-are-so-many-young-fi...

Isn't the purpose of making opioids available to addicts to allow addicts to "find a way" (i.e. manage their addiction)? We have no easy/effective treatments for such addictions so harm reduction is the best we can hope for.

Yes absolutely, I'm all for giving addicts the help they need. I just don't think haphazardly making it available OTC without a prescription like the GP suggested would be the right decision in the current situation. People already abuse OTC medications with a lot less recreational potential, stuff like whippits and DPH. Adding Suboxone to the mix would, in addition to helping the addicts that want to quit, raise a new generation of buprenorphine addicts.

Despite its miraculous efficacy for addiction treatment it certainly has some recreational potential and the long lasting opioids used for maintenance are a bitch to quit. Many people stay on the stuff for life because while you can taper down it's really, really hard to drop the last bit. While milder than with the fast-acting opioids, the physical withdrawals go on for weeks. With heroin or fentanyl they're over by day 3 or 4 and it's all mental after that.

In my ideal gay luxury space communist world most drugs would be available for anyone after a doctor's consultation where you learn basic harm reduction and such. Currently people abuse OTC medications or buy fentanyl laced stuff of the street to get high even though they're absolute trash for that. Safer options exist.

I suggested making it OTC without a prescription largely due to a couple of practical reasons - many users of illicit drugs who are not "street junkies" want to keep the whole thing hidden for various reasons (social stigma, worries about health insurances, medical discrimination), etc.

Not sure about where you are, but in the countries in EU/UK I've lived, OTC can mean either "behind the counter" (where you must speak with the pharmacist), or "in front of the counter" (you just pick it up and buy it).

Depending on country, different drugs are sold differently.

In Germany and Ireland, to buy normal antihistamines or pretty much any good OTC painkiller, I have to request it and usually get asked some questions, depending on the drug, whereas in the UK I can buy the same medications in Tesco.

I'm also of the view that a lot more drugs should simply be available via the model of informed consent or just "available by asking for them".

Waiting weeks and paying 60 euros for a GP to toss a coin on if they are going to agree with you about a medicine is a nightmare.

Though that may be due to the broken health system here making me wait 4 weeks for a GP appointment so I could get a fucking salbutamol inhaler after my asthma came back, among other things.

Interesting aside, the "mental" addiction can be harder to kick than the physical. Some former opiate and gabapentin users I know have mentioned this - psychological cravings for even years after stopping. Anyone who has ever tried quit nicotine will also know this.

> Interesting aside, the "mental" addiction can be harder to kick than the physical. Some former opiate and gabapentin users I know have mentioned this - psychological cravings for even years after stopping. Anyone who has ever tried quit nicotine will also know this.

Oh yes for sure, didn't mean to make it seem like it wasn't. I was(/am) a poly drug addict from Finland. Buprenorphine and amphetamine were my jam for a couple years. One year of using intravenously daily. It's been years since my last time but I still think about shooting up every now and then. It's a deviously strong urge. But the mental battle doesn't only start after the physical stuff is over: at the beginning they both compound on each other and it's absolutely devastating when you've been awake for two weeks because of the restless legs...

If you don't mind me asking, how did you get into that in the first place? Was it purely recreational? Escapism? Or..?

I first got into opioids at age 16 or so when I found boxes and boxes of tramadol prescribed for my father who had died of cancer some years earlier. Eating them made me feel good, really good. I guess that sparked my love for drugs.

I was a recreational user and managed to keep things under control (except spending all my money) for many years. But in those circles most people are a bad influence on you. Eventually it all just spiraled out of control. It was so easy to keep slipping deeper a little at a time while taking steps in the other direction felt enormously hard.

It's been about 6 years since I last shot up. Everything's going really good now. Granted I'm not sober by AA standards; I still smoke weed, and drink a couple of beers every now and then, and do psychedelics maybe once or twice a year. Whenever I start feeling blue.

TIL about the abuse in Finland. I was aware it was sometimes abused by prisoners, but that's new.

In another comment I went into a bit more detail around ways of dealing with the issue, using Finland's homeless housing policy as part of it.

Its a complex issue that certainly isn't going to be resolved through the criminal system.

Narcan will be available OTC in the US starting later this year.

https://www.fda.gov/news-events/press-announcements/fda-appr...

suboxone can be abused due to the differences in half life's of the components.

Are you referring to the scene where Sy Richardson admonishes them before giving them their methadone doses? That's a methadone clinic not not a pharmacy and he's a public health/social worker.

France also has much lower homelessness and supports child care and health care to a greater extent. In the US the most prominent cause of bankruptcy is medical debt, rents are up an extraordinary amount, homelessness is up quite a lot. Child mortality in the US is the highest in the developed world, from a combo of our terrible infant mortality stats and gun accidents.

What are drugs for? For most people, it's not as much chasing the high as pushing away the pain. Look at your own drinking for example (not necessarily you, dminor, but many readers). Mind-altering chemicals are overwhelmingly used in the US to numb oneself and push away the pain of daily living. Folks start with a little to take the edge off, dull the fear & give themselves a bit of mental space, not have to think about the bills, and then...

> gun accidents

https://injepijournal.biomedcentral.com/articles/10.1186/s40...

> We estimate that there were 110 unintentional firearm deaths to children 0–14 annually in the U.S. during this 8 year time period, 80 % higher than reported by the Vital Statistics. The victims were predominantly male (81 %). Approximately two thirds of the shootings were other-inflicted, and

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> Yet life is better on pretty much every material metric you list. [...] You think Americans dealing with bills need drugs more than subsistence farmers in Bangladesh?

This is irrelevant. When it comes to using drugs, all that matters is the user's own perception of their life. The fact that we have a mental health crisis among young people clearly indicates that, despite any measurable increase to their material quality of life, these young people are increasingly likely to perceive their lot as being dismal. Look at the article and see how many of these kids thought they were taking Xanax, which is an anti-anxiety medication. They weren't even trying to get high, they were seeking something to help them make it through the day. Finding and addressing the cause of this anxiety is, alas, more complicated than just beheading anyone who gets caught popping a pill.

I don’t see the two things as being in conflict. None of the countries I mentioned use the death penalty on drug users. You can address the demand side by figuring out what’s causing these mental health problems. That doesn’t mean you can’t attack the supply by executing drug dealers.

I think a lot of people in the US agree with you, but I think you'd all be surprised to know there are a lot of juvenile drug dealers out there. Sometimes they're indies, others they're low on the totem pole of some gang. You can't solve the problem by killing these kids, also they want to be drug dealers because of the money and prestige, and the (perceived) control they get over their life.

There's also not a lot of evidence in favor of the death penalty as a deterrent. The most likely outcome of this policy is we just start executing hundreds of young men, mostly minorities.

> Yet life is better on pretty much every material metric you list. Drug overdose rates have skyrocketed even as Obamacare and Medicaid expansion dramatically cut the number of uninsured people.

Is it? From what I hear living costs are higher and higher, real wages are flat or declining especially for the bottom 20%, and while more people might "have" "health insurance" it doesn't seem to have reduced the costs or rate of bankruptcies.

Perhaps looking at data would be in order.

Real income over time: (about 10% higher today than in 2000): https://fred.stlouisfed.org/series/LEU0252881600A

Bottom quintile over time (about 20% higher today than in 2000): https://fred.stlouisfed.org/series/CXU900000LB0102M (edit to add: this one looks to be nominal rather than real income; I’ll see if I can find the real chart on the computer before the edit window closes; I can’t effectively find it on the phone)

How does that compare to the change in people's expenses?

The CPI for rent is more than double what it was in 2000: https://fred.stlouisfed.org/series/CUSR0000SEHA

My apologies. Only the first chart I posted is real wages (after taking CPI changes into account). I was searching for “real wages over time” but didn’t detect that only the first result was real.

(I’ve now edited my post to call that out.)

I appreciate your candor. I missed that the first chart indicated real income.

I do find it interesting that housing and living costs seem more unaffordable than the CPI data implies. I came across some Statista data that indicates that real hourly earnings fell for non-managerial workers from a high in 1964 and took nearly 60 years to recover in 2019[0]:

> On average, workers in the United States in nonsupervisory positions got paid $23.38 an hour last month. Denominated in constant 1982-1984 dollars, that amounts to real average hourly earnings of $9.40, the highest amount on record since 1964.

I could be wrong but I imagine that many of these workers were probably hit harder by the pandemic and current inflation than those lucky enough to be able to work through it.

[0] https://www.statista.com/chart/17679/real-wages-in-the-unite...

> I do find it interesting that housing and living costs seem more unaffordable than the CPI data implies.

I agree with you that things "feel worse" than the data suggests. I asked an old friend a while ago about this, observing "I never worried about how much going out to eat cost 20 years ago, and I was making a lot less money then. Now, it seems so expensive."

"You have a family, house, and retirement to think about now" was his answer.

Part of the spread in feeling vs CPI is likely that CPI represents reported purchases. If people want steak and buy ground beef, CPI reports on the ground beef while you and I in daily life might be noticing our desire for the steak.

I think housing accounts for this almost entirely by itself. Take a look at this graph of inflation adjusted increase in house prices https://www.housepricecrash.co.uk/indices-nationwide-nationa...

That's a 2.5x - 3x increase since 1975, which is huge given that it is the single most expensive thing that anybody buys in their life. If you take housing out of the equation, most people I know wouldn't need to worry about money.

For housing, I think you have to back out the effects of interest rates as well, since the purchase price isn't what hits the monthly budget of households, but rather the payment price. I don't know what the reputable sources for UK mortgage rates are, but in the US, until quite recently, mortgage rates were about 30-45% of what they were in 1975 (~9%), so I'd expect the same monthly budget in real dollars to show up as a lot more capital buying power (expressed as a purchase price).

Well interest rates are now rapidly rising, so we're about the get the worst of both worlds.

> "You have a family, house, and retirement to think about now" was his answer.

That's a fair point from an individual perspective. Although, it's concerning that society as a whole appears to be experiencing the same shift.

> Part of the spread in feeling vs CPI is likely that CPI represents reported purchases. If people want steak and buy ground beef, CPI reports on the ground beef while you and I in daily life might be noticing our desire for the steak.

That's true. I also suspect that people that were struggling before have been impacted much more severely by price rises. In my country, prices in budget supermarkets have increased by a much greater percentage[0]. Own brand products seem to have been affected even more[0]:

> we found other Tesco products, including Hearty Food Co Two Garlic Chicken Kievs (260g), Grower's Harvest Orange Juice (3 x 200ml) and Rosedene Farms Small Pear Pack (550g), all soaring by more than 60% in price.

> At Asda, two versions of its Free From cream cheese products – its Soft Cheese Alternative (170g) and its Garlic & Herb Soft Cheese Alternative (170g) – went up from 93p to £2.12, an increase of 128%.

[0] https://www.which.co.uk/news/article/supermarket-budget-and-...

> You think Americans dealing with bills need drugs more than subsistence farmers in Bangladesh?

well it sure seems that way, don't it?

perhaps the issue is because Americans spend their time alone staring at screens, getting mad about politics and depressed while the Bangladeshi are toiling outside in well integrated communities...

or maybe it's just a supply issue. Then again, wouldn't alcohol and Afghan opium be relatively easy to acquire in Bangladesh?

further reading:

https://en.wikipedia.org/wiki/Rat_Park (although it has't been well replicated, from what I gather)

https://o-meditation.com/2012/06/12/the-attraction-for-drugs...

I don't live in the US, but it doesn't look like a place getting more liberal to me.

Living in California, I can tell I you it most certainly is and has been for a while.

Maybe the news paints it as a bunch of cowboys trying to restrict abortions. But look at California, Oregon, Washington, New York, etc laws. They have become so liberal that it has become a meme. Drugs are almost completely decriminalized, you can buy/sell and consume drugs openly on the street, police will not investigate property crimes under $1000 at all anymore, eviction is almost completely impossible even if the tenant hasn’t paid rent in a year. California is about to spend 800 BILLION dollars giving money to black people even though slavery never existed there.

It’s legitimately a struggle to think up ways coastal cities in the US could be more liberal.

> California is about to spend 800 BILLION dollars giving money to black people even though slavery never existed there.

This isn't actually happening.

https://www.pbs.org/newshour/nation/reparations-could-cost-c...

https://www.pbs.org/newshour/nation/what-are-the-next-steps-...

It seems like it's happening to me..

This thread is an interesting example on how not very well defined terms can let people talk past each other… the original poster suggested “let’s try to be more like France, where this problem is solved”, the next one said “no, more liberalism is not the solution” (apparently implying that liberalism is what France does) and now someone states you can’t get more liberal than California, listing as examples things none of which work like that in France!

Regardless of the merits of each argument (I am doubtful if you can easily transfer examples from one country to another) we obviously have people arguing with each other here based on completely different definitions of key terms in the discussion.

We need a thread summary like this more often. GPT-summary?

police will not investigate property crimes under $1000 at all anymore

That's just cops being lazy and not doing their job. They like to say "the D.A. will just throw it out!" or "they'll just be back on the street due to overcrowding!" as if either of those has anything to do with the cops' job of enforcing laws and arresting perpetrators.

I don't really know the reason for it, but it's an actual policy that cities have:

https://www.wsj.com/articles/san-francisco-shoplifters-theft...

Just walk the street on any given day in SF, you are guaranteed to see at least one broken car window. Smash and grabs are rampant.

I don't know if the rest of the article is behind a paywall, but I don't see anything about a policy.

The only policies I've heard of are either police department policies -- which is just codified laziness and refusal to do their job -- or district attorney policy which, as I said, shouldn't be relevant to whether or not police make arrests. It's their job to arrest people for crimes, not to solely arrest people for crimes for which they think they can get a conviction.

> Maybe the news paints it as a bunch of cowboys trying to restrict abortions.

They successfully restricted those abortions. They are trying to criminalize traveling to other states for abortions. And by abortions here we mean also medically necessary abortions.

> Drugs are almost completely decriminalized

This is simply not true. Like ... I dont think it is liberal media lying issue here. Maybe the specific subset of media you read is lying to you - which is way more likely to be conservative.

>They successfully restricted those abortions.

Sort of, yes. They are not restricted in any coastal cities though, the vast majority of Americans still have access to abortion.

The states I mentioned (CA, OR, WA, NY, and most other states too) have not restricted it. It's a few states in the south. These states/cities I mentioned are where most Americans actually live.

>This is simply not true.

I mean, have you driven through LA, SF, Seattle, or NY? You can watch people consuming and selling drugs 7 days a week in broad daylight. I am not relying on any news source for that information, I have lived it. Have you been assaulted or screamed at by someone high out of their mind on the street in SF? I have.

That does not remove the fact that conservatives are successfully restricting the abortion. Yes, they are trying to create more damage and enjoy the pain they cause. They also provably don't care about lives themselves - they are restricting healthcare in general and don't care about children.

The drugs in USA were not decriminalized. You lied.

That is a corruption issue and cannot be solved by drug laws.

What’s the corruption issue?

Lack of / selective law enforcement

The coasts are going for more liberal, the south and central (mid west) are going more right.

They’re moving left too, just more slowly compared to the coasts. If you go issue by issue (god, guns, taxes) the only major shift for republicans has been same sex marriage, where they’ve moved significantly to the left. Democrats meanwhile have moved sharply to the left across the board: https://jabberwocking.com/if-you-hate-the-culture-wars-blame.... For example marijuana is fully legal in North Carolinian, and medical marijuana is legal all across the Deep South. But in California, the legislature passed (though Newsom vetoed, with an eye to his presidential prospects) a bill allowing cities to have government-sponsored drug injection sites.

It absolutely is. Even Trump didn’t oppose same sex marriage (when it was still illegal in several European countries) and also signed major legislation aimed at reducing incarceration: https://www.bop.gov/inmates/fsa/overview.jsp. Drug prosecutions are handled primarily at the state level, and there has been a broad move to reduce such prosecution. Marijuana has been fully decriminalized in deep red states like Ohio and North Dakota. Does anyone even remember 2000? The big kerfuffle was covering up naked statutes. It was a vastly more conservative country (with far fewer drug overdoses).

Depends what kind of liberal you mean. If you mean DEI departments and getting fired for misgendering then it's much more liberal.

>Yet life is better on pretty much every material metric you list.

Lack of housing and the subsequent high cost of housing is a serious issue. Taking steps to avoid people becoming homeless in the first place is extremely important. And has certainly become much, much worse. It is a large factor in the amount of addiction and street drug use.

What is your perspective on the cause?

It's also quite easy to obtain Buprenorphine in NYC and the problem has only worsened in NYC. I strongly doubt that Buprenorphine was the sole cause of France's improvements, and given its already-wide availability in NYC I strongly doubt it will solve the problem.

Buprenorphine just makes opiate dependence more manageable. It doesn't make you not dependent on opiates and it doesn't make you stop wanting to change how you feel. And given it also doesn't much change how you feel, if you want to change how you feel, you'll stop taking it.

Addiction is a predictable outcome of inequality and lack of social safety net in the US. If you don't give people any way to solve their problems they'll settle for feeling better about their problems. We only help people if it's profitable to do so. The war on drugs just gives people more problems. The changes we'd have to make to fix the opiate epidemic are a lot more fundamental than giving people more manageable opiates.

> Addiction is a predictable outcome of inequality and lack of social safety net in the US. If you don't give people any way to solve their problems they'll settle for feeling better about their problems.

Opiate addiction doesn't give a damn about the size of your bank account, your social class, or how loving your family is.

The president's own son has struggled with addiction. Heck go back in history and you'll find the roots of the Opium war in China are tied to the emperor's own son dieing from an opium overdose.

Opiates destroy people at the neural level.

Yes there needs to be medical interventions for addicts. There also needs to be enforcement actions to reduce the supply of the drugs in the first place. Don't just target street dealers either, this crisis started with Perdue and other big pharma players. They shouldn't be able to wash their hands of responsibility simply by writing a big check.

>> Addiction is a predictable outcome of inequality and lack of social safety net in the US. If you don't give people any way to solve their problems they'll settle for feeling better about their problems.

>Opiate addiction doesn't give a damn about the size of your bank account, your social class, or how loving your family is.

He didn't say that addiction only affects poorer or more marginalized people, he said it's more likely to affect them. Which is true. Yes this means the president's son can get addicted too. Anyone can. Which is why it's a big deal for people with less access to resources such as expensive rehab and medical care

People oversell this stuff. I was on hydromorphone for a week, and some times fentanyl, and I still have some oxycodone left.

One year later, with the spare oxy in my closet, do you know how often I take it? Zero times.

These drugs helped me handle, with minimal fuss, massive physical trauma. And for 9/10 people opiates are not addictive. You will ban them and rid doctors of them over my dead body.

Did the opioid epidemic simply not happen in your world?

> Purdue has known about the problem for decades. Even before OxyContin went on the market, clinical trials showed many patients weren’t getting 12 hours of relief. Since the drug’s debut in 1996, the company has been confronted with additional evidence, including complaints from doctors, reports from its own sales reps and independent research.[0]

> OxyContin taken at 12-hour intervals could be “the perfect recipe for addiction,” said Theodore J. Cicero,[0]

> Patients in whom the drug doesn’t last 12 hours can suffer both a return of their underlying pain and “the beginning stages of acute withdrawal,” Cicero said. “That becomes a very powerful motivator for people to take more drugs.”[0]

Richard Sackler:

> When another family member sent him a press cutting in 2001 about 59 deaths in a single state linked to their drug, he responded: ‘This is not too bad. It could have been far worse.’ Then he asked a friend why addicts deserved sympathy, since ‘they are criminals’.[1]

Preventing companies from pushing doctors to prescribe medication in a manner that encourages addiction isn't anything like saying they should be banned.

[0] https://www.latimes.com/projects/oxycontin-part1/

[1] https://www.spectator.co.uk/article/the-scandal-of-oxycontin...

If you've never needed a high grade analgesic, you're going to lecture from a screen. But I recovered without significant emotional trauma and with great sleep and rest as a result of a month of oxycodone which I tapered with ibuprofen.

The opioid epidemic happens because 1/10 is a crazy ratio. It means every doctor is creating multiple addicts a week.

I'm fine with them denying this degree of painkiller to most people so long as ones like me can receive it. From my actual lived experience that it is not addictive, and that all of fentanyl, hydromorphone, and oxycodone were tremendously helpful, I'm not going to go along with this banning stuff.

The ratio is probably more like 1/5 if you believe the results of the Capture Rates study on wikipedia https://en.wikipedia.org/wiki/Substance_dependence.

That said, I agree with you that patients who need these drugs should get them. I had to get emergency surgery a few years ago and they also gave me morphine, oxycodone and fentanyl at the hospital. I find it hard to imagine how awful the experience would have been without medication.

> That said, I agree with you that patients who need these drugs should get them. I had to get emergency surgery a few years ago and they also gave me morphine, oxycodone and fentanyl at the hospital. I find it hard to imagine how awful the experience would have been without medication.

Almost no one is suggesting this medication should be banned. A significant driver of the problem was that Purdue pushed heavily for 12 hour dosing periods despite knowing that the medication wore off in only 8 hours for a non-negligible number of patients. Their motivation for this was explicitly financial.

Patients were faced with following the dosing periods Purdue were strong-arming which meant enduring 4 hours of pain, finally salved by an addictive opiate or taking the medication more frequently than prescribed, running out early, and exposing many of them to black market alternatives.

> Opiates destroy people at the neural level.

So do coffee, tobacco, antidepressants and antipsychotics.

Coffee and tobacco are not neurotoxic

Sorry, that's wrong, at least as far as caffeine is concerned, and certainly as far as adverse behavioural effects ("behavioural toxicity") are concerned in humans.

https://www.sciencedirect.com/science/article/pii/S131901642...

That Kang et al. study was 50mg/kg of caffeine administered three times a day. That would be about a hundred cups a day of coffee for my body weight. Don't they say the dose makes the poison?

Curse you science! Still, this is just in rats. Rats with their weak rat brains. My superior human brain can easily absorb this caffeine with no ill effects!

Oh, interesting, thanks. I'm not sure why you're downvoted. What about nicotine?

No idea on that front. The caffeine one struck a chord because I'm a slow metaboliser, and it can cause me issues with anxiety under the wrong circumstances. It does make me wonder how many cases of anxiety are at least exacerbated by genetic issues with processing caffeine and other stimulants.

Both contain practically the entire family of beta-carbolines, which includes several neurotoxic alkaloids.

Opiates are not neurotoxic.

There are many reports of opiate neurotoxicity https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1949075/

https://www.pharmacistsmb.ca/files/2001/May-June/Opioid_Indu...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9007125/

Neurotoxic in the sense of having adverse events of a neurological nature.

Neurotoxic does not mean “your neurons are damaged”, at least not how those articles define it.

So there are two totally different definitions of neurotoxic used in the medical field?

No, the scientific field uses it differently than the layman.

Neurotoxic to a scientist means “can have negative impact to neuron function, whether temporary or permanent”.

The layman thinks neurotoxic means “kills your brain cells”.

Both definitions are correct.

From Wikipedia:

> Neurotoxicity is a form of toxicity in which a biological, chemical, or physical agent produces an adverse effect on the structure or function of the central and/or peripheral nervous system. It occurs when exposure to a substance – specifically, a neurotoxin or neurotoxicant– alters the normal activity of the nervous system in such a way as to cause permanent or reversible damage to nervous tissue.

Brain cells getting killed is a normal process, you could call it pruning. Cells grow back, you know!

What makes you think any of us were using the lay definition?

Because if someone said “opioids are neurotoxic” from a scientific definition, it’s stating the obvious.

> Buprenorphine just makes opiate dependence more manageable.

"More manageable" is a very creative way of saying less deadly, I congratulate you on your turn of phrase.

In all seriousness though, buprenorphene has a number of benefits aside from being difficult to overdose on. It lasts much longer and lacks the euphoric effects of other opioids. People on buprenorphene tend to get their life back together, and if you're truly concerned about getting someone off opioids that's a much better starting point.

> it doesn't make you stop wanting to change how you feel

that's actually one of the things buprenorphine and methadone help with, but as you point out it's easier for that part to work if you have a good life already

> Addiction is a predictable outcome of inequality and lack of social safety net in the US.

I don't know why this keeps getting repeated. The southern neighbor of the US, Mexico, suffers from greater inequality and substantially less social safety net and does not have any comparable opiate situation as the US.

Most of these kids are not addicts, they bought what they thought was a Xanax from some dude on Snapchat, and it turned out to be fentanyl.

I somehow feel that maybe the pharmaceutical marketing machine, which has successfully turned drugs into name brands that are recognized by kids, might have something to do with the problem. But what do I know?

Correct. Recreational drug users are being poisoned by counterfeit prescription drugs manufactured by Mexican drug cartels that contain fatal doses of fentanyl.

https://peterattiamd.com/anthonyhipolito/

That is a bit like during Prohibition there was a lot of illegal alcohol much of which was bad quality containing methanol instead of ethanol, making people blind or dead

https://www.pastemagazine.com/drink/alcohol-history/prohibit...

"Suffice to say, the public didn’t take too kindly to that kind of “it’s their own damn fault they’re dead” reasoning, and it fanned the flames of the growing movement to repeal Prohibition. "

Are you suggesting to legalize fentanyl so it can be purchased over the counter like aspirin?

I think the idea would be more like legalise and/or decriminalising Xanax or MDMA or whatever it is that recreational users actually want to take (the number of people who intentionally consume opiates is dramatically lower), and to make a reliably uncontaminated supply of these substances available. This could be over the counter (presumably with age restrictions), or it could look more like no questions asked drug testing services.

Xanax (alprazolam) is already legal with a prescription. It is frequently prescribed for insomnia and other sleep disorders. But patients often sell some of their pills on the black market, and now drug cartels are manufacturing counterfeit Xanax pills which replace the active ingredient with fentanyl. Xanax itself has some pretty severe side effects so there would be a lot of resistance to making it available OTC.

Yes there should be good drugs more easily available than bad drugs. Rational people understand they don't want to get their body into a condition where they get into terrible pain if they don't get their next injection soon. Where they have to commit crimes to finance their addiction.

Rational people don't want to take street-drugs which they know might kill them because of bad quality. They are seeing a lot of people dying around them so they know.

This is conceptually not that different from methanol-laced alcohol being available during prohibition. Of course nobody wants to take methanol if they can take ethanol instead. Ethanol is very bad as well. But harm reduction should be the thing that guides our policy.

Don't be silly.

You should probably restrict it to people over the age of 18 like cigarettes

https://en.wikipedia.org/wiki/Systembolaget

if the market is a government monopoly, you'll likely have fewer problems than if t's run by violent criminals.

Benzos like Xanax are extremely addictive and popular party drugs.

Buprenorphine hasn't been as effective as hoped[1] for addiction treatment specifically for people who have taken fentanyl.

[1]: https://www.statnews.com/2022/11/16/fentanyl-isnt-just-causi...

That's a very good point, although we've recently discovered that narcan can help here: https://www.boulder.care/quickstart

(I work for Boulder)

That's interesting. It surely deserves a study rather than relying on anecdotal evidence.

the way the programme works is using established medications with well-understood mechanisms of action. Your reference to anecdotal evidence seems to disparage the programme and makes your call for a study look like a bad faith position.

Who cares about an argument on some random Internet forum? Doing a study and then publishing a paper on the efficacy of using Narcan to treat OUD would open up that treatment to more people, saving lives.

Perhaps you misunderstood me. I don't think this needs any further study because the drugs are already licensed and in use. Just needs publicity and for other places to adopt the treatment protocol.

Suboxone, particularly from France, seems to have come with big problems of its own, as is candidly shown in the film/docu Reindeerspotting - Escape from Santaland: https://imdb.com/title/tt1584813/

Exactly! Like most problems the US faces, we know exactly what to do to reduce the impact, even if we can’t entirely eliminate it.

This should be patently evident from the fact that other countries don’t face similar issues.

The U.S. is simply not willing to do what it knows it must do. And worse, the public, using US exceptionalism, simply ignore the fact that the rest of the world doesn’t face the same problems, and so excuses the politicians who tell them that nothing can be done.

What about since? That's ancient history in drug terms

It’s stayed low. France had 0.6 OD deaths per 100,000 people in 2020. The US had 27.9 OD deaths per 100,000 people.

In other words the US numbers are roughly 50x as bad.

France has an overland connection to the heroin trade. Most of the heroin in the US either flows from Europe or Asia.

With a steady supply of heroin, there is no demand for synthetics like fentanyl, and dealers dont need to sell fake heroin - they can sell the real thing.

Fentanyl is much cheaper than heroin, and produces a stronger high. Dealers would still be pushing fentanyl even with a ready supply of heroin.

But they arent in Europe, which has a plentiful synthetic drug pipeline.

So the question is why?

I argue it’s because heroin is so plentiful there is no need and if you try and sell fentanyl people will stop buying from you.

I would argue it's also the users. PCP never got big, gashits are not very popular in most of Europe, GHB never got that big either.

Essentially unsafe drugs aren't popular. Available but not mainstream.

Here in Switzerland they get clean heroin from the state, not surprised fentanyl is still a niche phenomenon.

How can it be the users when you cant tell what drug is in that tablet of knock-off “Xanax” you bought?

Why are they buying knock-off Xanax from a unreputable source in the first place?

Darknet works like Amazon, but unlike Amazon reviews are usually real. Bad actors get blamed.

If they do, and there is a known risk, why did nobody in the distribution chain use a $15 test kit to verify the quality? Someone must have bought a few hundred pills at once to redistribute them, $15 and 5 minutes wouldn't matter.

Or general save drug use. You have a pill you haven't tried yet. No way to check properly. So you only take a bit and see if it turns out as expected.

This fentanyl thing is new and wasn't a thing when I popped pills. However there have always been dangerous pills. We've checked them, online, at labs, in person and small doses. If they were shit we throw them.

I believe the main difference is culture. We were aware of the dangers, we had mobile labs at parties and flyers about the current bad pills.

(Other than that Xanax and prescription drugs are nowhere as popular in Europe than they appear in the US)

Fentanyl is one of many possibles, and the test strips themselves may be bunk. The odds a 13 year old without a car is dropping off their pills at the gas chromatography machine in their STEM magnet school in the morning is pretty much nill.

Also worth noting in my state possessing kits design for testing for illegal drugs is a felony. [note: not legal advice]. No one reputable is going to risk a felony to sell drug testing kits for shitty margins.

https://www.azleg.gov/viewDocument/?docName=http://www.azleg...

See that's exactly my point. If these kits aren't even legal there simply is no drug safety culture to even build on.

Because, in the Netherlands you can get your 'illegal' drugs tested anonymously for safety for free (or a really small fee like 2,5 euro in high traffic places like Amsterdam).

You can do it in the US as well. You can buy fentanyl test strips easily.

https://dancesafe.org/drug-checking/

That said, how many users actually test every single drug they purchase? Especially if they are addicted and using multiple times per day?

Just to be clear, france doesn't have mexico on its boarder. The illegal drug trade in France is ~3b, in the US it is ~150 billion

France is not targeted by the 2nd largest economy in the world through an act of social warfare to knock them off the top rung so that their adversary (China) can take over. More than 90% of the fentanyl on the streets of the US originated in China.

Can I have a citation here? Can't find your 90% number with a quick Google.

https://www.cbsnews.com/news/fentanyl-seizures-rise-u-s-mexi...

Even with the CBS "slant" for migrant support, they do say this:

"According to the DEA, most of the fentanyl is smuggled over land across the U.S.-Mexico border. Smaller amounts are smuggled by air from China."

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Are you seriously suggesting TikTok is responsible for fentanyl overdose?

(TikTok is also available in France btw)

And I doubt border security is a partisan issue in France whereas one of the two parties seems hell bent on open borders here.

Migration is absolutely a partisan issue in France.

As part of the EU, France's borders are basically wide open (except for the relatively small or less important borders with the UK, Suriname, Brazil and more surprisingly the border with the Netherlands).

Border security is very much a partisan issue, with the far-right being very much opposed to freedom of movement.

France has a border with the Netherlands? I guess if you count St. Maarten that's correct but that border is wide open. Is there another one I'm missing?

I though it was not totally open since I've heard for a long time about some difficulty to get to some agreement on border control, but apparently it's only for the airports, so the border itself is open indeed.

I'm sure you are blaming democrats here. It's not true in practice. Dems don't want endless crime, they don't want open borders for fentanyl to come through. It's a lazy, incorrect statement.

I've spoken with many democrats (since I live in a democrat controlled city in a democrat controlled state, it's hard to avoid) and what they say they want and who they vote for are completely divergent.

I mean... If you vote to let violent criminals out of jail in the hopes violent crime will go down, something is missing up there. This has been my universal experience with democrat voters. It is what drove me away from the party. They'll trust 'experts' ridiculous advice over their own common sense. Most of them are extremely partisan, and will quickly label any independent candidate as a Republican, which is enough reason to not vote for them.

Either way, democrats have been in charge of cities for years in this country and it simply hasn't turned out well.

I often align with democrats on fiscal policy, but the voting bases inability to use common sense reasoning and their overuse of the cliche of everything being 'complicated' has driven me away

We know exactly what to do, it's just that nobody's willing to pay for it. The poor don't have any money by definition, the middle class, particularly in New York, is already at or near its limit, the rich are too busy being the main character to bother, and the political class is entrenched enough that this issue alone won't produce enough political force to dislodge them or move them to significant action. Addicts typically aren't very motivated voters, and most of them probably didn't have a supportive family to begin with.

So I guess we're back to the tried-and-true approach of charities putting as many band-aids on the broken leg as they can, politicians spouting empty rhetoric with crocodile tears around election season, and cops policing the affluent neighborhoods while largely leaving the rest to rot.

How do we fix all of this, that might have a chance of actually happening? Capital controls. Make TVs, mixers and smart toasters expensive again, but made in America. We need a full economic ladder, not just the top rungs. College degrees should not be required to enter the middle class, in their current state many degrees don't even provide that anymore.

What leads you to be confident that (we already know that) making society more equal will reduce the fentanyl epidemic?

Because for many (most?) addicts drug use starts as a coping mechanism. So the question is what are people coping with that's so bad it causes them to turn to drugs, despite all the readily available information about how bad they are? Lack of economic opportunity among the lower classes is a big one.

There are certainly other causes of addiction, but at the end of the day a lot of rehab programs fail because even if the addict gets clean, they're immediately sent back to the living situation that got them addicted in the first place. This is especially true for the homeless, "congrats you're free of heroin, now go back to your tent under the bridge where you live in constant fear of rape from other drugged-out homeless people and no employer will touch you! You're free!"

You should read up more on the opioid crisis and fentanyl specifically. Poverty and "lack of economic opportunity" is not a new thing. We're dealing with something entirely different and these armchair expert comments and opinions don't help things.

The crack epidemic in the 80s wasn't fentanyl. Whatever its divergent chemical properties, I'd rather address the reason people start using it in the first place. If we don't fix that, then even a magic rehab pill that instantly cures addiction won't have any meaningful impact.

As for "poverty and lack of opportunity" not being a new thing, no shit. But we've seen a hollowing out of the middle class over the past few decades. So a lot of newly impoverished people who grew up middle class, or are else seeing their quality of life decline through no fault of their own. That is relatively new on the scale that we're seeing it.

And I say this as someone who's immediate family has had some past issues with fentanyl addiction, so it's anecdotal, but I'm hardly just speaking from my armchair here.

While I completely agree with you on the causes of social malaise, and the importance of it, I'm not sure "we know exactly what to do" is really an accurate statement.

Opioid addiction has been a spectacularly difficult nut to crack as long as there have been opioids, and highly related issues like alcoholism likewise.

There's a lot of inputs to addiction. You rightly point out the input of economic dignity, which probably is top of the list from a policy standpoint. And on a public policy basis there's also culture, media, simple availability of the drug, availability of interventions, and many other inputs.

But the largest input to addiction is family structure and dynamics, and it's not even kind of close.

Opiate addiction is not nearly as big a problem as overdoses though.

It isn't the end of the world if someone becomes addicted to opiates. There are pathways to recovery and one can live a relatively normal life while addicted. What makes it exceptionally harmful is the amount of fentanyl in street drugs, the legal ramifications of use, and the lack of realistic treatment.

That's an interesting take. Kinda like drunk driving is not nearly as big a problem as drunk crashing.

As a thought experiment, what would be wrong with drunk driving if it we could always prevent drunk crashing? It feels wrong, but I guess we should in theory be fine with it.

True enough, where I was coming from with that is we haven't even tried the obvious stuff. Sure they'd only be partial solutions, but right now we're like an obese person who eats 100 oreos a day but wants to lose weight. The first steps at least are blindingly obvious.

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Capital controls are communist? That's funny, because up until the Post-WWII order that's pretty much what everyone had. It's what some western nations still have to this day. It's what we do for our entire military supply chain. You know, like those radical lefty organizations Lockheed Martin, Boeing and Raytheon.

Adam Smith himself is communist by many modern capitalists' definitions, the label is getting tiresome. They (and possibly you) just want money without any responsibility, a child's idea of a good life.

Indeed. The US had capital controls: https://www.elibrary.imf.org/view/journals/024/1975/001/arti... .. introduced by noted communist Lyndon B Johnson.

I wish people advocating these views would visit Eastern Europe and ask them how well Communism prevented disparities and despair.

I wish people advocating capitalism would visit my hometown in rural southeast US and see it too honestly. 18% of children and 25% of elderly adults under the poverty line. Every single family I know of directly touched by at least one of the wave after wave of addiction crises we've been having.

We aren't better you just don't have to look at it.

The problem is that, no matter the organization or system we devise, people who want power and control sooner or later (and usually it's sooner) find a way to work their way to the top, where they can f*ck over everyone else.

Until we fix that problem, the best we can do is to pick systems and ways of organizing that tend to limit the ability of these people to get control.

What town/state are we talking about? Is it a mining town where the mines are shutdown? Is it a mill town where the mills are shutdown? Is it a auto manufacturing town where the cars went obsolete? Agricultural town where the farms are gone?

You mean sort of attention to context and nuance that wasn't part of the conversation when we were talking about other economic systems?

For a people who won the cold war y'all are very defensive about this whole thing lol. Like the slightest acknowledgement that this system also sucks for a lot of people means we're headed straight for the gulags again.

People in your town can keep fruits of their labor? Do what they want with their money?

Have you ever lived an entire family on $18k/year? What you want to do with your money is completely moot.

It is definition of capitalism. You get money for work and spend on what you want.

Do what they want with their money, like not be able to afford a home, or a means of transportation, or adequate food.

Real fucking freedom you have there.

So you don't have capitalism there.

No no. The way I would do communism would be good!

That wasn't real communism.

We've known how to solve opioid addiction for decades: give people opportunity, hope and community and they won't choose to escape reality. Rat park generalized to humans.

Our politicians would rather feed the drug-incarceration-industrial complex than serve our society at the expense of their rent seeking patrons.

We don't have zero idea what to do: the solution is just something that people who are part of this machine refuse to grok.

Fun Fact: Rat Park has never replicated, and is now considered bunk: https://en.wikipedia.org/wiki/Rat_Park#Replication

One graduate student failing to replicate does not support the assertion that it 'is now considered bunk'

You’re being disingenuous. ”There has been little subsequent interest in replicating the studies due to several methodological issues present in the originals”

A paper with many egregious methodological issues is, at worst, a paper that should be ignored, as though it never happened. We cannot say that it is "wrong" or "incorrect" or "bunk" because it's a nothing, a non-argument. Until the experiments are repeated, sans egregious methodological issues, we can't logically make that determination.

So if it’s generally accepted that the world is flat, we shouldn’t listen to anyone claiming otherwise?

A better analogy would be "If it’s generally accepted that the world is flat, we shouldn't assume its round because one student was unable to measure the curvature."

The machine refuses to work against its self-preservation.

Plato wrote in his famous work on democracy that the body of citizens in a polis should not exceed 10000, else the direct democracy disintegrates, and both electing officials consciously, and keeping them accountable becomes hard.

The representative democracy in the US works with 350M people, 240M eligible to vote, is hopelessly part these confines. It's not a wonder that it works not really ideally; it's a wonder that it works at all for nearly 250 years.

The US needs to upgrade the mechanisms of its democracy to better suit its scale. Switching to Condorcet voting or other preferential voting schemes on municipal and state levels in a few states is one such upgrade. Maybe people will start electing more officials who actually care, and who might shake the inadequate equilibria, in drug-related policies, and elsewhere.

We don’t know what to do because we have no idea what the root cause of the problem is.

Gabor Mate worked with those dealing with addiction for many years. In his book, Hungry Ghosts, he explains that addiction is an escape from deep psychological pain usually caused by childhood trauma.

The solution, then, is psychological help – something we do very poorly with for addiction right now. This is in part because psychologists often don’t understand the nature of addiction either.

And we can avoid making the problem worse by not trying to punish away pain and instead implementing harm reduction strategies.

I think it is dangerous to look at addicts who lost everything or most things and derive your definition of Addiction from that. Andrew Huberman in his podcast defines addiction as a "progressive narrowing of things that bring us pleasure", which I think hits the mark quite a lot more.

If you google things like "When does someone have a drinking problem?", the vast majority of sites will use a really weird and vague definition like "If you answer yes to more than 3 of these 7 statements, you might have a problem". I think this is because we want to draw a (pretty arbitrary) line between what we consider normal drug use and addiction, when in reality it makes more sense to say that everyone who drinks or smokes semi-regularly has a light addiction. Most people manage to more-or-less stagnate on this light addiction, although from my limited experience, I feel like people generally drink ever slightly more as they age, so it is just a very slow increase in addiction, others don't.

The reason why I think this is really important is because a) it reduces stigma; Most of us are more or less in the same boat and b) addicts don't have a fundamental different psychology or life experience. Yes, if you have trauma or a generally bad life experience, you are more likely to binge on drugs, but the reasons for this are quite obvious given the definition above: The narrowing of pleasure comes both from addiction as well as external circumstances.

I agree with you on the solutions though, we need more empathic care and therapy, harm reduction plans, and reduce poverty and the causes of extreme psychological trauma where possible.

Mate explains addiction as a sliding scale. He worked with those whose lives were in complete toil. But he also worked on his own addictions which made his life worse but are not comparable in terms of severity of consequence.

Similarly trauma is also on a sliding scale.

Agreed that low-level addiction, even in cases that it may similarly be a form of escapism, is not necessarily caused by trauma. But I think that's actually why addicts are stigmatized. I just need a little more willpower today- a good night's sleep and some exercise is often enough- to avoid addictive behaviors. But for those suffering from severe addiction it's not helpful to think with that mindset. Understanding the root cause has opened me up to truly empathizing to those with addiction- something often lacking in our society.

This is a great book! I read about 3/4 of it before I got distracted with something else but you've reminded me and now I want to finish it!

It really changed my outlook on severe addiction.

Call me cynical but:

Nothing is getting done because the deaths are concentrated among populations that a) don't pay a lot of taxes b) don't have a lot of wealth c) can't easily be manipulated as a homogeneous blob of political pawns.

Basically there's little upside to solving the problem for government, big business, moralizing ideologues and the rest of the usual suspects who weigh in on these sorts of things.

Do most fentanyl overdoses come from people taking opiates? Or people taking something random laced with fentanyl? The solution to the latter would seem to be test kits, too.

A while ago I listened to an interview about drugs and drug manufacturing where one of the participants, and I wish I remembered who it was, said we probably should think about what is going on with fentanyl and the various other synthetic opiates through the lens of what happened with the Opium war. It didn't sound like fearmongering to me, but rather someone trying to describe to other people what he saw in his reporting or public health work.

I'll try to look at what I've listened to tomorrow and see if I can find it.

> It's the most serious issue facing the country, and we have 0 idea what to do

https://substanceabusepolicy.biomedcentral.com/articles/10.1...

We know what to do, but we don't want to do it because it would be deeply unpopular with people. Thailand, Singapore, and other nearby countries have demonstrated how to stop the flow of highly addictive drugs - by using a culture of shame and highly punitive measures around possession and distribution.

China learned this lesson during the opium wars, too. They couldn't stop the flow of opium because it would have been terribly unpopular with the people. The script has been flipped with Fentanyl (and to a lesser extent, TikTok).

It remains to be seen whether we actually care about the drugs, though. Simply ignoring their presence may be a legitimate strategy.

Thailand still suffers from hard drugs abuse, including opiates. Singapore is a very tiny city-state with a massively repressive government. Not really good benchmarks/role models. Even in Singapore you can find drugs, it's just absolutely stupid to do it if you are a tourist given how draconian drug laws are there.

On the other hand, countries like the Netherlands and Portugal figured out a way for drug users to not die. That's probably the first thing you should fix: how to help people to not die when using drugs. Educate your population about it, most Dutch people I know are very aware of drugs; their effects, risks, etc.

The cat's out of the box, there's only one level of repression that could have a chance to work on stopping the flow of drugs: maximum repression by the government, maximum shame by the population, is that really what you want? I don't believe that's a solution if you are already in a free society...

You say Thailand has figured it out but 4% of Thais have used illegal drugs in the past year. Which is pretty close to the 5-6% of Asians in the USA who have used illegal drugs in the past year.

Interesting that two very different national legal policies have such similar outcomes among Asians.

Phillipines has experimented with allowing anyone to murder anyone else they suspect of using drugs. That hasn’t significantly decreased the rate of illegal drug use in the country. This is despite making payments to people to summarily execute drug addicts. Thousands have been executed across the Phillipines. I can’t find any evidence that drug use in the Philippines has decreased in the past 5 years.

> 4% of Thais have used illegal drugs in the past year.

Care to wager on the fraction of US users of illegal drugs?

https://www.fmprc.gov.cn/mfa_eng/wjbxw/202302/t20230209_1102...

> In 2021, findings by NCDAS show about 19.4 percent of Americans have used illegal substances at least once. Out of the 280 million aged 12 and older, 31.9 million are drug users, with 11.7 percent on illegal substances and 19.4 percent either having consumed illicit drugs or misused prescription drugs in 2020. If alcohol and tobacco users are included, the number of people in the United States who are abusing substances totals 165 million.

> During the past 12 months, 48.2 million Americans over the age of 18 consumed cannabis at least once.

> During the past 12 months, 10.1 million Americans have consumed opium at least once.

US statistics are very skewed because marijuana is an “illegal drug” sold legally in most states. I did provide numbers for Asians in USA though, which was similar to Thais in Thailand.

Opium is at 3.3% by your number, which is comparable to the numbers I showed on Thailand.

We can both cherry pick data but USA has tried prohibition of various substances for over 100 years. Prohibition by itself caused more problems than it solved.

Philippines ended up with a lot of end users getting killed while doing little to stop suppliers. Which was all the more ironic as a lot of poor philippinos use cheap stimulants to work long hours in low wage jobs.

Who says it failed in the Philippines? I have a lot of anecdotes from talking with locals around Bohol and family in Mindanao that it has been very successful.

A lot of average Joes getting killed is a high price for success.

But I can understand people wanting strong government action, especially in Mindanao which has two different insurgencies (Islamic and Communist) to contend with besides drug gangs. One of my relatives had a work trip (she worked for the national government) to rural Mindanao and they sent her by military helicopter with a squad of soldiers for protection.

We should study it seriously, but it's worth noting even the article you linked to (which seems to be pretty biased, it should be noted) suggests the Portuguese model is far from a simple silver bullet:

> Despite encouraging results, conclusions indicate that these policies are marked by contradictions and ambiguities that have permeated its history since the very beginning, and modest ambitions, particularly regarding the implementation of harm reduction measures. Moreover, the polemical Supreme Court judgment that reestablished, in 2008, drug use as a crime when the quantities at play exceeded those required for an average individual’s use for 10 days, might have impacted the landscape of drug use penalization. The last decade saw an increase of punitiveness targeted at drug users, including criminal sentences of jail terms.

But it's hard to take the article entirely seriously when it acts as if the goal is, in their words, "emancipate drug use from the stigma that associates it either with crime or pathology," and it opposes acting as if drugs are a problem:

> Finally, casting drugs as malevolent agents that allow classifying users as bad or sick (or both) became a fabrication that eases the stigmatization of users and human rights violations.

archive.org link [1]

[1]: https://web.archive.org/web/20230330052658/https://www.newyo...

> It's the most serious issue facing the country, and we have 0 idea what to do.

If only there was a thing to learn from other countries. That already starts with the basics such as in which amounts pills are available over the counter. From a European's perspective the entire idea that you get pills in a bottle is so wild.

Fentanyl use is synonymous with suicide. People use fentanyl to die. So what we are seeing is a massive amount of suicides (overwhelmingly men). Yet this is never shown in media, it's not in line with the current political posturing.

If we consider increased drug use a natural response to increasingly adversarial and stressful environment, could we use this as an inspiration to maybe reverse some of the forces behind the stressors?

https://archive.is/okksn

> we have 0 idea what to do

We have plenty of ideas. The most obvious one is to begin controlling the areas of the border through which these drugs are entering the country.

Unfortunately that would require an admission by the current US administration that there is a catastrophic crisis at the southern border - one encompassing human, financial, drug, cartel, Chinese, terrorist, human trafficking, and a myriad of other elements. This harsh admission of reality is a current impossibility for the Biden administration and US Democrats.

And just to be clear, the southern border isn't the only point of entry, but it is the largest and most elaborate. There is an entire industry set up exclusively for opioids. Ignoring the human trafficking, slavery, coyotes, and other elements: just the fentanyl trade alone involves at least two cartels, and an international supply chain that includes India, China, and MexicoS[1][2]. The US would be the fourth sovereign participant in that it facilitates a degree of free trade that would make anyone else incredibly jealous.

---

[1] https://www.dea.gov/sites/default/files/2020-03/DEA_GOV_DIR-... Note this is from 2020, and as predicted, the bulk of fentanyl did in fact shift to entering through Mexico, even if the precursors arrive from China and India to Mexico.

[2] https://www.wilsoncenter.org/article/briefing-senate-foreign...

Drugs are smuggled from Mexico to US. And GUNS are smuggled from US to Mexico. It's a bit ironic isn't it? The reason Mexican cartels can hold so much power is not only the dollars they get from US in return for drugs, but also the assault rifles they get from US, in return for dollars.

"... Mexico — which has just one gun store and issues fewer than 50 gun permits a year "

https://www.usatoday.com/story/news/nation/2021/08/25/americ...

The war on drugs is great for US gun-manufacturers.

US has a drug-problem. Mexico has a cartel-problem. I think Mexico's problem might be worse, because everybody suffers from criminals ruling the country.

The problem didn't start when Biden was inaugurated. It has been getting worse during the previous administration. It doesn't feel like Biden did anything about it, but neither did Trump. Trump made false claims about closing the border and said his work would reduce the problems. It did not. We don't know what to do to stop it, and both parties in the us have no real solution.

He tried pretty hard but was thwarted by Democrats. This line of argument is disingenuous - for example, Biden has many plans he strongly fights for like expanding healthcare, but that he can't get through, due to the Republicans. It would be very unfair to say the equivalent of your comment about Biden/healthcare.

> thwarted by Democrats

The 115th United States Congress: Senate majority - Republican, House majority - Republican, Presidency - Republican.

Blame the party not in power.

As you should know, they did pass legislation in that time, only to have it blocked once they lost power and further neutered with the recent admin.

Further, there's only so much an admin can focus on and they had a variety of other issues. My point stands which is that one party is very focused on this issue and worked towards concrete measures against it, while the other worked against them.

Tump was trying to build wall to prevent immigration. Drugs do not come from immigrants but from cartels through different means. Trump's idea has never been about stopping all commercial exchange at the border nor dismantling every single vehicle crossing the border in search of pills.

Additionnally, if cartels can't smuggle drugs through the border, they'll build fentanyl shops inside the USA.

Sorry, but you really need to listen to what Trump actually said instead of listening to his stuff filtered by the media. He definitely did say that the wall would help stop drugs. Even DEA law-enforcement agreed with him that it would help. And yes, there is a significant amount of drug trafficking carried out by people crossing the border. Whether they are "true" migrants or "cartel employed" is irrelevant.

https://cis.org/Arthur/Yuma-Reveals-How-Migrant-Surge-Has-Fu...

"..they'll build fentanyl shops inside the USA..."

US law-enforcement would love this to happen. Damn easy to get a court order and bust up. Damn easy to setup informants to reveal such locations. Its like comparing peanut impacts versus asteriod impacts. You solve the critical asteroid problem first. The peanuts don't really make any significant difference.

"Unauthorized" border crossing (and otherwise innocent) immigrants are a key piece of the cartel smuggling apparatus. They are used as bait to overwhelm CBP resources (and asylum seekers often want to be caught, theyll be given a court date to make their asylum case and in many cases released), once the resources are overloaded the drug smugglers go through the rugged terrain to drop-off points.

By this you are basically implying we should rather open the border totally so that drug smugglers can't use them.

That's what I would do, yes. Although I didn't mean to imply that with my previous statement. The closed border approach would be to somehow erect a barrier that lessens the ability for them to consume CBP resources between ports of entry.

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