Why aren't fentanyl test strips more widespread? (2021)(healthaffairs.org)
healthaffairs.org
Why aren't fentanyl test strips more widespread? (2021)
https://www.healthaffairs.org/do/10.1377/forefront.20210601.974263/
124 comments
> The real question we should be asking is why can't these poor people get access to proper medicine and treatment?
Well, here in San Francisco you can access both relatively easily. But it turns out that people with substance abuse addictions tend not to exhibit strong executive functioning (at least contemporaneously) as compared to the average non-abuser. So when you remove all coercive policies whatsoever (because of abstract academic arguments that equivocate all policies short of giving out free drugs and free money and turning a blind eye to dealers), you manifestly end up nurturing a base of hard-core, long-term addicts. Also, fentanyl is cheaper and some users have even begun preferring fentanyl for its unique effect. Here in San Francisco fentanyl is becoming (or has already become) less an adulterant and more the drug you're knowingly buying. Plenty of people--users and public service workers--do carry naloxone, though. So that's something.
Well, here in San Francisco you can access both relatively easily. But it turns out that people with substance abuse addictions tend not to exhibit strong executive functioning (at least contemporaneously) as compared to the average non-abuser. So when you remove all coercive policies whatsoever (because of abstract academic arguments that equivocate all policies short of giving out free drugs and free money and turning a blind eye to dealers), you manifestly end up nurturing a base of hard-core, long-term addicts. Also, fentanyl is cheaper and some users have even begun preferring fentanyl for its unique effect. Here in San Francisco fentanyl is becoming (or has already become) less an adulterant and more the drug you're knowingly buying. Plenty of people--users and public service workers--do carry naloxone, though. So that's something.
> So when you remove all coercive policies whatsoever (because of abstract academic arguments that equivocate all policies short of giving out free drugs and free money and turning a blind eye to dealers), you manifestly end up nurturing a base of hard-core, long-term addicts.
Except that's not at all what happened in Portugal (or in other European programs)...?
Except that's not at all what happened in Portugal (or in other European programs)...?
> Except that's not at all what happened in Portugal (or in other European programs)...?
The Portugal narrative hasn't actually been as positive as initially reported by the Cato papers that were based on the first few years following the policy change. More recent data has shown an uptick of lifetime drug use and an increasing trend of drug deaths that doesn't really support the initially successful picture of their program.
One of the challenges with interpreting the Portugal data is that they had relatively low drug use to begin with. The initial declarations of victory for their decriminalization programs were based on relatively small numbers and sample sizes that wouldn't pass muster in more rigorous analysis.
I know the narrative about Portugal was set years ago by the Cato papers and a few authors, but it isn't really the success story that it's made out to be. It did, however, reduce the number of drug-related prosecutions, though that's an obvious downstream effect of removing a class of drug-related offenses.
The Portugal narrative hasn't actually been as positive as initially reported by the Cato papers that were based on the first few years following the policy change. More recent data has shown an uptick of lifetime drug use and an increasing trend of drug deaths that doesn't really support the initially successful picture of their program.
One of the challenges with interpreting the Portugal data is that they had relatively low drug use to begin with. The initial declarations of victory for their decriminalization programs were based on relatively small numbers and sample sizes that wouldn't pass muster in more rigorous analysis.
I know the narrative about Portugal was set years ago by the Cato papers and a few authors, but it isn't really the success story that it's made out to be. It did, however, reduce the number of drug-related prosecutions, though that's an obvious downstream effect of removing a class of drug-related offenses.
> narrative
Thing is, it's actually better there, regardless of what papers are written. Everyone's healthier, using less drugs and there's less violence.
Like HIV dropped by 90% among drug users, being the original goal, this is quite a success. Drug related deaths dropped to by 85%.
Thing is, it's actually better there, regardless of what papers are written. Everyone's healthier, using less drugs and there's less violence.
Like HIV dropped by 90% among drug users, being the original goal, this is quite a success. Drug related deaths dropped to by 85%.
The opioid and fentanyl epidemic exploded over this last decade and earlier. If the data you say exists shows this trend, I'd like to that trend compared to the corresponding trends elsewhere in the world.
In the US[1], for example, drug overdose deaths went from about 20k in 2001 to 40k in ~2006, then to 80k in the mid to late 2010's, and now over 100k as of last year[2].
[1] https://nida.nih.gov/drug-topics/trends-statistics/overdose-...
[2] https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/...
In the US[1], for example, drug overdose deaths went from about 20k in 2001 to 40k in ~2006, then to 80k in the mid to late 2010's, and now over 100k as of last year[2].
[1] https://nida.nih.gov/drug-topics/trends-statistics/overdose-...
[2] https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/...
Do you know of a good source of info?
> recent data has shown an uptick of lifetime drug use and an increasing trend of drug deaths
Depends on the numbers, of course. But I think that is what folks realistically should have expected. Most societies tolerate the same with alcohol.
> recent data has shown an uptick of lifetime drug use and an increasing trend of drug deaths
Depends on the numbers, of course. But I think that is what folks realistically should have expected. Most societies tolerate the same with alcohol.
Here is an excellent interactive tool for the last 20 years. https://www.norc.org/Research/Projects/Pages/appalachian-ove...
Drug usage increased in almost all places on the globe or perhaps we have better means to track it. You have to compare it with instances where drug prosecution is strict and those places saw an even higher rise in drug abuses and drug death. By significant margins in some cases bordering on a complete other magnitude. I think Fentanyl in the US is a good example although it also increased in Europe. In countries where usage and dealings are illegal too.
The "just decriminalize" narrative about Portugal is a lie.
https://twitter.com/shellenbergermd/status/14153458369139220...
Portugal has humane, coercive policies to get people off drugs, public use is illegal, and people get arrested.
https://twitter.com/shellenbergermd/status/14153458369139220...
Portugal has humane, coercive policies to get people off drugs, public use is illegal, and people get arrested.
No, it's not "a lie."
> Thing is, it's actually better there, regardless of what papers are written. Everyone's healthier, using less drugs and there's less violence.
> Like HIV dropped by 90% among drug users, being the original goal, this is quite a success. Drug related deaths dropped to by 85%.
>> Portugal has humane, coercive policies to get people off drugs, public use is illegal, and people get arrested.
Okay? Same as mental health most places? It's still decriminalized and mostly treated as a health problem.
> Thing is, it's actually better there, regardless of what papers are written. Everyone's healthier, using less drugs and there's less violence.
> Like HIV dropped by 90% among drug users, being the original goal, this is quite a success. Drug related deaths dropped to by 85%.
>> Portugal has humane, coercive policies to get people off drugs, public use is illegal, and people get arrested.
Okay? Same as mental health most places? It's still decriminalized and mostly treated as a health problem.
The lie isn't that Portugal has a good approach, the lie is that places like SF are emulating Portugal. SF is anarchy, and an insult to Portugal, and an immoral horror show for addicts.
The lie is that there are no coercive policies in Portugal for drug addicts. It is not all treated like mental health, especially in the US. Public drug use is illegal, police enforce it, and addicts who are arrested can be jailed if they have more than 10 days personal supply, and they can be coerced in to treatment. Open drug scenes like we have in San Francisco are not all allowed.
The lie is that there are no coercive policies in Portugal for drug addicts. It is not all treated like mental health, especially in the US. Public drug use is illegal, police enforce it, and addicts who are arrested can be jailed if they have more than 10 days personal supply, and they can be coerced in to treatment. Open drug scenes like we have in San Francisco are not all allowed.
If you were a junkie looking to earn a quick buck for your next fix and you decided to engage in petty theft how long do you think you'd get away with that kind of behavior in Portugal?
Compare to SF.
There's your answer.
It's not the drugs that's different. It's that one jurisdiction actually gives a crap about making sure the ancillary problems (that are the reason drugs were ever criminalized to begin with) are mitigated.
Compare to SF.
There's your answer.
It's not the drugs that's different. It's that one jurisdiction actually gives a crap about making sure the ancillary problems (that are the reason drugs were ever criminalized to begin with) are mitigated.
> If you were a junkie looking to earn a quick buck for your next fix and you decided to engage in petty theft how long do you think you'd get away with that kind of behavior in Portugal?
No idea what you're trying to imply...
No idea what you're trying to imply...
There's a whole prepackaged narrative for right wing types about drug harm reducement being so bad it's counterproductive.
Example headlines:
Why We Must Arrest Drug Addicts
This is revealing as to where they are coming from:
> People who want to kill themselves in the privacy of their own homes by smoking fentanyl should be free to do so. But people who use drugs, camp publicly, and break other laws stemming from their addictions, such as shoplifting, should be arrested.
And a big part of it is lying about how other countries deal with drugs to try to paint liberal American cities in a bad light.
https://michaelshellenberger.substack.com/p/why-we-must-arre...
Example headlines:
Why We Must Arrest Drug Addicts
This is revealing as to where they are coming from:
> People who want to kill themselves in the privacy of their own homes by smoking fentanyl should be free to do so. But people who use drugs, camp publicly, and break other laws stemming from their addictions, such as shoplifting, should be arrested.
And a big part of it is lying about how other countries deal with drugs to try to paint liberal American cities in a bad light.
https://michaelshellenberger.substack.com/p/why-we-must-arre...
>Well, here in San Francisco you can access both relatively easily.
It's no surprise that San Francisco is attractive to a certain kind of lifestylist. But when you look at the country you have 2 million addicts and only 400k on methadone. I find it very hard to believe that the average methadone clinic is running at 20% capacity.
https://www.healthaffairs.org/do/10.1377/forefront.20190920....
It's no surprise that San Francisco is attractive to a certain kind of lifestylist. But when you look at the country you have 2 million addicts and only 400k on methadone. I find it very hard to believe that the average methadone clinic is running at 20% capacity.
https://www.healthaffairs.org/do/10.1377/forefront.20190920....
"SF still has coercive policies. You think having the cops take your tent and all your stuff isn't coercive?"
Except that's not what happens. The group of tents closest to my home ~2 years ago is still there. And it's no longer the nearest.
Except that's not what happens. The group of tents closest to my home ~2 years ago is still there. And it's no longer the nearest.
Commenters are so weird. 90% of the effort in that comment went into the first paragraph and guess what people responded to? It's gone. It's not worth arguing.
"Commenters are so weird."
"It's not worth arguing."
In cases where it's not worth arguing, it's usually not worth mounting an ad hominem attack, either.
"It's not worth arguing."
In cases where it's not worth arguing, it's usually not worth mounting an ad hominem attack, either.
The poster I responded to asserted some utter nonsense about a serious issue. I provided a source refuting those claims. That is what is worth discussing. The reality is that there isn't enough opioid treatment access. Whether this is true in SF specifically, I didn't find a source confirming or the opposite.
Your claim that tents aren't being removed isn't true either.
https://www.sfexaminer.com/findings/tent-dwellings-are-down-...
It's plausible that enforcement in SF is lighter than what is efficient (prison overcrowding will do that), but the claim that it isn't happening is, again, false.
Your claim that tents aren't being removed isn't true either.
https://www.sfexaminer.com/findings/tent-dwellings-are-down-...
It's plausible that enforcement in SF is lighter than what is efficient (prison overcrowding will do that), but the claim that it isn't happening is, again, false.
"The poster I responded to asserted some utter nonsense about a serious issue."
Your comment "commenters are so weird" was a reply to my comment, so presumably was directed at me. I didn't assert "some utter nonsense".
"Your claim that tents aren't being removed isn't true either."
The article you linked says that tents are being removed from the Tenderloin, so that they can be relocated to other areas of the city. So, unless you live in the Tenderloin (a small % of SF), your experience will be just like mine: tents are permanent and are not being removed by the police.
Your comment "commenters are so weird" was a reply to my comment, so presumably was directed at me. I didn't assert "some utter nonsense".
"Your claim that tents aren't being removed isn't true either."
The article you linked says that tents are being removed from the Tenderloin, so that they can be relocated to other areas of the city. So, unless you live in the Tenderloin (a small % of SF), your experience will be just like mine: tents are permanent and are not being removed by the police.
I'm from Portland which recently decriminalized drugs. I'm worried that this has the effect that dealers feel there is no prosecution for selling, and that this has led to a difficult situation for addicts. I'm of the opinion that without good mental health treatment options, this is an idea that creates more addicts who have no way to recover. I would love to understand if I'm wrong, and I know the pandemic is a context unlike anything we've ever seen, but the downtown streets of Portland look like they have many people in shocking states of crisis that to me look like unfettered access to drugs.
As I understand it they only decriminalized it for small amounts.
True. And, I've also heard that basically the police have said that there is no point in enforcing any kind of trade because dealers can always find a way to make it look like the amounts are under the limit. So dealers are operating in a completely laissez faire environment. I suspect the police are collaborating on that story to avoid dealing with arresting drug dealers until public sentiment changes, but that is just my own biased opinion.
> Decriminalisation and regulation are the biggest harm reduction measures that could be taken
It's not actually a solution to the Fentanyl problem.
Fentanyl ends up in drugs because it's extremely cheap (among other reasons). The price difference between fentanyl-laced illicit narcotics and the actual substance these people are seeking is actually massive, and end-user cost becomes a huge motivator for people dependent on constant daily intake of opioids. Even in a hypothetical world where regulated opioids were available over the counter, you'd still have significant inflows of illicit and potentially contaminated drugs.
Decriminalization and regulation have been floated as magic bullets, yet even when it comes to drugs like Marijuana in states like California and Colorado we have multiple estimates suggesting that the majority of marijuana sales are still illicit rather than via regulated channels ( http://www.cahcc.com/Portals/0/ADE%20Cannabis%20Report%20_8-... ).
> The real question we should be asking is why can't these poor people get access to proper medicine and treatment?
There is no one, singular "real question" we should be asking. This needs to be addressed on every level. Even in a theoretically idealized world there would still be a need for fentanyl test strips. Experimenting with "research chemicals" (aka obscure drugs synthesized in clandestine labs) is an increasingly common hobby even among people with access to common drugs. There isn't really a scenario where we just flip the decriminalization switch and all of these problems go away.
It's not actually a solution to the Fentanyl problem.
Fentanyl ends up in drugs because it's extremely cheap (among other reasons). The price difference between fentanyl-laced illicit narcotics and the actual substance these people are seeking is actually massive, and end-user cost becomes a huge motivator for people dependent on constant daily intake of opioids. Even in a hypothetical world where regulated opioids were available over the counter, you'd still have significant inflows of illicit and potentially contaminated drugs.
Decriminalization and regulation have been floated as magic bullets, yet even when it comes to drugs like Marijuana in states like California and Colorado we have multiple estimates suggesting that the majority of marijuana sales are still illicit rather than via regulated channels ( http://www.cahcc.com/Portals/0/ADE%20Cannabis%20Report%20_8-... ).
> The real question we should be asking is why can't these poor people get access to proper medicine and treatment?
There is no one, singular "real question" we should be asking. This needs to be addressed on every level. Even in a theoretically idealized world there would still be a need for fentanyl test strips. Experimenting with "research chemicals" (aka obscure drugs synthesized in clandestine labs) is an increasingly common hobby even among people with access to common drugs. There isn't really a scenario where we just flip the decriminalization switch and all of these problems go away.
Why does it matter if decriminalization and regulation are floated as "magic bullets" or not? The Nirvana fallacy so often shows up in discussions of drug policy.
It literally does not matter if decriminalization is "only 5% effective" (in whatever metric you're using to measure success, which here is just marijuana sales?). Sane polities implement laws that don't have 100% effectiveness.
It literally does not matter if decriminalization is "only 5% effective" (in whatever metric you're using to measure success, which here is just marijuana sales?). Sane polities implement laws that don't have 100% effectiveness.
Decriminalisation doesn’t seem to be working in San Francisco.
Decrim without legalization or free supply to addicts doesn't do a lot for the poverty side of things. People are still going to spend every cent they can scrape together on their drug. We could supply the entire country's heroin/fent supply for probably 1/1000 what the average street user is paying for their doses, and we could prevent overdoses since there would be a chemically pure version of the drug with a labeled dosage available.
Until we, as a society, get over our desire to punish people for getting inebriated, addicts will continue to dwell in abject poverty while funding violent drug distribution organizations. This is a choice that we have made, and we're going to live with the consequences until we reverse course.
Until we, as a society, get over our desire to punish people for getting inebriated, addicts will continue to dwell in abject poverty while funding violent drug distribution organizations. This is a choice that we have made, and we're going to live with the consequences until we reverse course.
Why would we want to accept normal people taking drugs which will fry their brains? Yes, only homeless addicts use these drugs because normal working people don't want to destroy their lives for a minor bit of fun.
This is a very misguided view. Majority of drug users are all around you, regular people who have families and hold jobs - your friends, your relatives, your coworkers. Just like majority of people who drink alcohol aren't alcoholics, majority of drug users aren't addicts.
Somehow I doubt that majority of drug users are from healthy families with kids.
Just considering it, it seems unlikely that the incredible economic volume of the hard-drugs industry is drivem by homeless people collecting change and redeeming cans.
Anecdotally, I know (or knew if they died) several people from PhD programs adjacent to my own who were habitual users of heroin (or stuff branded as such). I have significant experience with it (originating with friends in academia!!!), and it is very nice, but it just so happens that I like pooping more than I like opioids, which apparently is a stroke of luck
Anecdotally, I know (or knew if they died) several people from PhD programs adjacent to my own who were habitual users of heroin (or stuff branded as such). I have significant experience with it (originating with friends in academia!!!), and it is very nice, but it just so happens that I like pooping more than I like opioids, which apparently is a stroke of luck
Most drug user I've seen were in private clubs in Paris or Nice/Monaco where the entry ticket was north of 150 euros
I also saw about 12 different heroin addicts in the streets next to my home, but tbh they were a lot less loud, aggressive and/or obnoxious than the alcoholics.
I also saw about 12 different heroin addicts in the streets next to my home, but tbh they were a lot less loud, aggressive and/or obnoxious than the alcoholics.
That could be because you probably assume that any drug use leads to addiction and despair. More often than not, despair leads to drug use as means for temporary escape and relief.
No, I assume most drug use leads to addiction except maybe "try once" cases, which I wouldn't call "use" like I don't call people who tried smoking once in their lifetime "smokers".
Despair is not even in the picture. Too bad you paint it as a viable excuse for making yourself even more stupid than usual.
Despair is not even in the picture. Too bad you paint it as a viable excuse for making yourself even more stupid than usual.
[deleted]
Taking drugs doesn't make you stupid. However, ignorance is a powerful contributor.
https://www.businessinsider.com/scientists-and-geniuses-who-...
https://www.businessinsider.com/scientists-and-geniuses-who-...
[deleted]
Free supply won’t really be a solution and I can’t imagine why it would. Would making junk food and soda free food end the obesity epidemic?
Making it free will only make that area a hub for people seeking to get high. Portland, Seattle, and SF are already hot spots where people actively come because they know they can get high easily. Making it completely free is just an even bigger invitation.
I think one of America’s greatest successes has been with tobacco. For the most part, Americans don’t want to smoke and find the idea disgusting—that’s a massive turnaround from a couple decades ago and even completely different from many countries in Europe or Asia. It’s also getting harder and harder to purchase tobacco in many places, but what kept me and much of my generation from ever touching a cigarette was media campaigns in the 90s that depicted cigarette smokers as vile, disgusting people. Other anti-drug programs try fear mongering with saying one dose of weed will kill you or whatever and people saw through that. But telling kids that they’re gross losers who everyone hates if they use a substance? That has a bit more effect.
But for people who are active addicts, treatment is hard. There are countless interviews with addicts on YouTube, and the conclusion every single one of them presents is “I could’ve gotten help, but I didn’t want it.” You need to make people want to overcome their addiction. Feeding it won’t do anything.
Making it free will only make that area a hub for people seeking to get high. Portland, Seattle, and SF are already hot spots where people actively come because they know they can get high easily. Making it completely free is just an even bigger invitation.
I think one of America’s greatest successes has been with tobacco. For the most part, Americans don’t want to smoke and find the idea disgusting—that’s a massive turnaround from a couple decades ago and even completely different from many countries in Europe or Asia. It’s also getting harder and harder to purchase tobacco in many places, but what kept me and much of my generation from ever touching a cigarette was media campaigns in the 90s that depicted cigarette smokers as vile, disgusting people. Other anti-drug programs try fear mongering with saying one dose of weed will kill you or whatever and people saw through that. But telling kids that they’re gross losers who everyone hates if they use a substance? That has a bit more effect.
But for people who are active addicts, treatment is hard. There are countless interviews with addicts on YouTube, and the conclusion every single one of them presents is “I could’ve gotten help, but I didn’t want it.” You need to make people want to overcome their addiction. Feeding it won’t do anything.
Making it free keeps people from needing to break everyone's windows to get their next fix. It also allows them to use their money on food/rent/etc so they are less likely to wind up homeless. It also means that they congregate in one area, so it's easier to provide resources if they decide to seek help.
It also prevents, you know, fentanyl from getting into the supply, having people get more addicted to a stronger drug.
It also prevents, you know, fentanyl from getting into the supply, having people get more addicted to a stronger drug.
There’s also the reality that people who don’t want to go through the shame and trouble of finding a person who could give them a solid hookup and so never try heroin in the first place.
Drugs are partly an issue of convenience. An 18-21 year old who isn’t thinking much about the future and figures “why not” is more likely to try something if it’s free and “safe” due to being distributed by someone reputable than they are to try a grimy baggy that could have anything inside.
When people know they can get a good, pure LSD hookup, they’re more likely to try it. People are more concerned about trying random research chemicals because the effects are unknown—that keeps quite a few people from ever trying LSD or psychedelics as a whole. If people could drop by a volunteer-operated free distribution center, I’m pretty sure we’d have loads more people trying LSD. (Not that I’m saying LSD is deadly like heroin, but the fear of danger is keeping people away from it)
Drugs are partly an issue of convenience. An 18-21 year old who isn’t thinking much about the future and figures “why not” is more likely to try something if it’s free and “safe” due to being distributed by someone reputable than they are to try a grimy baggy that could have anything inside.
When people know they can get a good, pure LSD hookup, they’re more likely to try it. People are more concerned about trying random research chemicals because the effects are unknown—that keeps quite a few people from ever trying LSD or psychedelics as a whole. If people could drop by a volunteer-operated free distribution center, I’m pretty sure we’d have loads more people trying LSD. (Not that I’m saying LSD is deadly like heroin, but the fear of danger is keeping people away from it)
Yeah, no one is advocating for a punch bowl of drugs on every streetcorner. Places that give away free drugs limit them to addicts.
I don't think GP was arguing for free drugs (that would indeed be crazy). I think they were making a point about how our current policy is an intentional choice to drive drug users into poverty by making drugs wildly expensive.
I'm not necessarily opposed to the idea of distributing it totally free of cost, along with needle exchanges, etc. But yeah, I was speaking more about difference between what an addict pays for fentanyl and the actual cost to produce it.
This is not as simple as labelled doses. This would reduce some overdoses but not all of them.
> We could supply the entire country's heroin/fent supply for probably 1/1000 what the average street user is paying for their doses
Nonsense. It's not that cheap to manufacture (under regulated conditions) and distribute opioids like that. 1/1000th of the price? Even the cheapest, most easily manufactured commercial opioid medications aren't coming anywhere near that after decades of optimization the manufacturing processes.
Nonsense. It's not that cheap to manufacture (under regulated conditions) and distribute opioids like that. 1/1000th of the price? Even the cheapest, most easily manufactured commercial opioid medications aren't coming anywhere near that after decades of optimization the manufacturing processes.
Fentanyl is dirt cheap to manufacture, and people on the street are paying tens of thousands of dollars per gram of it, given that a dose for an equivalent amount of heroin can be much lower than a milligram. The actual cost to manufacture that much would be several orders of magnitude less than what it drug users are paying for it.
This is the worst sort of hn pedantry, but I have to agree. The security premium paid by cartels down through street dealers is indeed real, but QC and regulatory compliance would eat a lot of that savings. And the executive tax at cartels is probably similar to public firms.
So now the government has to buy people their drugs? We don't do that for alcoholics. There's a very strong moral hazard argument against doing that, but it's just plain cruel to the very population you think you are helping.
We do create a safe supply of drugs and a safe, monitored use site for alcoholics. We call them bars.
We don't provide this for other drugs.
There's a handful of safe injection sites for drugs in some cities around the world (such as Vancouver) but the drugs are still toxic. It's good that people are on hand to handle the inevitable overdoses and other issues. This saves lives.
The further necessary solution however is a safe supply of drugs, so that people can actually know what they're using. This is the core problem that is driving so many deaths.
Imagine if there was no such thing as legal liquor or bars and alcoholics just drank some stuff that some guy made. There'd be a lot more deaths and poisonings from this.
We don't provide this for other drugs.
There's a handful of safe injection sites for drugs in some cities around the world (such as Vancouver) but the drugs are still toxic. It's good that people are on hand to handle the inevitable overdoses and other issues. This saves lives.
The further necessary solution however is a safe supply of drugs, so that people can actually know what they're using. This is the core problem that is driving so many deaths.
Imagine if there was no such thing as legal liquor or bars and alcoholics just drank some stuff that some guy made. There'd be a lot more deaths and poisonings from this.
> So now the government has to buy people their drugs? We don't do that for alcoholics.
GP said “legalization or free supply”, and for alcohol we have legalization. So, yes, we do what the GP actually suggested, though not your strawman, for alcoholics.
GP said “legalization or free supply”, and for alcohol we have legalization. So, yes, we do what the GP actually suggested, though not your strawman, for alcoholics.
Decriminalization is part of solution, but there's a lot more that needs to be done.
Probably a lot more than two issues here, but two significant ones are that:
1) the real problem is that the drugs are toxic and no one knows what they're taking. Maybe the dose is wrong or maybe it's not even fentanyl, and just a bunch of crazy shit (eg. benzos). The drugs aren't what people expect and people die. The fastest way to end deaths would be to create a safe supply of drugs so people know what they're taking.
2) "Decriminalization" doesn't necessarily mean and end to police harassment, drug confiscation, and related issues that all make life hard for drug users and create barriers to them getting the real help they need.
While under decriminalization you may not end up in jail for having drugs, you are still able to have them confiscated and get a ticket (or summons to some thing), and then you're back at square one, needing to find more money to get drugs again. No wonder petty theft is such an issue in some places.
High policing and confiscation of drugs from drug users just helps the dealers sell more illegal product.
Circling back to point one again, a real safe supply of prescribed drugs handles this issue well in dealing with the money issue. But beyond this if we're going to allow people to have a safe supply of drugs, we also need to let people hold drugs too and not be harassed by police.
Ideally there's not just a safe supply of drugs but also a safe use site as well where medical staff can monitor and help people. These sorts of sites can be touch points where people can build relationships and help people when they're ready to move to some further stage of recovery.
Probably a lot more than two issues here, but two significant ones are that:
1) the real problem is that the drugs are toxic and no one knows what they're taking. Maybe the dose is wrong or maybe it's not even fentanyl, and just a bunch of crazy shit (eg. benzos). The drugs aren't what people expect and people die. The fastest way to end deaths would be to create a safe supply of drugs so people know what they're taking.
2) "Decriminalization" doesn't necessarily mean and end to police harassment, drug confiscation, and related issues that all make life hard for drug users and create barriers to them getting the real help they need.
While under decriminalization you may not end up in jail for having drugs, you are still able to have them confiscated and get a ticket (or summons to some thing), and then you're back at square one, needing to find more money to get drugs again. No wonder petty theft is such an issue in some places.
High policing and confiscation of drugs from drug users just helps the dealers sell more illegal product.
Circling back to point one again, a real safe supply of prescribed drugs handles this issue well in dealing with the money issue. But beyond this if we're going to allow people to have a safe supply of drugs, we also need to let people hold drugs too and not be harassed by police.
Ideally there's not just a safe supply of drugs but also a safe use site as well where medical staff can monitor and help people. These sorts of sites can be touch points where people can build relationships and help people when they're ready to move to some further stage of recovery.
I have my suspicions that prior American governments intended (with full knowledge) for the cartels to get more powerful (by means of increasing corruption and letting only those kinds of crime-willing people to service the outlawed black markets)
I recall reading about an economist who based on studying the failure of the prohibition, tried to warn about the futility of 'war on drugs'; from this I thought that if some economist knew it'd fail, so could the government have known....
I recall reading about an economist who based on studying the failure of the prohibition, tried to warn about the futility of 'war on drugs'; from this I thought that if some economist knew it'd fail, so could the government have known....
> why can't these poor people get access to proper medicine and treatment?
Speaking of the US, one of the issues is that drug treatment and mental health care are for-profit businesses, so someone reaching out for help is likely to get grifted even if they have insurance or can pay for the treatment on their own.
Speaking of the US, one of the issues is that drug treatment and mental health care are for-profit businesses, so someone reaching out for help is likely to get grifted even if they have insurance or can pay for the treatment on their own.
There's also perpetual waiting lists, forcing some people who need help to wait six months or longer to get care. Then that care can potentially cost more than a four year degree. Many treatment programs will leave their patients dependent on maintenance drugs that can costs hundreds of dollars a month to fill, and require regular appointments with expensive specialists to get. Those specialists have months long waiting lists, as well
> why can't these poor people get access to proper medicine and treatment?
Maybe the Government doesn't like the type of people that get addicted to drugs... a friend of mine just died this week from overdose... maybe from Fentanyl but I don't know.
Maybe the Government doesn't like the type of people that get addicted to drugs... a friend of mine just died this week from overdose... maybe from Fentanyl but I don't know.
There's people out there whose opinions are that addiction is a problem that "eventually solves itself". When I first heard that I just tried to change topics as quick as possible, it was just a conversational dead end. I still don't know what to say.
What we need is the scientific community to come together like they did for Covid vaccines... we need an addiction vaccine for drugs and alcohol...
It probably killed a lot more people then Covid-19...
It probably killed a lot more people then Covid-19...
There is actually research in that area! Apparently one can make a vaccine that trains the immune system to attack and remove drugs. But it could interfere with medical procedures because of the overlap with recreational drugs. Also the huge ethical and moral questions it poses like who gets final say over what you do with your own body. Unlike a viral disease, getting high isn't contagious and doesn't directly and immediately affect those around you.
> Unlike a viral disease, getting high isn't contagious and doesn't directly and immediately affect those around you.
I'm pretty sure that most heavily addicted people would voluntary get such a vaccine... unless there's a major downside
I'm pretty sure that most heavily addicted people would voluntary get such a vaccine... unless there's a major downside
Would they though? This sounds like it could give withdrawal symptoms, and it wouldn't solve the other issues that most highly addicted people face ...
It would be great for folks who are in remission and don't want to be tempted back though
It would be great for folks who are in remission and don't want to be tempted back though
well I don't know for sure... just look at this youtube channel for "some" insight: https://www.youtube.com/watch?v=ub_nUoTlmV4
Voluntarily taking it isn't such an issue. It's when the state imposes it (ie. 10 year sentence for a related crime OR take this vaccine and get out early) or the case of a parent getting their child to take it. Does a parent have a right to take away a child's ability to get high? Irreversibly and lasting into adulthood for said child? Even if it's "for their own good" and in the face of changing legal landscape where it may not be a criminalized activity in future like with cannabis?
Vladimof: Unfortunately it's not only a physical ailment. It's a complex mental and emotional issue, too. Hard to concoct a vaccine targeting all 3 axes with current technology levels.
You live in a country that does not consider Healthcare a right even for the moral, law abiding citizens.
Why would they care about the "illegals" (immigrants, addicts etc) or "immorals" (women or transgender who want control over their body) ?
Why would they care about the "illegals" (immigrants, addicts etc) or "immorals" (women or transgender who want control over their body) ?
Here in Canada there is exception to the federal drug law, for the purposes of analysis and testing. Some public health departments run testing programs. In practice, I can get GC/MS done without cost for a street drug at a hospital lab by dropping off samples in a vial at my local pharmacy.
As far as I can tell, this program is not widely known. It shouldn't be too hard to scale up the pharmacy collection side, and make it available in pretty much every community. I don't know how to convince people to actually use it, though.
As far as I can tell, this program is not widely known. It shouldn't be too hard to scale up the pharmacy collection side, and make it available in pretty much every community. I don't know how to convince people to actually use it, though.
Fentanyl test strips are illegal in Florida, the legislature refused to decriminalize them for some reason.
At best, they're cowards who don't want to face ads that imply they condone drug use; at worst, they simply refuse to make it safer for anyone with a drug problem because they see them as human detritus.
If an addict tested their drugs and the test came back saying “do not take these” do you think an addict is just going to shrug and toss it in the trash? The test strips really do nothing for addicts. It’s not an easy problem.
Test strips are not just for addicts. Casual users use them as well. Believe it or not some dealers also use them.
I mean if that were the case, they wouldn’t test to begin with. I agree it’s a difficult, morally fraught problem but this extra tool doesn’t feel like that to me. Plus think of the casual coke user like a college kid; they might test and their life might be saved.
Yeah you’re right, all addicts are equally stupid and are uniformly unaware that a positive fentanyl result can mean instant death. /s
Fentanyl strips are not only for drug addicts. Anyone buying recreational drugs is affected by such legislation.
> do you think an addict is just going to shrug and toss it in the trash?
I assume they'd have a word with their dealer? Or at least adjust the dose?
I assume they'd have a word with their dealer? Or at least adjust the dose?
They want to "solve" the problem by everyone dying.
Test strips are inconvenient to use.
You have to mix you drugs in water to test them, which means if you want to snort your drugs you need to plan ahead far enough to dry them back out again.
If you don't mix the correct ratio of drugs to water its very easy to get false positive (for amphetamines and mdma) or a false negative with others.
Also, frankly, it makes the whole experience less sexy and fun. I know its a dumb reason but its true.
If you don't mix the correct ratio of drugs to water its very easy to get false positive (for amphetamines and mdma) or a false negative with others.
Also, frankly, it makes the whole experience less sexy and fun. I know its a dumb reason but its true.
Should really just start selling "Illegal Drugs" in standardized doses like alcohol and pharmaceuticals so people don't get surprised. Drug users may be rational but individual testing puts a huge burden on the consumer that many aren't going to want to pay for in the name of preventing a tail risk.
Yes. It can probably be demonstrated that the most dangerous things about many drugs are impurity, the people you buy them from, and the law enforcement consequences.
Training people how to use drugs in order to be allowed to purchase them and offering mental health services would be far less expensive to society.
Training people how to use drugs in order to be allowed to purchase them and offering mental health services would be far less expensive to society.
> people who use drugs (PWUD)
New acronym just dropped. :-/
New acronym just dropped. :-/
It's consistent with the practice of using "people-first language"[1]. It sounds a little clunky to my ears in a lot of individual instances, but the overarching goal (making it harder to subconsciously dehumanize people) seems reasonable to me.
[1]: https://en.wikipedia.org/wiki/People-first_language
[1]: https://en.wikipedia.org/wiki/People-first_language
Acronyms are dehumanizing! Someone’s grandfather might be an “alcoholic.” A “PHUA” is a subject being addressed at arm’s length by someone in a lab coat.
Well, that's sort of what this is: the article in question is written by and for medical professionals.
I actually agree, at least partially: I think both people-first language and acronyms have the potential to depersonalize, even if they prevent more general dehumanization. But I also think there are plenty of contexts in which their use makes sense, like an article written for a medical audience (like this one).
I actually agree, at least partially: I think both people-first language and acronyms have the potential to depersonalize, even if they prevent more general dehumanization. But I also think there are plenty of contexts in which their use makes sense, like an article written for a medical audience (like this one).
Being clunky is the point. The idea is that clunky phrases are harder to use as slurs, interrupting the euphemism treadmill.
It doesn't seem reasonable to me. In this usage it is normalizing drug use. When you use this terminology, you're implicitly saying "They're a person and they just so happen to be addicted to drugs" as if that drug use doesn't imply anything about the person's character.
A drug user is not the same as a disabled person. If you're a drug abuser, I think the words people use to describe you are the least of your problems.
All this politically-correct clamoring accomplishes nothing in the end. If these new words like "PWUD" became widely adopted, they would just inherit the same stigma as their predecessors. It's happened time and time again.
It has nothing to do with improving people's lives and everything to do with providing lip service to a voting demographic. If you're not a politician, why waste your (and everyone else's) time with this doublespeak?
A drug user is not the same as a disabled person. If you're a drug abuser, I think the words people use to describe you are the least of your problems.
All this politically-correct clamoring accomplishes nothing in the end. If these new words like "PWUD" became widely adopted, they would just inherit the same stigma as their predecessors. It's happened time and time again.
It has nothing to do with improving people's lives and everything to do with providing lip service to a voting demographic. If you're not a politician, why waste your (and everyone else's) time with this doublespeak?
I don’t care either way about the acronym, but drug addiction has nothing to do with character. It is a disease and should be treated as such, and in fact the only proven way to stop drug addiction is through treatment.
You can't get addicted to drugs if you never take drugs in the first place. Absent situations like getting addicted to opioids after surgery, taking drugs does say something about your character.
Drug addiction is a biological phenomenon, but it can't happen without drug use, which is a social problem. For example, drug overdose death rates are six to eight times higher among white Americans than among Asian Americans: https://www.kff.org/coronavirus-covid-19/press-release/drug-.... I'm pretty sure the biology of drug addiction doesn't meaningfully differ between those groups.
Drug addiction is a biological phenomenon, but it can't happen without drug use, which is a social problem. For example, drug overdose death rates are six to eight times higher among white Americans than among Asian Americans: https://www.kff.org/coronavirus-covid-19/press-release/drug-.... I'm pretty sure the biology of drug addiction doesn't meaningfully differ between those groups.
I just noticed it appearing fairly out of the blue in all the articles regarding the monkeypox spread; pretty much all outlets are using the same language viz "gay, bisexual or other men who have sex with other men."
It seemed extremely awkwardly worded but now I know why! Thanks for sharing that link.
It seemed extremely awkwardly worded but now I know why! Thanks for sharing that link.
Ah yes, because an acronym is more humanising that "drug user."
Sometimes I think people who are writing these dumb articles are living in a parallel world. Nobody in real life would use these expressions, the word they are looking for is junkie or addict. Are they trying to sound fancy or what?
I’d be very interested to see the accuracy rates with the test strips. There is also a sampling issue where fentanyl may not be evenly distributed.
So the user does a test that shows no fentanyl and makes poor decisions based on a false negative.
So the user does a test that shows no fentanyl and makes poor decisions based on a false negative.
And this is why i stopped consuming unregulated substances that I have not personally grown, extracted, or synthesized. Teaching yourself O-chem is fun, avoid trying to profit from it and you will do fine.
Interesting, what do you produce? And how difficult is it?
I heard even Chem students can produce some mainstream drugs sometimes with easy to get products.
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They are stigmatized along with the drug. Their presence will draw suspicion even if you are using them to test for the presence of fentanyl in other drugs. The overdose epidemic is a social crisis as much as a public health crisis.
Can one even get stuff not laced with it these days?
As a casual outside observer I thought no. In which case test strips are less useful
As a casual outside observer I thought no. In which case test strips are less useful
Define “stuff”. And I’m not being pedantic.
I am aware, in passing, of the purity of club drugs. I mean, theoretically. Totally in the abstract, in case you’re a DEA plant.
It heavily depends on what, and where. In my…research…
Street-level opiates? I honestly have no idea, besides what I hear in the media. Not my bag.
Cocaine? It’s rare, but it happens, and it seems to be ramping up in scale, unfortunately. And more realistically, it’s contaminated with significant amounts of filler, including lidocaine to give you that mouth tingle.
Ketamine? Nah. Either pretty darn pure, or just cut with filler. (Well…mostly nah, I am pretty sure a friend got some cut with PCP one time.)
Ecstasy/molly (which is such a semantic jumble): rare, but it happens. But more likely, instead of the MDMA you want, it’s MDA, or some other substituted phenethylamine…or just sucrose as filler, and it does nothing at all.
Other more obscure club drugs, such as the stuff people claim is 2C-B? Rare, but plausible, and there was a rash of that in California recently.
I am aware, in passing, of the purity of club drugs. I mean, theoretically. Totally in the abstract, in case you’re a DEA plant.
It heavily depends on what, and where. In my…research…
Street-level opiates? I honestly have no idea, besides what I hear in the media. Not my bag.
Cocaine? It’s rare, but it happens, and it seems to be ramping up in scale, unfortunately. And more realistically, it’s contaminated with significant amounts of filler, including lidocaine to give you that mouth tingle.
Ketamine? Nah. Either pretty darn pure, or just cut with filler. (Well…mostly nah, I am pretty sure a friend got some cut with PCP one time.)
Ecstasy/molly (which is such a semantic jumble): rare, but it happens. But more likely, instead of the MDMA you want, it’s MDA, or some other substituted phenethylamine…or just sucrose as filler, and it does nothing at all.
Other more obscure club drugs, such as the stuff people claim is 2C-B? Rare, but plausible, and there was a rash of that in California recently.
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> In which case test strips are less useful
Addiction is a powerful compulsion, but so is safety: an addict (or someone who isn't yet an addict) might choose not to use a particular batch if they have access to test strips. Even if they do choose to use: access to test strips allows them to plan for other harm reduction activities.
Addiction is a powerful compulsion, but so is safety: an addict (or someone who isn't yet an addict) might choose not to use a particular batch if they have access to test strips. Even if they do choose to use: access to test strips allows them to plan for other harm reduction activities.
And surely it's useful to provide tools to those not yet fully down the addiction path?
My drug awareness extends little beyond watching The Wire, but I'd guess users might test before purchasing or be more likely to work with dealers who would accommodate testing. In theory, at least.
It's all a multi-faceted problem and providing tools seems smart to me. It's remotely akin to being distressed about abortion but not keen on sex education or providing birth control. Attack the issues from all angles.
My drug awareness extends little beyond watching The Wire, but I'd guess users might test before purchasing or be more likely to work with dealers who would accommodate testing. In theory, at least.
It's all a multi-faceted problem and providing tools seems smart to me. It's remotely akin to being distressed about abortion but not keen on sex education or providing birth control. Attack the issues from all angles.
In the US and Canada: not really.
In other countries, yes. Australia's heroin supply is still basically just heroin, and extremely high purity, even on the street, interestingly.
While fentanyl does exist here, it's not that common. I cannot give a good reason as to why. It's interesting.
In other countries, yes. Australia's heroin supply is still basically just heroin, and extremely high purity, even on the street, interestingly.
While fentanyl does exist here, it's not that common. I cannot give a good reason as to why. It's interesting.
I'm not saying this is the reason, but out of curiosity: does Australia's drug agency/agencies place as strong of an emphasis on border interdiction? A large part of the US's drug policy emphasizes "flashy" seizures of large amounts of drugs at the border, which has incentivized smugglers to pursue more potent (and therefore more compact) alternatives.
> does Australia's drug agency/agencies place as strong of an emphasis on border interdiction
Yes, even more so than the US frankly. Our border is difficult to get black market goods through.
It's also why heroin is nearly 10x the cost here in Australia, of course.
Yes, even more so than the US frankly. Our border is difficult to get black market goods through.
It's also why heroin is nearly 10x the cost here in Australia, of course.
On darknet markets there's a pretty big markup on product sold within Australia compared to what you could get from Europe. I always assumed it was because if you ordered the Europe stuff there was a much higher chance of it not showing up. We also don't share a lengthy land border with a country partially run by cartels.
So I would be shocked if it was anywhere near as easy to get drugs in to Australia as it is the US, let alone easier.
So I would be shocked if it was anywhere near as easy to get drugs in to Australia as it is the US, let alone easier.
My information on the scene is extremely out of date, but 10 years ago it was more common for users to get some prescription morphine and convert it to heroin themselves. There was also a pretty big market for illicit acetic acid because of this, too.
This was because importation was difficult, making any imported product vastly more expensive than what you could make yourself.
This was because importation was difficult, making any imported product vastly more expensive than what you could make yourself.
Homebake is long gone. To be honest it was on the way out even a decade ago, though you're right it was slightly more common.
These days the bulk of the heroin in the country is brought in from Asia, controlled by Chinese and Vietnamese crime syndicates.
These days the bulk of the heroin in the country is brought in from Asia, controlled by Chinese and Vietnamese crime syndicates.
Very much possible. Non street level dealers tend to prefer repeat customers vs large volume of random people. Because of that they tend to monitor quality of their own products. I've met dealers who go as far as actually wash the product. Funny enough, the only time I bought from a random guy, I got baking soda instead.
AIUI (via npr?) the market is shifting anyway. Many, if not most users want fentanyl since it's so much cheaper
I doubt that addicts would just chuck their drug if they found it was contaminated.
If the fentanyl is due to cross-contamination rather than deliberate adulteration test strips are unlikely to catch it without destroying an unacceptable amount of the product.
NIMBY doesn't want the association, and people prone to OD are more interested in taking the drug than testing it.
Dealers lace it because it can't be easily detected. If they have access to this, then they may lace it with carfentanyl instead, if then you offer carfentanyl test strips, they'll find the next toxic thing to do it. It's just a cat chasing the tail.
Most "lacing" of drugs with fentanyl is accidental contamination - for example when dealers use the same scales to measure different drugs and don't clean them between uses.
Dealers don't commonly go around lacing drugs on purpose - killing your customers is bad for business.
Dealers don't commonly go around lacing drugs on purpose - killing your customers is bad for business.
Instead they have to resort to playing Russian roulette every time they use.
Decriminalisation and regulation are the biggest harm reduction measures that could be taken and it would have the added bonus of freeing up space in the prisons and reducing the power of the cartels.
There wouldn't be a fent problem at all if sufferers could get reliable access to real meds. It's absurd that we're even still having these types of discussions in this day and age.