[HN Gopher] America's syringe exchanges kill drug users
___________________________________________________________________
America's syringe exchanges kill drug users
Author : ryzvonusef
Score : 30 points
Date : 2022-12-03 17:18 UTC (5 hours ago)
(HTM) web link (www.economist.com)
(TXT) w3m dump (www.economist.com)
| gusgus01 wrote:
| For those interested, the study from Ms. Packham:
| https://apackham.github.io/mywebsite/opioidpaper_webcopy.pdf
| rhaway84773 wrote:
| That's interesting. I read the approach details. Nothing in
| there indicates why the results should reflect causation versus
| correlation.
|
| Before reading that I thought that maybe the SEP groups were
| wrong to call the publishing of the paper a mistake, but now
| having read it and seeing that it presents correlational data
| as causational data I understand why those groups were
| criticizing the research itself.
|
| I'm not an expert in this field so I would appreciate if others
| can also read the actual paper and explain to me why the author
| is correct to claim causation instead of correlation.
| wwarner wrote:
| Cigarettes are taxed at $4.35/pack to discourage smoking. But you
| can get syringes for free.
| tonyarkles wrote:
| I get the point you're trying to make, but there's a bit of
| nuance here and there. Long-term I agree with you:
|
| - smoking has long-term negative health outcomes
|
| - drug abuse also has long-term negative health outcomes
|
| Short term:
|
| - I can't even really think of a dirty-needle equivalent for
| smoking
|
| - using a dirty needle has a large number of short-
| term/acute/immediate outcomes: infection, incurable disease
| (Hepatitis, HIV, etc) and spreads between users
|
| It's not as if we're taxing cigarettes and giving away fentanyl
| for free to everyone. Yes, we even do give some drugs out for
| free (e.g., methadone and suboxone), but only to people who
| have already ruined their reward systems and become addicted. I
| couldn't go to a doctor or a clinic and say "the last time I
| consumed an opiate was 12 years ago after my knee surgery but
| please sign me up for free methadone!"
| its-obvious wrote:
| Legalize opium and the number of overdoses would plummet, as well
| as blood-transmissible diseases like these.
|
| It's at the point that if you're not aware of and advocating for
| obvious solutions like this, the blood is on your hands.
| edgyquant wrote:
| This is a lie that is continuously propagated. Portugal has not
| seen a reeducation in overdoses: quite the opposite
|
| https://www.statista.com/statistics/911927/drug-overdose-dea...
| jeffbee wrote:
| I assumed that Zurich's failed experiment decades ago would
| have ended the possibility of further debate.
| TylerE wrote:
| Part of the problem, ironically is the war on opioids. I've
| read many accounts of people with legit chronic pain being cut
| off by the doctor... which simply results in them getting
| relief wherever they can find it.
| ROTMetro wrote:
| Many dudes I knew in prison on drug charges were ex-military
| recent vets who picked up a pill habit from their service
| related injuries/chronic pain. That pill habit needed to be
| fed and pills got harder to find leading to dealing/importing
| fentanyl analogs from China.
| vorpalhex wrote:
| Would opium deaths be then on your hands?
| its-obvious wrote:
| Sure, because there would be a fraction as many. It's very
| unlikely to OD smoking opium, sublingual is slightly more
| dangerous but still nothing compared to fentanyl, dipshit.
| edgyquant wrote:
| Smoked opium is not gonna cut it for heroin junkies. Save
| your condescension for after you have actual points.
| standardUser wrote:
| Why downvote this? It's plainly true. Most drug-related deaths
| are from disease, contamination (fentanyl), improper dosing and
| black market violence. Those issues all virtually vanish with
| legal access to drugs. So we can choose to a) change our
| obviously failed policies and start saving lives or b) keep
| doing what we're doing and keep paying the cost in taxes,
| personal liberty and lost human lives.
|
| If you need data, look at Portugal.
| edgyquant wrote:
| 1. Because it isn't plainly true. The number of drug
| overdoses has risen in Portugal over the last decade
| https://www.statista.com/statistics/911927/drug-overdose-
| dea...
|
| 2. Even if it were true, nations get to dictate their
| policies and it is perfectly understandable for them to not
| want to subsidize drug abuse.
| standardUser wrote:
| Portugal has had massive success across the board with
| decriminalization, but they have not gone far enough to
| prevent overdose deaths because they still ban
| manufacturing and distribution. As long as a government
| protects a black market, there will be preventable deaths.
| vorpalhex wrote:
| Legalizing has resulted in more ODs so you want to..
| legalize more?
|
| How does legalizing manufacturing of a killer substance
| stop ODs?
| tonyarkles wrote:
| > How does legalizing manufacturing of a killer substance
| stop ODs?
|
| It's not legalizing it that could potentially help with
| ODs but regulating it. It's the difference between
| injecting a random-assumed-to-be-heroin substance
| dissolved in tap water on a heated spoon and injecting a
| known 10mg/mL vial of heroin.
| [deleted]
| ryzvonusef wrote:
| > Decades of research prove that these programmes curtail
| disease. Junkies are in fact less prone to sharing needles when
| they get free ones. That sharply decreases rates of blood-borne
| illnesses. In 2014 an analysis found that every dollar spent on
| syringe exchanges spares the government around $7 in HIV-related
| health-care costs. Needle exchanges opened across America and
| Europe. For years no one detected the feared rise in substance
| abuse. > That was before the opioid crisis plagued
| America and economists started looking into the trade-offs. A new
| study by Analisa Packham published in the Journal of Public
| Economics uncovers an uncomfortable truth: this particular harm-
| reduction tool does lots of harm. Ms Packham compares how drug
| users fared in counties that opened syringe exchanges between
| 2008 and 2016 with those in counties that did not. Before the
| clinics opened, upticks in HIV diagnoses or overdoses in one set
| of counties were mirrored in the other. Once a syringe exchange
| came to town, outcomes diverged. Rates of HIV fell by 15% in
| counties with the new programme. But deaths soared. On average
| syringe-exchange programmes led to a 22% spike in opioid-related
| mortality. > Simply lowering the risks of getting
| sick--and the costs of paraphernalia, as Flaco from the Bronx
| articulated--could also incentivise drug use. Distributing PrEP,
| an HIV-prevention medication, has been shown to make gay men less
| inclined to use condoms during sex. So too could harm-reduction
| tools make addicts use drugs more incautiously. In a study
| published in 2018 Jennifer Doleac and Anita Mukherjee found that
| when states legalised naloxone, a medication that reverses
| overdoses, opioid abuse increased. Though lauded by public-health
| advocates, naloxone did not save lives as intended. In some
| regions, fewer addicts died; in others, more did.
| croes wrote:
| And how many are these 15% and 22%?
| f38zf5vdt wrote:
| In terms of burdening the already dysfunctional healthcare and
| criminal justice systems of the US, it sounds like it works
| great. If the junkies no longer exist and less frequently get
| HIV, their cost to society is less than if they were alive,
| disease spreading, and committing crime.
| giraffe_lady wrote:
| This comment is an excellent example of how you can openly
| call for violence against the vulnerable on HN without
| censure or consequence as long as you do it in a certain
| tone.
| throwayyy479087 wrote:
| Saying that we shouldn't enable certain behavior is not
| violence. Violence is violence, stop messing with the
| meaning of words.
| ROTMetro wrote:
| I am sure you currently work with or have family members
| who secretly are addicts. Labeling them as a cost to
| society, disease spreading, and committing crime and
| justifying their death instead of talking about them as
| people in pain is definitely disgusting and not the type
| of discourse I would have expected from this site. But
| hey, keep on with your reductionism as justification for
| complicity in peoples deaths. Also remember, they can't
| get needles not because they don't want to buy them but
| because it is illegal to sell them.
| giraffe_lady wrote:
| What is the meaningful difference between killing someone
| yourself and letting them die when it's in your power to
| prevent it?
|
| Saying that a certain population should die because of
| their criminal nature and high "cost to society" is
| straight up nazi shit. What's the policy implementation
| of that opinion just curious? It really doesn't get more
| clear than this.
| nkrisc wrote:
| Why not extend this to everyone? When your projected costs to
| society exceed your projected benefit to society you get
| ground into food for the rest?
| the_only_law wrote:
| > Why not extend this to everyone?
|
| They already implicitly did. Turns out the dysfunctional
| criminal justice and medical system the praise affect more
| than just addicts. Who would have thought.
| f38zf5vdt wrote:
| There is a reason economics is called "the dismal science".
| Most resources on the planet are finite and their
| consumption is a zero-sum game. If one less drug addict
| means having the public resources to supply one more
| diabetic child with life-saving insulin, which would you
| choose?
| [deleted]
| mcguire wrote:
| Essentially all choices real people make are not
| economically optimal.
| ryzvonusef wrote:
| seems like people would rather suppress the truth rather than
| let research be allowed to stand scrutiny on it's own merit
| > These works have been met with anger. Their findings upset
| harm-reduction defenders who consider their efforts already
| besieged by critics. The experience was so miserable that Ms
| Doleac, who studies crime, has decided never to write another
| health paper. > Leo Beletsky, a former drug
| dealer, now at Northeastern University, deems Ms Packham's
| findings "nonsensical" and thinks her paper should not have
| been published. Don Des Jarlais, at New York University, argues
| that addicts do not respond to incentives like others do,
| making the moral-hazard effect inconceivable. Susan Sherman of
| Johns Hopkins University says she doubts that new evidence that
| harm reduction does more bad than good would convince her to
| disregard previous research demonstrating otherwise.
| > A barrage of complaints led the editors of the International
| Journal of Drug Policy to retract a meta-analysis that found
| that safe-injection sites, where users do drugs in supervised
| settings, did not decrease rates of deadly overdose.
| "Retractions used to be reserved for fraud," says Keith
| Humphreys of Stanford University, a former drug-policy adviser
| for the Obama administration. No longer, it seems.
| version_five wrote:
| People are really bad at accepting information that
| superficially contradicts something they want, and react by
| disputing the information instead of taking it into
| consideration while still pushing for the ends they want to
| achieve.
|
| In this case, I'd speculate that harm reduction advocates aim
| is to (tautologically) reduce the (physical/health) harm of
| drug use so that it's one less problem users face. One aspect
| of this may be safe consumption, which this article says
| doesn't work on it's own. Another aspect is overdoses form
| Fentanyl et al, (which I would argue is largely a byproduct
| of a drug war that has made heroin too hard to import, and no
| safe medical supply options for treatment). So the focus
| could shift to addressing this (which in tandem with safe
| injection sites could still produce better overall outcomes).
|
| My point is that it's not productive to dispute the studies,
| better to accept on balance of probabilities and look at how
| it fits with your overall aim.
|
| (Climate change is very similar. People dispute the studies
| because they don't like the political rhetoric about how we
| should react, not because deep down they think all the
| research is flawed)
| hooverd wrote:
| I think some drug warriors become harm advocates. If drug
| users can't overcome their moral failures, before they
| suffocate on their vomit than be resuscitated with
| naloxone.
| the_only_law wrote:
| What? This isn't even a sentence. It's a collection of
| sentence fragments and I can't tell what the hell it's
| trying to say.
| hooverd wrote:
| It should read "better they" not "before they". Anyways,
| I was thinking of a specific incident where a fire chief
| came out and said they would prefer that junkies just die
| vs adding naxolone to their kit.
| cma wrote:
| The meta-analysis largely relied on studies that used cities
| or states as a control on deaths to the small (usually
| hardest hit) regions where the programs were offered. Like
| doing an intervention in Skid Row, then using LA as the
| control for the non-intervention.
|
| Many of the problems are detailed in "Supervised consumption
| sites: a nuanced assessment of the causal evidence."
|
| It mentions the reason for retraction, something about
| "pooling diverse outcomes into a composite measure," anyone
| have a link to the actual details of the retraction other
| than that it wasn't for fraud?
| slowmovintarget wrote:
| > "Retractions used to be reserved for fraud," says Keith
| Humphreys of Stanford University...
|
| Science denial has many forms. This appears to be one of the
| older ones.
| joe5150 wrote:
| > The experience was so miserable that Ms Doleac, who studies
| crime, has decided never to write another health paper.
|
| Good move on Doleac's part; her naloxone paper was atrocious.
| Mistletoe wrote:
| What was bad about it?
| aqme28 wrote:
| The article is paywalled, but this suggests to me we go further
| in harm-reduction. The problem is specifically opioid
| overdoses, so we should have more supervised-injection sites.
| dmix wrote:
| Yeah there's still plenty of solutions here within the
| current system.
| the-printer wrote:
| Helping the drug users get off the drugs could reduce plenty
| of harm, I reckon, but when that fails why is the alternative
| helping them stay on?
| aqme28 wrote:
| Why are those mutually exclusive? We should help drug users
| get off drugs, but we shouldn't make it deadlier for them
| if we fail.
| the-printer wrote:
| Because making it "less deadly" somehow equates to
| enabling them.
|
| I think that people are more concerned with opioid death
| statistics than opioid addiction itself. And there is a
| shattering sense of defeat, which is normal, that is
| associated with realizing that you cannot help anyone who
| doesn't want to help themselves. And if they don't want
| to help themselves, then they may go down a collision
| course that will be their undoing. In this case that
| often means death.
| aqme28 wrote:
| > people are more concerned with opioid death statistics
| than opioid addiction itself.
|
| I feel strongly this way, or maybe I'm missing your
| point. Addiction is terrible, but _death_ is clearly
| worse than addiction. Addiction is survivable.
| the-printer wrote:
| Would you choose addiction over death? I'm talking hard
| drugs. Bottoms out on the same street that you grew up
| on, or raised your children on, or worked on.
|
| My point is that the "preventive maintenance" approach to
| opioid addiction is more about death _statistics_ than it
| is about death itself. It's a numbers game. A nation's
| response to situations such as this will largely be
| determined by how many people don't die, because people
| have a distaste toward death and the general public is
| subservient to what data suggests irrespective of its
| practical and tangible representations.
| cwmma wrote:
| Easy because if you fail to get them to quit, then the goal
| is to keep them alive so you can help them quit latter.
| mcguire wrote:
| What alternative do you propose?
|
| "Helping them stay on drugs" is very much the wrong way to
| look at it. How about "reducing the harm they do to
| others"?
| the-printer wrote:
| Who designed the standard for harm in this instance? How
| is the self-inflicted harm of addiction that is the
| actual foundation of the secondary harm caused, for
| example, by dirty needles and overdose weighed? Is the
| harm dealt to one's family considered?
|
| "Helping them stay on drugs" is the practical way of
| looking at it, because in practice that's what's
| happening. "Reducing harm" in this context sounds like
| some sort of neo-Hippocratic Orwellian spin on the fact
| that the alternative is to address the greater issues
| that lead to and foster drug addiction that are beyond
| the scope of this tiny box that I'm typing into and do
| not involve more needles.
| puppycodes wrote:
| Calling drug users "junkies" made me feel like this was written
| in the 80's
| throwawayoaky wrote:
| Horrifying pull quote:
|
| "Simply lowering the risks of getting sick--and the costs of
| paraphernalia, as Flaco from the Bronx articulated--could also
| incentivise drug use."
| rhaway84773 wrote:
| The study mentioned makes no effort to show causation.
|
| And the correlation can very easily be backwards. In fact, its
| more likely backwards.
|
| Counties which are facing an increasing barrage of opioids and
| all the issues related to it, especially spread of disease and an
| increase in deaths due to unsafe use are almost certainly more
| likely to create safe needle exchanges.
|
| For the economist to write this article as if causation is
| established, and further to moralize is insane.
|
| Especially since the Economist famously doesn't provide bylines
| so this becomes the official view of the magazine as opposed to a
| specific editor's.
|
| And finally, even if the causation is correct, all it indicates
| is that needle exchange programs need to also provide drug
| testing capabilities so the presence of fentanyl can easily be
| identified.
| theptip wrote:
| The paper opens with a discussion of causation.
|
| > the data from the studies included in the aforementioned
| literature reviews (i.e. General Accounting Office (1993);
| World Health Organization (2004)) rely on small sample sizes
| and self-reported data regarding individ- uals' drug use, and
| do not typically consider attrition nor spillover effects on
| those not directly treated. Additionally, many studies use data
| from Canada, Sweden, or New Zealand to serve as a comparison
| group for drug rates in the US. Such methods are problematic
| for addressing causality, given that other developed countries
| have differing policies on the operations of SEPs and greater
| access to substance abuse treatment.1 I overcome these existing
| limitations by cre- ating a novel dataset that combines
| information on SEP opening dates with restricted administrative
| county-level data on HIV diagnoses. These data proxy for drug
| use without relying on self-reporting behavior, and are
| representative of counties across the US.
|
| It's using newly-opened SEPs for a discontinuity analysis,
| which does provide evidence of causation (and furthermore notes
| that previous studies were correlational).
| vorpalhex wrote:
| You're assuming the fentanyl is accidental, not intended.
| htag wrote:
| I agree with most of what you said, but I think one line is out
| of touch.
|
| > And finally, even if the causation is correct, all it
| indicates is that needle exchange programs need to also provide
| drug testing capabilities so the presence of fentanyl can
| easily be identified.
|
| This assumes that there are no individuals that are knowingly
| injecting fentanyl or that a drug user would not take drugs in
| their possession if they knew it contained fentanyl. Yes, there
| are individuals that unknowingly take a fentanyl containing
| substance but I am doubtful that those deepest in opioid
| addiction avoid it.
| ThrowawayTestr wrote:
| Fentanyl is not a pleasurable drug. Someone buying heroin
| wants heroin, not a drug that will just knock them out or
| kill them.
| hotpotamus wrote:
| The only opioid I've ever taken was fentanyl when I had my
| wisdom teeth taken out. I highly recommend it if it's an
| option, and frankly there are many calls I've been on where
| I wish that sedation was available.
| newaccount74 wrote:
| I got a local anesthetic and Ibuprofen when my wisdom
| teeth were taken out. Worked fine.
|
| I don't understand why doctors are still so quick to
| prescribe opioids.
| saltcured wrote:
| Having wisdom teeth removed can range from a simple tooth
| extraction to invasive oral surgery.
|
| In the heavier cases, a flap of gum tissue and covering
| jaw bone are cut away to expose a submerged tooth that is
| oriented the wrong way. The tooth is then demolished in
| place so that the chunks can be lifted out. The patient
| would be sedated during this procedure, and the wound and
| recovery period is significantly different.
| effingwewt wrote:
| I had impacted (the aforementioned submerged and inward-
| facing) wisdom teeth- one of which had fractured from the
| pressure.
|
| Went from fine one day with the caveat that one day I'd
| need oral surgery to have them removed, to burning with a
| fever while finding an oral surgeon ASAP.
|
| Needed invasive oral surgery. Had to be put under twice-
| once before operation, and once when bringing me out
| after, as I had a paradoxical reaction and was thrashing
| about. Me screaming I didn't know the surgeon and
| anesthesiologist and thrashing about isn't super good
| after oral surgery.
|
| Hurt like the dickens afterwards and had to eat soup for
| a good while.
|
| They gave me ibuprofen and tylenol with codeine
| afterwards. I only used the ibuprofen and was fine. It
| only blunted the pain but was definitely manageable after
| the first day or so.
|
| I've had doctors try and prescribe narcotics for some
| weird things. I've always denied them as I had a friend
| who became addicted to heroin after being prescribed oxys
| for serious 3rd degree burns.
|
| Every time I have to deny narcotics multiple times before
| they relent and offer something non-narcotic.
|
| Anyways just one person's experience.
| hotpotamus wrote:
| I paid $400 for it because the last time I had a tooth
| taken out was among the worst pains of my life. At one
| point they had to split my tooth apart and I perceived it
| as a light tapping, so I think it did the job. I did also
| get a few vicodin for after they were taken out, but I
| didn't have very much pain so I ended up not using them
| and actually cancelling the PTO I had scheduled for
| recovery.
|
| So from my perspective, as a very acute surgical drug, it
| would seem to be a great innovation, but it's probably
| not something you want to use to relax after a tough day
| at the office.
| jstarfish wrote:
| I get the impression it's to keep patients stupefied so
| they don't do anything that would complicate the recovery
| process.
| jeffbee wrote:
| Yeah I don't get that either. I took a Motrin after I got
| my teeth removed and I gave the Vicodin to my friends.
| And these days Vicodin looks like Pez because the
| dentists are dealing fentanyl for reasons nobody can
| understand.
| xyzzyz wrote:
| This is wrong. There is no heroin anymore, only fentanyl.
| The addicts know what they are getting.
| jeffreyrogers wrote:
| You're getting downvoted but I have heard the same thing
| directly from addicts. And many prefer fentanyl.
| ROTMetro wrote:
| Why is this being downvoted? I'd expand it to almost all
| pills are now just mexi's being called 'xyz' as well.
| Dudes are just ordering fentanyl analogs off the web from
| China, testing it on themselves so they don't get hit for
| selling bunk work, then moving it. If you are desperate
| and addicted yourself this route is preferred to sketchy
| alternatives and dealing with super scary individuals.
| Your biggest risk of getting caught isn't the trafficking
| but people so easily dying sticking you with a case with
| a body on it. The reverse opium war has begun with China
| but no one wants to talk about it. Over half the dudes I
| did time with with drug charges went this route and got
| it all over the intermail/international shipping vs
| cartel and the only reason a case would get strong enough
| to convict was if it got a body put on it.
| throwaway82388 wrote:
| That is a reasonable assumption, however, many opioid users
| deliberately use fentanyl.
|
| https://www.sciencedirect.com/science/article/abs/pii/S0955
| 3...
| rhaway84773 wrote:
| That's interesting. I had no idea that was the case.
|
| That being said, a needle exchange program could always
| require the testing of fentanyl and if fentanyl is found
| decline service.
|
| So the people who apparently want fentanyl and are
| encouraged by the needle exchange programs would not have
| them as an incentive anyways.
| rhaway84773 wrote:
| To be clear, I think the research is excellent and
| important. My problem is with the spin the Economist puts
| on it (and it's always more egregious with the economist
| because of the lack of a byline).
|
| The Economist predisposes it's readers to believe that
| this indicates needle exchange programs are bad, as
| opposed to leaving open the possibility that due to
| changing circumstances needle exchange programs which
| have proven to be extremely successful, also need to
| adapt, much like every other individual, program, company
| or non-profit at any time.
| throwaway82388 wrote:
| One thing is clear: the problem--the problems--are too
| multivariate for any one solution. Programs like these
| are triage, the root causes are distant and largely
| unaddressed.
| d0mine wrote:
| <<SEPs increase rates of opioid-related mortality>> is a direct
| quote from the study.
|
| https://news.ycombinator.com/item?id=33845544
| photochemsyn wrote:
| Opiate users can't distinguish any 'quality of intoxication'
| differences across the opiate analog spectrum. Remember, this
| class of drugs exert their effects via the endorphin system:
|
| https://en.wikipedia.org/wiki/Endorphins
|
| > "Endorphins are released from the pituitary gland, typically
| in response to pain, and can act in both the central nervous
| system (CNS) and the peripheral nervous system (PNS). In the
| PNS, b-endorphin is the primary endorphin released from the
| pituitary gland. Endorphins inhibit transmission of pain
| signals by binding m-receptors of peripheral nerves, which
| block their release of neurotransmitter substance P. The
| mechanism in the CNS is similar but works by blocking a
| different neurotransmitter: gamma-aminobutyric acid (GABA). In
| turn, inhibition of GABA increases the production and release
| of dopamine, a neurotransmitter associated with reward
| learning."
|
| All that matters is that the drug molecule binds to the
| receptor proteins in the brain and peripheral nerves. Studies
| show that the active dose is directly related to the binding
| strength of that specific molecule (fentanyl binds more
| strongly than heroin, so less is needed to get the same effect,
| oxycontin is about as strong a binder as heroin, about twice as
| potent as morphine).
|
| Overdose deaths are generally due to (1) unusually high
| concentrations of active substances or (2) Users who've lost
| tolerance for some reason taking too much.
|
| Legalization would likely eliminate most accidental overdose
| deaths as products would be clearly labeled as to contents.
| googlryas wrote:
| Do exchanges even require an exchange? Here in Boulder city
| funded groups will just give junkies needles for free. And then
| you end up with needles littered all over the place. At least
| with an exchange junkies would keep their needles if they can
| manage. A few years ago 4 year old was pricked multiple times by
| a used needle that they found in a park.
| OmahaBoy69 wrote:
| Where in Boulder are you finding needles? I'm yet to see one
| after ~4 years here, but I've mostly stuck around CU campus and
| Pearl and the surrounding areas. Plenty of discarded vapes
| everywhere, though.
| googlryas wrote:
| Boulder Creek is the most glaring spot, but you might have
| trouble finding them until the homeless campers tents are
| forcibly removed once every 9 months. Scott Carpenter is
| another good spot. Park East Park is where the aforementioned
| kid was pricked.
| PaulHoule wrote:
| I am definitely seeing them on the ground within a few blocks
| of the needle exchange in Ithaca, NY and this is something
| that's become noticeable in the last few years. It's part of a
| general coarsening of urban life, where it is not unusual to
| hear gunshots at night, you hear about fatal stabbings just a
| few blocks from where a friend of mine lives downtown, etc.
| theptip wrote:
| A general point in drug harm reduction - the "classic" drugs are
| mostly surprisingly safe. MDMA, LSD, cocaine, even heroin (when
| pure) have quite favorable safety profiles compared to, say,
| alcohol as a benchmark.
|
| Also, the long-term health effects are well understood, and
| treatments for overdose established. For example, it's safe to
| take (pure) heroin regularly (though I wouldn't personally
| advocate for this of course).
|
| On the other hand, the new families of synthetic drugs
| (Cathinones that replaced MDMA, random novel psychedelics, and
| fentanyl replacing heroin) all have far worse safety profiles.
|
| When you make drugs illegal, the market responds by finding the
| cheapest illegal substitute, with little concern for safety. On
| the other hand, if we made heroin legal, then nobody would mess
| with fentanyl. Ditto with MDMA over m-cat or whatever. And while
| drug use would increase a bit at the margin, harm to society
| would dramatically decrease. Most people don't actually want to
| be junkies it turns out!
|
| The money saved from not criminalizing drugs could provide
| extremely good addiction counseling for anyone that wanted it,
| further reducing the harm.
|
| And lots of crime is just stealing to buy drugs; it's plausible
| that overall crime would go down substantially if we gave heroin
| prescriptions to addicts. I'd rather prescribe heroin (with free
| access to good addiction counseling) to someone who is addicted
| than have them breaking into cars stealing stuff to fund their
| habit.
|
| Finally, another related argument - the geopolitical harm of the
| drug trade is immense. Drugs flow north to the US, and money and
| weapons flow south to the cartels. If we legalized cocaine, then
| we'd stabilize many regimes (eg Mexico, Columbia) that are
| currently struggling with cartel violence. On net you'd see a
| massive flourishing of humanity under this policy. A little bit
| more drug addiction in countries that can afford to treat it, and
| way less murder and kidnapping in countries that are trying to
| catch up. (Surprisingly, the Economist recently advocated for
| legalizing cocaine:
| https://www.economist.com/leaders/2022/10/12/joe-biden-is-to...)
| jpm_sd wrote:
| No, fentanyl kills drug users.
| ahoy wrote:
| No way, The Economist, a right wing publication, is against non-
| carceral drug policy. Who could have predicted that.
| slavik81 wrote:
| The Economist favours legalization. No, they are not against
| non-carceral drug policy.
| wisemang wrote:
| The case for legalisation (2001, but still):
| https://www.economist.com/leaders/2001/07/26/the-case-for-le...
| boeingUH60 wrote:
| The Economist is definitely not a "right-wing"
| publication...not everything must be turned to tribal politics.
| vorpalhex wrote:
| Their front page is a sex positive article and an anti-Musk
| twitter article.
|
| Just because they say something you dislike doesn't make them
| "right wing".
| edgyquant wrote:
| Because the economist (a left liberal organization) is
| evidence based all far leftists will see it as right wing
| even though it never endorsed conservative candidates.
| edgyquant wrote:
| The economist is a center left publication
| jupp0r wrote:
| https://archive.ph/fzBoE
| tinus_hn wrote:
| Paywall bypass:
|
| https://archive.ph/fzBoE
| jeffbee wrote:
| I used to live in San Francisco at the corner of Guerrero and
| Market, about 200m from where some do-gooders operated the needle
| exchange on Duboce between Market and Church. On the day after
| the needle exchange I always had to 1) remove some unconscious
| drug addict from my stoop, either by just shoving him out of the
| way or by calling an ambulance in extreme cases, then 2) put on a
| disposable Tyvek suit and pressure-bleach all the feces and vomit
| off my porch. Meanwhile the "harm reduction" perpetrators were at
| their own homes which were evidently in far-away neighborhoods.
|
| The only way needle exchange fits into civilized life is as one
| aspect of a shelter-first treatment scheme that gets these people
| to a place where they can vomit in their own rooms for a change.
| ROTMetro wrote:
| This. A shelter first scheme is where taxes on legalized drugs
| should go. Gas tax funds the highways, drug taxes should fund
| mitigating drug's harmful effects on society first, with any
| other use secondary.
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