Pointers from Portugal on Addiction and the Drug War(nytimes.com)
nytimes.com
Pointers from Portugal on Addiction and the Drug War
https://www.nytimes.com/2020/10/05/upshot/portugal-drug-legalization-treatment.html
106 comments
It's not the first time the NYT insists in this idea. Ok, it's good advertisement to our tourism but this is just fake news.
I grew up in one of the "drug towns" of the late 80's/early 90's in Portugal. It was bad, really bad. There wasn't any extended family without a drug problem. That generation, bornt after the 1974 revolution, now in the mid 40's, was almost erased from there. Some died and those remaining, after a life of petty crime and prison, eventually escaped.
Completely agree with your comment. I would just add another relevant factor to the roll: decriminalization gave even more visibility to the addiction problem and newer generations didn't like what they saw. It wasn't cool to use drugs anymore.
I grew up in one of the "drug towns" of the late 80's/early 90's in Portugal. It was bad, really bad. There wasn't any extended family without a drug problem. That generation, bornt after the 1974 revolution, now in the mid 40's, was almost erased from there. Some died and those remaining, after a life of petty crime and prison, eventually escaped.
Completely agree with your comment. I would just add another relevant factor to the roll: decriminalization gave even more visibility to the addiction problem and newer generations didn't like what they saw. It wasn't cool to use drugs anymore.
Personally, growing up in Appalachia in the 90s it was more likely my extended family was abusing drugs than not. Cracking down on pill mills and making Oxy less abusable has pushed more and more to heroin/meth/synthetics. The drug problem is still rampant in the area. People need help and the barrier to receiving help in this country is too high.
I had a friend begging for help with treatment and the only in patient place at the time for substance abuse in the area had an 8 week waiting list... and you had to pay your way so unless you had a family/friend with extra resources you were on your own.
We wonder why the drug problem still exists in this country where we punish those struggling instead of help them.
I had a friend begging for help with treatment and the only in patient place at the time for substance abuse in the area had an 8 week waiting list... and you had to pay your way so unless you had a family/friend with extra resources you were on your own.
We wonder why the drug problem still exists in this country where we punish those struggling instead of help them.
Your description of the in-patient problem sadly reflects the state of affairs up in Canada too, where most, but not all, healthcare is free (eyes and teeth are strange exceptions).
I’ve got an older friend who did a lot of drugs back in the day, but got his life mostly figured out until a few years ago when he had to get shoulder surgery. Prescribed Oxy for recovery, even after telling the surgeon about his past addiction struggles. As expected, they become less effective over time, he likes getting high, so he starts taking larger doses. Gets to the end of his prescription and can’t get a refill.
Did he make bad choices here? Definitely. But then the health care system screws up:
“I want to detox and get clean again.”
“Sorry, you’ve never overdosed, so you can’t detox in the hospital. Maybe you can get on a waiting list for a private (out of pocket) facility. Oh, and no refills, you’re an addict”
“Maybe I can be a short-term patient at a mental health facility?”
“Sorry, you’ve never tried committing suicide because of your drug use. Maybe you can get on a wait list at a private facility? Oh, and no refills, you’re an addict!”
So... what does an opioid addict who is in withdrawal and can’t get support from the health care system do? Goes and scores some heroin...
Today he’s mostly clean again. I think he pops a pill here and there but isn’t high all day. But... this could have all been avoided. The health care system had many opportunities to help out here, but didn’t.
Edit: one last note: the private facilities are quite expensive and have massive waiting lists. Even if he had had the cash to go, he would have still been in limbo for weeks-to-months with no access to clean drugs nor support to get clean.
I’ve got an older friend who did a lot of drugs back in the day, but got his life mostly figured out until a few years ago when he had to get shoulder surgery. Prescribed Oxy for recovery, even after telling the surgeon about his past addiction struggles. As expected, they become less effective over time, he likes getting high, so he starts taking larger doses. Gets to the end of his prescription and can’t get a refill.
Did he make bad choices here? Definitely. But then the health care system screws up:
“I want to detox and get clean again.”
“Sorry, you’ve never overdosed, so you can’t detox in the hospital. Maybe you can get on a waiting list for a private (out of pocket) facility. Oh, and no refills, you’re an addict”
“Maybe I can be a short-term patient at a mental health facility?”
“Sorry, you’ve never tried committing suicide because of your drug use. Maybe you can get on a wait list at a private facility? Oh, and no refills, you’re an addict!”
So... what does an opioid addict who is in withdrawal and can’t get support from the health care system do? Goes and scores some heroin...
Today he’s mostly clean again. I think he pops a pill here and there but isn’t high all day. But... this could have all been avoided. The health care system had many opportunities to help out here, but didn’t.
Edit: one last note: the private facilities are quite expensive and have massive waiting lists. Even if he had had the cash to go, he would have still been in limbo for weeks-to-months with no access to clean drugs nor support to get clean.
> decriminalization gave even more visibility to the addiction problem and newer generations didn't like what they saw
I can believe this. My father used to tell me that drugs like heroin have recurring waves of popularity, because when a dangerous drug becomes popular enough, the Russian roulette aspect becomes so obvious. Everybody knows somebody whose life has been ruined by it. When a drug becomes niche, the few people you know who use it might be handling it okay (or early in their trajectory with the drug) and their experience with it can look cool and attractive. He also said his generation was the last one where basically everybody had seen firsthand what heroin could do to people, but he was optimistic that it had "killed enough famous musicians" that it couldn't come back. That was in the 1990s, so....
I can believe this. My father used to tell me that drugs like heroin have recurring waves of popularity, because when a dangerous drug becomes popular enough, the Russian roulette aspect becomes so obvious. Everybody knows somebody whose life has been ruined by it. When a drug becomes niche, the few people you know who use it might be handling it okay (or early in their trajectory with the drug) and their experience with it can look cool and attractive. He also said his generation was the last one where basically everybody had seen firsthand what heroin could do to people, but he was optimistic that it had "killed enough famous musicians" that it couldn't come back. That was in the 1990s, so....
Sorry, but what's your complaint about this specific piece from the NYT?
Just skimming, I see 21 links to other sources. I haven't clicked through on all of them. It appears to weigh various pros and cons. It seems even handed to me on a quick skim.
Further, the NYT has many sections and voices. This piece is specifically from from The Upshot which has this tagline: "Analysis that explains politics, policy and everyday life, with an emphasis on data and charts."
And this specific piece is written not by a reporter, but by a expert in the field: Austin Frakt is director of the Partnered Evidence-Based Policy Resource Center at the V.A. Boston Healthcare System; associate professor with Boston University’s School of Public Health; and a senior research scientist with the Harvard T.H. Chan School of Public Health.
I appreciate the rest of your comment.
Just skimming, I see 21 links to other sources. I haven't clicked through on all of them. It appears to weigh various pros and cons. It seems even handed to me on a quick skim.
Further, the NYT has many sections and voices. This piece is specifically from from The Upshot which has this tagline: "Analysis that explains politics, policy and everyday life, with an emphasis on data and charts."
And this specific piece is written not by a reporter, but by a expert in the field: Austin Frakt is director of the Partnered Evidence-Based Policy Resource Center at the V.A. Boston Healthcare System; associate professor with Boston University’s School of Public Health; and a senior research scientist with the Harvard T.H. Chan School of Public Health.
I appreciate the rest of your comment.
Not the grand parent comment and I don't have anything specifically against the NYT or this piece, which I agree is pretty balanced.
It is great that they paint a positive picture of Portugal as a forward-thinking progressive nation, the point that Portuguese people often take an issue with this and other pieces, in american and british press, is that they fail to explain the motivation behind this policy.
These measures were not a hippie social experiment, they were created out of a desperate lack of alternatives in the face of a de facto public health crisis due to a heroin epidemic.
I cannot put in words that make it justice, you had entire neighbourhoods become drug slums with hundreds of heroin dealers and people inject on the sidewalks in broad daylight. It was crime problem, it was a health problem, it was a whole generation of people lost to this. It's this omission in the 'why' of decriminalization that feels somewhat dishonest.
It is great that they paint a positive picture of Portugal as a forward-thinking progressive nation, the point that Portuguese people often take an issue with this and other pieces, in american and british press, is that they fail to explain the motivation behind this policy.
These measures were not a hippie social experiment, they were created out of a desperate lack of alternatives in the face of a de facto public health crisis due to a heroin epidemic.
I cannot put in words that make it justice, you had entire neighbourhoods become drug slums with hundreds of heroin dealers and people inject on the sidewalks in broad daylight. It was crime problem, it was a health problem, it was a whole generation of people lost to this. It's this omission in the 'why' of decriminalization that feels somewhat dishonest.
Reading highly reductive US coverage of my country is what makes me skeptical they do much better in covering their own national news.
I've been living in rural Portugal for a little while now, and these are some excellent comments. Especially the first point.
I'd also add that there is still a Heroin problem, albeit diminished. It is not unusual to see someone walking though the local village, out-of-their head drunk at 9am on a Wednesday. It isn't alcohol though, it's Heroin. But it is also an economically poor area. The weather is amazing and the place is gorgeous, but for someone raised here who doesn't manage to escape it can also be a trap. Many of the older people work in the fields in the morning, the in the late afternoon they meet in the cafes and chat about village life. Coffee is $0.15, a beer is $0.7. There a very few younger people. Those that can leave have left for a city. The ones who remain are that ones who were not able to leave. I spoke with the local President last week and he himself said that the area has become a skills desert.
So yes, I think the route to Heroin addition looks something like this. Get financially stuck in the local area. Get a bad reputation for being lazy. Try to become YouTube/Insta famous. Give up. Turn on those that tried to help. Drink & smoke weed as an escape. When those stop working try Heroin. I know a couple of people in my village that are on this path right now.
There is some crime here. It seems to fall into two categories. First is petty crime where something goes missing that's worth about $100. That's enough to quickly sell for immediate cash (likely for some form of drug). This has happened to me twice, and I don't really mind.
There is more 'organised' crime where a place gets methodically burgled when someone is away. I know people this has happened to.
There is a rapidly growing contingent of foreigners here now, and we're mostly accepted. Economically, I get the impression that most businesses prefer to deal with the foreigners. Even the guy that sells firewood says that 95% of his customers are now foreigners, and that he prefers it that way. There are lots more foreigners arriving too (leaving cities due to covid, basically), very few Portuguese people being added. Most people in my village are over 60. It'll be interesting to see how the demographics play out over the coming years.
Anyway, maybe that is of some interest. The region of Portugal I am in is Castelo Branco. I'm starting an ISP here too: https://gardunha.net
I'd also add that there is still a Heroin problem, albeit diminished. It is not unusual to see someone walking though the local village, out-of-their head drunk at 9am on a Wednesday. It isn't alcohol though, it's Heroin. But it is also an economically poor area. The weather is amazing and the place is gorgeous, but for someone raised here who doesn't manage to escape it can also be a trap. Many of the older people work in the fields in the morning, the in the late afternoon they meet in the cafes and chat about village life. Coffee is $0.15, a beer is $0.7. There a very few younger people. Those that can leave have left for a city. The ones who remain are that ones who were not able to leave. I spoke with the local President last week and he himself said that the area has become a skills desert.
So yes, I think the route to Heroin addition looks something like this. Get financially stuck in the local area. Get a bad reputation for being lazy. Try to become YouTube/Insta famous. Give up. Turn on those that tried to help. Drink & smoke weed as an escape. When those stop working try Heroin. I know a couple of people in my village that are on this path right now.
There is some crime here. It seems to fall into two categories. First is petty crime where something goes missing that's worth about $100. That's enough to quickly sell for immediate cash (likely for some form of drug). This has happened to me twice, and I don't really mind.
There is more 'organised' crime where a place gets methodically burgled when someone is away. I know people this has happened to.
There is a rapidly growing contingent of foreigners here now, and we're mostly accepted. Economically, I get the impression that most businesses prefer to deal with the foreigners. Even the guy that sells firewood says that 95% of his customers are now foreigners, and that he prefers it that way. There are lots more foreigners arriving too (leaving cities due to covid, basically), very few Portuguese people being added. Most people in my village are over 60. It'll be interesting to see how the demographics play out over the coming years.
Anyway, maybe that is of some interest. The region of Portugal I am in is Castelo Branco. I'm starting an ISP here too: https://gardunha.net
starting ISP - that is very cool!
What about Portuguese language ? do you need to able to speak to be accepted there ?
In urban settings, most Portuguese natives 50 or younger speak English (fluency varies, naturally). I can't really speak for rural areas. In order to integrate socially, however, you'll find it's easier if you speak Portuguese -- i.e. if planning to stay for a few years, learning the language is a good investment.
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Nitpicks. Prices are good (specially outside of large cities) but I believe that "Coffee is $0.15" is a typo. A coffee will hardly ever cost you less than 0,5€. And $0,7 is for a 200ml beer not a pint.
> most businesses prefer to deal with the foreigners.
Businesses prefer to deal with costumers able to pay more (or quicklier) for the same services/products.
(edited - typo)
> most businesses prefer to deal with the foreigners.
Businesses prefer to deal with costumers able to pay more (or quicklier) for the same services/products.
(edited - typo)
> Nitpicks. Prices are good (specially outside of large cities) but I believe that "Coffee is $0.15" is a typo. A coffee will hardly ever cost you less than 0,5€. And $0,7 is for a 20ml beer.
20ml is a very small amount of beer. Maybe you meant something else?
20ml is a very small amount of beer. Maybe you meant something else?
"I've been living in rural Portugal for a little while now"
Not long enough! I'm from Castelo Branco and coffee is not $0.15... not even a "carioca de limão". Needle exchange program started 1993 along with other programs like "metadoda" to help addiction. With a needle they also provided condoms and an open door if you wanted help. During the 80's you could find needles everywhere, people stealing from their own parents, houses, business, everyone knew someone with drug problems. Was a mess. And even worst in big cities. The government also start ending slums.
Decriminalization was not the start of this "war"!
The situation is not perfect, and will never be, but is a LOT better than before! Portugal is a lot safer. The crime that you talk about is probably not drug related and probably not local people. Just read the news. Did you find any place to sell used things? No except for gold.
And if you find someone "drunk" at 9am you bet he is drunk lol "evita a ressaca, mantente bebado" something like "void hangover, stay drunk" every village has a chronic drunk! Maybe now the biggest problem is alcool, not heavy drugs. Why do you think police stop people at 9am and force them to do an alcohol test? They are drinking since 6am!
Regarding your ISP. Your target is people in a rural area? In one of the most less dense population area in Portugal? I will be waiting for the pricing. Good Luck.
The situation is not perfect, and will never be, but is a LOT better than before! Portugal is a lot safer. The crime that you talk about is probably not drug related and probably not local people. Just read the news. Did you find any place to sell used things? No except for gold.
And if you find someone "drunk" at 9am you bet he is drunk lol "evita a ressaca, mantente bebado" something like "void hangover, stay drunk" every village has a chronic drunk! Maybe now the biggest problem is alcool, not heavy drugs. Why do you think police stop people at 9am and force them to do an alcohol test? They are drinking since 6am!
Regarding your ISP. Your target is people in a rural area? In one of the most less dense population area in Portugal? I will be waiting for the pricing. Good Luck.
> And if you find someone "drunk" at 9am you bet he is drunk
People "gouching out on smack" do not look like they are drunk, so I think you're correct.
People "gouching out on smack" do not look like they are drunk, so I think you're correct.
I stand corrected. It's good to hear from another HNer in the region.
Best of luck on your ISP venture, hope the bureaucracy isn't too much to handle
> - The main public opinion driver for both the needle exchange programs and the decriminalization was a _massive_ Heroin epidemic
There were politicians that publicly spoke about their personal experiences. Others that had family members that were caught up with it.
It was a widespread issue across all classes, not just the poor.
Here's a recent interview about one of the main drivers of this policy (in Portuguese).
https://www.perguntarnaoofende.pt/pno/joao-goulao
There were politicians that publicly spoke about their personal experiences. Others that had family members that were caught up with it.
It was a widespread issue across all classes, not just the poor.
Here's a recent interview about one of the main drivers of this policy (in Portuguese).
https://www.perguntarnaoofende.pt/pno/joao-goulao
> which lead to an HIV, Hepatitis B/C, AND Tubercolosis epidemic
It seems like these problems are not directly caused by the drug, but by the fact users cannot buy clean medical grade with a safe method of administration. Portugal model doesn't seem to address that, but only makes consumption slightly more "comfortable" to the users.
It seems like these problems are not directly caused by the drug, but by the fact users cannot buy clean medical grade with a safe method of administration. Portugal model doesn't seem to address that, but only makes consumption slightly more "comfortable" to the users.
Portugal have needle exchange programs and places with health practitioners for people to shoot drugs, this last point was very controversial when it was implemented. Nowadays there are even mobile sites for this: https://idpc.net/alerts/2019/07/inside-portugal-s-first-mobi...
That is helpful, but even with a clean needle they will administer something possibly contaminated anyway. Good program would also give out medical grade clean heroin like they do in Switzerland. Clean heroin is relatively safe contrary to popular opinion. This removes the dealers from that segment of the market or at least severely reduces the sales volume.
Needle exchanges are more about preventing multiple people from using the same needle, which is an excellent way to transmit diseases like hepatitis, HIV, etc.
Yes this is helpful in that way, but call me cynical - without removing the market from the hands of criminals, what it does is ensures that the consumer will be a paying client a little bit longer. But if a dealer messes up and mixes the Fentanyl unevenly, the clean needle won't help much.
Dealers are typically not cutting their products with HIV or hepatitis virii.
They cut drugs with various substances to increase volume and / or perceived strength, and that can cause health issues just as dangerous or even death by accidental overdose. In fact the number of overdose deaths have increased in Portugal since that policy has been implemented. Another flaw of this policy is that when users don't have to spend money on paraphernalia, they will have more money to spend on drugs. So I would say this is not about safety of the consumers, but to protect Portugal's healthcare system. It is easier and cheaper to deal with a dead overdosed consumer than a consumer who caught HIV.
> They cut drugs with various substances to increase volume and / or perceived strength, and that can cause health issues just as dangerous or even death by accidental overdose.
This is true, but you're saying something different than what you started off saying.
I agree with you that the government should be supplying heroin to addicts, and if you're decriminalizing drug usage, there's no reason that you shouldn't be doing this. A doctor having the ability to monitor addicts under their care would give us the means to keep them happy and productive, and to make sure they can get off the drug when they're willing to risk the effort.
This is true, but you're saying something different than what you started off saying.
I agree with you that the government should be supplying heroin to addicts, and if you're decriminalizing drug usage, there's no reason that you shouldn't be doing this. A doctor having the ability to monitor addicts under their care would give us the means to keep them happy and productive, and to make sure they can get off the drug when they're willing to risk the effort.
Many people who take drugs lead happy and productive life and use them as a tool and this approach doesn't seem to address why people reach for drugs in the first place. That's why I believe this policy is dishonest.
> That is helpful, but even with a clean needle they will administer something possibly contaminated anyway
In general, the main drug-related vector for disease is needle sharing. Most pathogens wouldn't survive long in the actual heroin, and it's not clear how they'd get there in the first place.
In general, the main drug-related vector for disease is needle sharing. Most pathogens wouldn't survive long in the actual heroin, and it's not clear how they'd get there in the first place.
This is true, but many contaminants can still cause serious diseases and uneven distribution of active substances may lead to accidental overdose. Also unknown composition of the "drug" can cause unexpected interactions with other drugs people may be taking at the same time.
There also seems to be no proof that drop in prevalence of those diseases caused by needle sharing actually is caused by this program and not by cultural change and education that maybe changing the method of administering the drug is "healthier" (e.g. consumers started to prefer smoking over injecting).
>"...healthcare is universally free in Portugal..."
In principle only.
In practice: how much have you spent on dentist bills in the past year?
In principle only.
In practice: how much have you spent on dentist bills in the past year?
Child birth.
Heart attack.
Broken leg.
Brain tumour.
Flu.
It’s free in practice.
It’s free in practice.
Yes, most things are free in practice. Just so happens that something critical for day to day general health and well-being (dental health) is not.
It's not by accident that Portugal has oral health on par with the poorest Eastern European countries.
It's not by accident that Portugal has oral health on par with the poorest Eastern European countries.
To note, in 2001 Portugal has decriminalized possession of small quantities of drugs, for first time offenders. Drug trafficking is still just as illegal as ever. There are no cannabis shops or pervasive cannabis advertisement, as opposed to US liberal states, for example CO or WA.
> But Portugal’s experience is often misunderstood. Although it decriminalized the use of all illicit drugs in small amounts in 2001, including heroin and cocaine, that’s different from making them legal. And it did not decriminalize drug trafficking, which would typically involve larger quantities.
> Portugal’s law removed incarceration, but people caught possessing or using illicit drugs may be penalized by regional panels made up of social workers, medical professionals and drug experts. The panels can refer people to drug treatment programs, hand out fines or impose community service.
> A lot of the benefits over the years from Portugal’s policy shift have come not from decriminalization per se, but in the expansion of substance-use disorder treatment. Such a move might bring the most tangible benefit to the United States.
> But Portugal’s experience is often misunderstood. Although it decriminalized the use of all illicit drugs in small amounts in 2001, including heroin and cocaine, that’s different from making them legal. And it did not decriminalize drug trafficking, which would typically involve larger quantities.
> Portugal’s law removed incarceration, but people caught possessing or using illicit drugs may be penalized by regional panels made up of social workers, medical professionals and drug experts. The panels can refer people to drug treatment programs, hand out fines or impose community service.
> A lot of the benefits over the years from Portugal’s policy shift have come not from decriminalization per se, but in the expansion of substance-use disorder treatment. Such a move might bring the most tangible benefit to the United States.
Take a look at the US per-capita incarceration rate over time [1]. Since the war on drugs began, it has grown 5x over what appears to have been a long-term steady state.
The war on drugs is a make-work jobs program for people who can't build anything useful. Relative to skill, these are well-paying stable jobs.
[1] https://upload.wikimedia.org/wikipedia/commons/thumb/4/48/U....
The war on drugs is a make-work jobs program for people who can't build anything useful. Relative to skill, these are well-paying stable jobs.
[1] https://upload.wikimedia.org/wikipedia/commons/thumb/4/48/U....
This is the key from my perspective:
"Moreover, as of 2008, three-quarters of those with opioid use disorder were receiving medication-assisted treatment. Though that’s considered the best approach, less than half of Americans who could benefit from medication-assisted treatment for opioid addiction receive it."
Buprenorphine has saved my life and I wish everyone could have access to it and that it would be provided for free. Pay for it from grabbing back cash from the Sackler's.
I'm surprised in the article the phrase 'less than half' which sounds like it's on the higher end towards 50.
I would have guessed much lower. I can't find a great source but this has some numbers [1]. Says only 36% of rehabs have access to at least one replacement therapy.
And that's people who can access rehab...
To be able to prescribe Suboxone - from what my Dr. has told me - MDs have to have a specific DEA certificate. And they limit the number of patients one single Dr. can treat at a few hundred.
In my state there aren't many prescribers - not nearly enough for the number of addicts. And I live in a liberal state.
It's easier for Drs to dole out opiates than prescribe buprenorphine.
We can also learn from Portugal in more community and healthcare intervention.
The big problem here to get there is that DAs, sheriffs, mayors are elected and there are 50 states. We will need to shift public opinion everywhere to make meaningful progress outside of big cities. Plus with Barr's Justice Department catholic radicalization who knows what happens if they get another 4 years.
It's gross that in America those who are poor, BIPOC, are far more likely to have their lives ruined by unequal drug prosecutions.
If we ever start treating addiction not prosecuting it, I hope we'll do better than marijuana and clear old records/convictions for small drug possession.
https://nam.edu/improving-access-to-evidence-based-medical-t...
Buprenorphine has saved my life and I wish everyone could have access to it and that it would be provided for free. Pay for it from grabbing back cash from the Sackler's.
I'm surprised in the article the phrase 'less than half' which sounds like it's on the higher end towards 50.
I would have guessed much lower. I can't find a great source but this has some numbers [1]. Says only 36% of rehabs have access to at least one replacement therapy.
And that's people who can access rehab...
To be able to prescribe Suboxone - from what my Dr. has told me - MDs have to have a specific DEA certificate. And they limit the number of patients one single Dr. can treat at a few hundred.
In my state there aren't many prescribers - not nearly enough for the number of addicts. And I live in a liberal state.
It's easier for Drs to dole out opiates than prescribe buprenorphine.
We can also learn from Portugal in more community and healthcare intervention.
The big problem here to get there is that DAs, sheriffs, mayors are elected and there are 50 states. We will need to shift public opinion everywhere to make meaningful progress outside of big cities. Plus with Barr's Justice Department catholic radicalization who knows what happens if they get another 4 years.
It's gross that in America those who are poor, BIPOC, are far more likely to have their lives ruined by unequal drug prosecutions.
If we ever start treating addiction not prosecuting it, I hope we'll do better than marijuana and clear old records/convictions for small drug possession.
https://nam.edu/improving-access-to-evidence-based-medical-t...
The current system in the US is a virtuous cycle - companies like Purdue make tens of billions creating a huge population of addicts, and then the resulting crime justifies the expansion of heavily militarized police to wage war "on drugs", which then can funnel the losers of the battle into a for-profit prison system. Imagine the profit potential of a nation of 150 million junkies. Actually solving the problem costs money.
> virtuous cycle
That example would probably be called a vicious cycle, rather than a virtuous one. ;)
That example would probably be called a vicious cycle, rather than a virtuous one. ;)
I think the word "virtuous" was used sarcastically.
And it is virtuous from the perspective of those entities profiting from the above cycle...
And it is virtuous from the perspective of those entities profiting from the above cycle...
Why are opiate treatment drugs so highly controlled? Do they have a high risk for recreational abuse, or extreme side effects, or is something else wrong?
They give you a good buzz, especially if you are a relatively opiate naive person. If you happen to have an addict friend that wants to sell their methadone or suboxen to buy real stuff, then it ends up being a lose lose for people trying to stop overall use
Bupe + naloxone doesn't give any buzz and it blocks you from getting high from other opiates. i guess maybe if you were opiate naive maybe it would IDK. but that would be really dumb to take if you want to get high take the real shit
Definitely can from methadone especially mixed with a benzo
for sure people sell it but they're going to use with or without it.
studies have shown that those who don't get long time sober and do replacement therapy on and off nonetheless have longer periods of abstinence and lower death time frames (not sure how to phrase that they dont die as much/soon)
Definitely can from methadone especially mixed with a benzo
for sure people sell it but they're going to use with or without it.
studies have shown that those who don't get long time sober and do replacement therapy on and off nonetheless have longer periods of abstinence and lower death time frames (not sure how to phrase that they dont die as much/soon)
Methadone is even more dangerous than the real stuff: just withdraw syndrome can be fatal.
yeah it's gross. i'm 100% for just giving actual pure opiates out for free to addicts that don't yet want to get clean.
in a lot of ways it would be safer. clean, known dose, less theft to pay for drugs, less violence no cartels
in a lot of ways it would be safer. clean, known dose, less theft to pay for drugs, less violence no cartels
i believe it's 100% because of stigma and 'values preaching' and the history of methadone
buprenorphine + naloxone is nothing like methadone
suboxone has few to none of the externalities of methadone
just in general with drugs and treatment we would be so much better off if those who force their personal values upon others had some sympathy and compassion
buprenorphine + naloxone is nothing like methadone
suboxone has few to none of the externalities of methadone
just in general with drugs and treatment we would be so much better off if those who force their personal values upon others had some sympathy and compassion
The purpose of the drug war isn't to prevent drug use or help people quit drugs.
There was a RAND study many years ago which showed that, from a pure cost benefit point of view, the best way to deal with drugs is through education and treatment, not policing and punishment.
Eg Americans today smoke a lot less tobacco and drink less coffee too. Education works!
Eg Americans today smoke a lot less tobacco and drink less coffee too. Education works!
Unfortunately, I think for many in America, the conversation need not even advance to discussing efficiency, effectiveness or value.
Government propaganda, a good deal of it channelled through TV and Hollywood have so thuroughly established unrepentant drug users as villians that many people want it prosecuted on its face for its immorality.
Lawmakers find it difficult to let up on drug crimes because they are quickly painted as weak and enablers of other crimes. It's the same tirh the death penalty. The problems with it are plain for all to see. But lawmakers feel the need to signal the virtue of "justice" or "strength" and enough voters still respond to that signal. Even in the supposedly lefty stare of Washington where I reside, progress on criminal justice issues has been glacially slow.
Government propaganda, a good deal of it channelled through TV and Hollywood have so thuroughly established unrepentant drug users as villians that many people want it prosecuted on its face for its immorality.
Lawmakers find it difficult to let up on drug crimes because they are quickly painted as weak and enablers of other crimes. It's the same tirh the death penalty. The problems with it are plain for all to see. But lawmakers feel the need to signal the virtue of "justice" or "strength" and enough voters still respond to that signal. Even in the supposedly lefty stare of Washington where I reside, progress on criminal justice issues has been glacially slow.
Agreed. Which in my view stems from the perverse need to simplify everything. Some things just aren’t simple.
The “solution” of locking someone up and then walking away is easier than it is to help someone, work through relapses and end up with a healthy individual after X years. The latter is obviously better, and cheaper, but it costs patience and empathy. Things that are in short supply these days.
The “solution” of locking someone up and then walking away is easier than it is to help someone, work through relapses and end up with a healthy individual after X years. The latter is obviously better, and cheaper, but it costs patience and empathy. Things that are in short supply these days.
bismuthsalt(1)
> drink less coffee
Really? Curious about this, because everyone around me (including me) drinks a metric crap ton of caffeine, either in tea, coffee, or energy drinks.
Really? Curious about this, because everyone around me (including me) drinks a metric crap ton of caffeine, either in tea, coffee, or energy drinks.
I've actually switched off caffeine in a big way since the pandemic started - I have a chance to sleep in later in the morning and get some activity before needing to get straight into work - additionally I can take a break mid-day to walk and clear my head or even shift some hours around and take a quick nap if I need it.
A nice upside to remoting.
A nice upside to remoting.
Yup, I’m in the same boat. I must have reduced my coffee intake from several bad cups from an automatic vending machine to only 1.5 moka (6 cups each) per day.
Still quite a lot of coffee, but it tastes much better.
Still quite a lot of coffee, but it tastes much better.
Whaa??
Coffee consumption has dropped more than 50 percent in 70 years https://www.outsidethebeltway.com/u-s-coffee-consumption-had...
Why??
Coffee consumption has dropped more than 50 percent in 70 years https://www.outsidethebeltway.com/u-s-coffee-consumption-had...
Why??
keep in mind that this is in gallons per capita, not in grams coffee beans or in a caffeine equivalent. So the stats may be misleading: People in 1960 would drink filter coffee. Today, they may take an espresso. Roughly same amount of ground coffee per cup, but less liquid. Then again, the stats for coffee beans per capita may trend in the same direction. We have other sources of caffeine today: You may drink a coke instead of a coffee when you're feeling sleepy.
It doesn't seem that reduction in coffee consumption had anything to do with education, but with increased availability and marketing of carbonated sugared drinks.
Also, in recent years total coffee consumption started to increase again, driven by hip coffee shops.
It's hard to win against billions in marketing.
https://www.ers.usda.gov/amber-waves/2007/june/coffee-consum...
https://qz.com/quartzy/1287862/american-coffee-consumption-i...
Also, in recent years total coffee consumption started to increase again, driven by hip coffee shops.
It's hard to win against billions in marketing.
https://www.ers.usda.gov/amber-waves/2007/june/coffee-consum...
https://qz.com/quartzy/1287862/american-coffee-consumption-i...
> Eg Americans today smoke a lot less tobacco and drink less coffee too. Education works!
Are there any scientific facts which would back this?
To me it feels like there have been several other causes to that which were much more relevant. Not allowing people to smoke inside, vaping and smoking getting "out of fashion" were much more successful.
It's just not cool anymore and those who still want to smoke are being confined to disgusting places to do it. Soo...it kinda works against your argument because it was a bad example. The only thing we may take away from it would be that if we'd have made smoking tobacco illegal everywhere, it would have remained cool to do so secretly...maybe.
Are there any scientific facts which would back this?
To me it feels like there have been several other causes to that which were much more relevant. Not allowing people to smoke inside, vaping and smoking getting "out of fashion" were much more successful.
It's just not cool anymore and those who still want to smoke are being confined to disgusting places to do it. Soo...it kinda works against your argument because it was a bad example. The only thing we may take away from it would be that if we'd have made smoking tobacco illegal everywhere, it would have remained cool to do so secretly...maybe.
It's not cool to smoke anymore because of all the aducation and PR campaigns.
The decline started decades before vaping and bans on smoking inside. It started when the message changed. In the US "peak smoking" occurred in the 1960s and consumptions has been decreasing ever since [1]
[1] https://www.ncbi.nlm.nih.gov/books/NBK294310/figure/ch2.f1/
The decline started decades before vaping and bans on smoking inside. It started when the message changed. In the US "peak smoking" occurred in the 1960s and consumptions has been decreasing ever since [1]
[1] https://www.ncbi.nlm.nih.gov/books/NBK294310/figure/ch2.f1/
Smoking was already generally in decline in most countries, including the US, who introduced public bans. It was a big part of what made the bans politically feasible in the first place.
The biggest driver of behaviour change is increasing the price. Cigarettes are considerably more expensive (even when adjusting for inflation) than they used to be.
https://247wallst.com/special-report/2019/06/19/price-of-a-p...
Other things (bans on ads, bans on smoking in venues, health information) do help, but they're a smaller part of the picture.
https://247wallst.com/special-report/2019/06/19/price-of-a-p...
Other things (bans on ads, bans on smoking in venues, health information) do help, but they're a smaller part of the picture.
True. I did forget this up there.
By contrast some European countries, like Austria, drink a lot of coffee and smoke a lot of tobacco(they just banned indoor smoking last year).
National culture plays a huge role in what vices people take on.
National culture plays a huge role in what vices people take on.
According to [1], Europe is the world's largest coffee market, at 33% of production. North America consumes 19%.
Consumption per capita up here in the wonderful Nordics is quite high, with Finland typically leading at 12 kg/person. The corresponding number for the US is around 4.2 kg (9.3 lbs). The Telegraph has a fun list [2] showing the top 20 consumers.
[1] https://www.cbi.eu/market-information/coffee/trade-statistic... [2] https://www.telegraph.co.uk/travel/maps-and-graphics/countri...
Consumption per capita up here in the wonderful Nordics is quite high, with Finland typically leading at 12 kg/person. The corresponding number for the US is around 4.2 kg (9.3 lbs). The Telegraph has a fun list [2] showing the top 20 consumers.
[1] https://www.cbi.eu/market-information/coffee/trade-statistic... [2] https://www.telegraph.co.uk/travel/maps-and-graphics/countri...
wow, 1 kg per month means 133 shots of espresso a month - roughly 4.5 espresso shots every day, including weekends.
Sounds about right for me here in Norway. I really need to cut back.
I went to Viena three years ago. It shocked me how much they smoke everywhere and also how much sugar addicted they were.
The food is soooo sweet, sugar, sugar and sugar everywhere.
Other places like Salzburg are different in so many ways. Viena has always been a political, bureaucracy center.
Cafeterias in Viena are political institutions, you can imagine Freud or Lenin or Stalin, Stefan Sweig, Carl Jung, Hitler, Marx, Goethe, just there, because they went there.
The food is soooo sweet, sugar, sugar and sugar everywhere.
Other places like Salzburg are different in so many ways. Viena has always been a political, bureaucracy center.
Cafeterias in Viena are political institutions, you can imagine Freud or Lenin or Stalin, Stefan Sweig, Carl Jung, Hitler, Marx, Goethe, just there, because they went there.
> I went to Viena three years ago. It shocked me how much they smoke everywhere
This is history now. But I agree that it was very bad, it was part of Austria's "coffee house culture" to have the stale smoke odour everywhere (furniture, curtains etc.). It was much worse in the 80's and earlier though.
The sugar addiction is mainly due to the influence of bohemian cuisine and popular sweet snacks like "Manner Schnitten".
This is history now. But I agree that it was very bad, it was part of Austria's "coffee house culture" to have the stale smoke odour everywhere (furniture, curtains etc.). It was much worse in the 80's and earlier though.
The sugar addiction is mainly due to the influence of bohemian cuisine and popular sweet snacks like "Manner Schnitten".
How is the food particularly sweet? The only sweet stuff I can think of are cakes and desserts and those are supposed to be sweet.
There's an anti-caffeine 'education' programme in the states? For real?
If there is, it's subtle. I've heard about studies that talk about the negatives of caffeine, as well as some that talk about the benefits. But none of that seemed to be pushing an agenda.
Practically everyone around me thinks they need caffeine to get through the day. I'm one of the only people I know who are caffeine-free.
Long ago, I thought caffeine gave me headaches, and I refused to drink it. Then I started having trouble staying away during the day and nothing the doctors did mattered. So I turned to caffeine reluctantly, and it helped for a while. Eventually I was drinking so much caffeine each day that I was getting sick from it.
So I cut back, and then I was falling asleep during the day again. (Or at least feeling exhausted and that I needed to sleep and kind of took a waking nap.)
So I cut off the caffeine again and, no big surprise, it's the same as when I was drinking caffeine. Except that I don't get any caffeine-withdrawal headaches when I can't get enough or forget to drink enough.
I know from the past that telling people they don't need caffeine doesn't work, though. They just won't listen. They have to figure it out themselves.
So yeah... If there's an anti-caffeine education here, it's very subtle.
Practically everyone around me thinks they need caffeine to get through the day. I'm one of the only people I know who are caffeine-free.
Long ago, I thought caffeine gave me headaches, and I refused to drink it. Then I started having trouble staying away during the day and nothing the doctors did mattered. So I turned to caffeine reluctantly, and it helped for a while. Eventually I was drinking so much caffeine each day that I was getting sick from it.
So I cut back, and then I was falling asleep during the day again. (Or at least feeling exhausted and that I needed to sleep and kind of took a waking nap.)
So I cut off the caffeine again and, no big surprise, it's the same as when I was drinking caffeine. Except that I don't get any caffeine-withdrawal headaches when I can't get enough or forget to drink enough.
I know from the past that telling people they don't need caffeine doesn't work, though. They just won't listen. They have to figure it out themselves.
So yeah... If there's an anti-caffeine education here, it's very subtle.
When the physician diagnoses you with caffeine abuse when you drink 1.5 liters of coffee over the day, yes.
> drink less coffee
Is this a good thing?
Is this a good thing?
(it has all switched to sugar/processed carbs!)
British Columbia’s medical health officer recently gave nurses the ability to prescribe opioid replacement drugs to improve the supply. Many more people are dying from toxic street drugs than are dying from COVID-19. It’s a “shadow pandemic” that has been raging for decades and is only getting worse as border closures make it harder for gangs to move drugs like heroin and fentanyl across borders, leading to shortages of “safe” ingredients and a shift toward exotic, extremely toxic alternatives like carfentanyl.
> Many more people are dying from toxic street drugs than are dying from COVID-19. It’s a “shadow pandemic”
In America, the worse year of the opioid crisis killed ~65k people from my recollection. The "real pandemic" killed that many americans in the past 2 months. Am I misunderstanding something?
Edit: I cannot spell.
In America, the worse year of the opioid crisis killed ~65k people from my recollection. The "real pandemic" killed that many americans in the past 2 months. Am I misunderstanding something?
Edit: I cannot spell.
do you think some pay back from China for the opium wars is part of the dynamic?
The opiates crisis was driven and enabled by US pharma marketing practices. Internationally-mailed fentanyl was only a small part of the problem.
US opiate deaths are now dominated by fentanyl and related synthetic analogues:
https://www.cdc.gov/media/releases/2020/p0318-data-show-chan...
https://www.cdc.gov/media/releases/2020/p0318-data-show-chan...
That’s going back a ways...
To the century of humiliation starting in 1839 with the opium war [1]. I’m told saving face is very important in Chinese culture. I could see it being quite easy for people in China whose job it might be to prevent the export of fentanyl or fentanyl precursors to only do the minimum to keep up appearances. not nearly as blatant as the British but were but we aren’t getting any help from China in preventing the deadly drugs from being shipped here. It would be better if they would just send actual heroin instead of having casual mdma and cocaine users dying from fentanyl.
[1] https://en.wikipedia.org/wiki/Century_of_humiliation
[1] https://en.wikipedia.org/wiki/Century_of_humiliation
I saw somewhere there was some confusion in translation what decriminalization means, as Portugal has Roman Law as opposed to Common Law found in English speaking countries. Portugal "decriminalization" of drugs left it in a similar state to British law anyway. I can't find a reference now though - does anyone know more?
From what I heard, the change led to treating drug usage as health problem, and removing the law enforcement aspect from the loop.
The police can still refer drug users to the healthcare institutions that deal with the problem.
Another interesting tidbit is that the Netherlands did not in fact legalized cannabis. They just decline to prosecute that crime. There's no legal framework to regulate its sale, like for any other consumable good.
This leads to silliness like people in "coffee shops" being allowed to smoke weed, but not tobacco since that is regulated for all indoors venues.
Another interesting tidbit is that the Netherlands did not in fact legalized cannabis. They just decline to prosecute that crime. There's no legal framework to regulate its sale, like for any other consumable good.
This leads to silliness like people in "coffee shops" being allowed to smoke weed, but not tobacco since that is regulated for all indoors venues.
One issue with drugs policy, I mean in general total prohibition, is that it has come about for moral and emotional (even religious in some case) reasons, like the prohibition of alcohol in the USA once had.
This can be seen in the fact that use is usually a crime. There are no other substances, however nasty they might be, that are a crime to drink/eat/inject. To me this elevates the use of drugs to some sort of sin for, really, arbitrary reasons.
This makes taking a pragmatic and facts-based approach difficult.
This can be seen in the fact that use is usually a crime. There are no other substances, however nasty they might be, that are a crime to drink/eat/inject. To me this elevates the use of drugs to some sort of sin for, really, arbitrary reasons.
This makes taking a pragmatic and facts-based approach difficult.
During the last years Portugal is doing a great job in a lot of fields like education or economy. A great example for southern Europe countries
Thanks. It's good to hear this opinion from the outside. The Portuguese are, as a group, pretty pessimistic. I often have to state that, in '74, when the dictatorship ended, we were massively illiterate. The education evolution is extraordinary, albeit inevitably slow: it takes a couple generations to change the education profile of a country.
It is a country far from perfect, but the people are nice, the cuisine is excellent, the weather is amazing and it is consistently moving in the right direction.
It is a country far from perfect, but the people are nice, the cuisine is excellent, the weather is amazing and it is consistently moving in the right direction.
We did a lot of good things, but I wouldn't say those are the samples we want to use as examples for other countries.
Drugs will never be decriminalized fully here in the US.
There is too much untraceable money involved.
It is said that after the housing bubble burst around 2008 that there was very little “liquid” cash floating around and that dark money from drug trafficking was one of things that helped the US from going completely under.
Add to that all the covert operations to overthrow governments and bribe crooked foreign leaders that require vast sums of money that doesn’t leave a paper trail.
The “war” on drugs is too keep drugs illegal and to sustain the flow of dirty monies.
It is said that after the housing bubble burst around 2008 that there was very little “liquid” cash floating around and that dark money from drug trafficking was one of things that helped the US from going completely under.
Add to that all the covert operations to overthrow governments and bribe crooked foreign leaders that require vast sums of money that doesn’t leave a paper trail.
The “war” on drugs is too keep drugs illegal and to sustain the flow of dirty monies.
The opposite of addiction is connection.
Teeth are a luxury.
This is one of the things that makes me proud to be Portuguese.
Also, does anyone remember the name of the doctor that started this whole movement? I think the first name is João, but I can't remember or find it. I might be tripping, pun intended.
Also, does anyone remember the name of the doctor that started this whole movement? I think the first name is João, but I can't remember or find it. I might be tripping, pun intended.
Thanks!
https://www.perguntarnaoofende.pt/pno/joao-goulao
He even gave a recent interview about all this.
He even gave a recent interview about all this.
Not sure why this policy is touted as a champion example how to deal with the drug "problem". Only thing it does it reduces exposure of drug consumers to law enforcement harassment while at the same time helps organised crime making more money. I would rather look into why some people promote this and maybe look into their finances.
Drug use is natural for intelligent beings and prohibition of that is like trying to ban music or sex. It will never work, but will create a plethora of problems that we experience. From the rise of organised crime to people being unable to access medication they need.
It is being tolerated by the population because of massive propaganda and manipulation (for example someone done something bad? Make sure to mention they used cannabis or other drug even if that had nothing to do with the thing that has been done). It is in a way similar to how it was possible to ban same sex intercourse in some countries - people were made to believe it was a "sin".
Many health issues are caused by the contamination in drugs available on the streets, that are attributed to drugs themselves. Some popular drugs could be much safer if you could buy a medical grade.
In other words it is another money maker based on people suffering and deception and promotion of Portugal model looks very suspicious.
How are the drug dealers making more money if there are alot less people consuming?
Do you have evidence that this is the case? Drug use comes from natural urge to explore consciousness and people take drugs regardless of the law around it. If they are no longer being harassed by law enforcement, then it is easier for them to pursue this and Portugal's policy does that. If I recall the drug use is estimated from surveys and people lie when it comes to that (for example there is thinking what if they start to investigate me if I respond "yes", even if the survey is "anonymous"). Other way to estimate is by looking at numbers of people caught with the system. Now, because the harassment has been relaxed obviously fewer LE will bother going after consumers and from that it is easy for propaganda machinery to tout the policy is working. Well, it is working for those involved in the trade. You sell more if your customers are not being harassed, simple fact of life.
- The main public opinion driver for both the needle exchange programs and the decriminalization was a _massive_ Heroin epidemic which lead to an HIV, Hepatitis B/C, AND Tubercolosis epidemic, the last one of those is particularly airborne contagious. I often see the lumping of 'heavy' drugs but (although decriminalized) Cocaine consumption in Portugal was marginal at the time (mostly because the majority of the population couldn't afford it). The main precipitator was Heroin consumption.
- These programs served as a 'trojan horse' anchor point to bring these, often homeless/missing, people back into the healthcare system. For added controversy for the americans out there, healthcare is universally free in Portugal.
- There was a clear rupture point both in crime rates and the prison system capacity due to the heroin epidemic. Police forces could no longer be bothered with the 'noise' of the numerous small possessions of 'non-heavy' drugs like haxixe or marijuana. Offloading that to mental health practioners was also logistically useful for law enforcement.
- It took a considerable amount of additional healthcare funding for these programs to be implemented. This would _not_ have been possible for an economy like Portugal without supplementary funds from the European Union economic development programs.
- I am very suspicious of the counter-argument insinuation that the program initially _caused_ an increase in crime rates and consumption, because the start of the program also matched the start of a fairly large economic downturn. The main idea of the program was that people could go and ask for help, without the fear of being put in jail. If you have a desperate person, willing to do desperate things, not pushing them against a corner is usually a good policy for crime rates.