[HN Gopher] Portugal eased its opioid epidemic, while U.S. drug ...
___________________________________________________________________
Portugal eased its opioid epidemic, while U.S. drug deaths
skyrocketed
Author : rntn
Score : 65 points
Date : 2024-02-24 20:03 UTC (2 hours ago)
(HTM) web link (www.npr.org)
(TXT) w3m dump (www.npr.org)
| Scramblejams wrote:
| _In Oregon, for example, where small amounts of drugs were
| decriminalized in 2020, police regularly hand out information
| cards referring people to a drug counseling hotline. Court data
| shows drug users rarely call.
|
| In Portugal, by contrast, government data shows roughly 90% of
| people referred to drug counseling sessions by police do turn up,
| at least for an initial session._
|
| Why?
| lkdfjlkdfjlg wrote:
| I'm from Portugal and I've lived in the US (not Oregon).
|
| Maybe related, maybe not, but I've noticed that people in the
| US seem to have a chronic distrust for the police, government,
| or generally any authority figure. Do you agree? In Portugal if
| you're asked to go talk to police/gov/drug counseling/etc, you
| show up because that's what you're supposed to do.
| silverquiet wrote:
| "Government is not the solution to our problem, government is
| the problem."
|
| That's a very famous quote by one of our presidents. Like all
| other American pathologies that have festered since I was a
| child, I assume it will get worse before it gets worse.
| babyshake wrote:
| Unfortunately, government is (part of) the problem, but
| also needs to be (part of) the solution.
| screenoridesagb wrote:
| People in Portugal have no exposure to American conservative
| values.
| wonderwonder wrote:
| In the US its not going to go well for me if I tell my boss I
| have to take the afternoon off to go to drug counseling.
| martinald wrote:
| Terrible article. In Portugal if you don't attend the meetings
| you can get a sanction of some sort (or at least you used to):
| https://en.wikipedia.org/wiki/Drug_policy_of_Portugal#Laws_a...
|
| This is quite different to giving someone an information card.
|
| For what it's worth there is increasing problems in Portugal
| with drugs. The overdose rate is starting to really spike
| again, there was a good article somewhat recently about this
| which I can't find, but you can see the trend here:
| https://www.statista.com/statistics/911927/drug-overdose-dea...
| WarOnPrivacy wrote:
| > The overdose rate is starting to really spike again
|
| From _50 deaths_ skyrocketing up to _70 deaths_. This is the
| kind of spike the US dreams about.
|
| The stats you link to do a pretty good job of countering the
| _pORtIgaL iS ON dRUg FIrE_ narrative. When
| compared with the rest of Europe, Portugal has a fairly low
| incidence of drug deaths.
|
| So thanks for posting them.
| mtlmtlmtlmtl wrote:
| It's a significant spike at 40%. But my guess is that this
| is due to the market being flooded with ultra potent
| opioids right now. Decriminalisation can't really prevent
| that, unfortunately. Only legalisation and regulation will.
| martinald wrote:
| That's not my point. The point is the trend is going the
| wrong way recently after dropping so sharply _after_
| decriminalization. I am /was in favour of that - it is
| clearly a healthcare problem; not a criminal justice
| problem.
|
| However, I think it is still a big and growing problem
| regardless of where you sit on that spectrum, which has
| sharply been brought into focus with fentanyl and other
| synthetic opioids (which are themselves a byproduct of 'the
| war on drugs' in many ways, but the genie is out of the
| bottle now with them).
|
| I found the article I was meaning to find -
| https://www.washingtonpost.com/world/2023/07/07/portugal-
| dru...
| lazyasciiart wrote:
| What's the demonstrated effectiveness of calling a hotline vs
| attending a group?
| atlantic wrote:
| I live in southern Portugal, and over the years I've observed
| big differences in how natives and foreigners react to
| Portuguese drug laws.
|
| The native Portuguese feel that it's not ok to consume drugs,
| but that for those that do, the law provides a path of
| rehabilitation before resorting to punishment. And this is in
| fact the intention behind the decriminalization of drug
| consumption.
|
| On the other hand, younger foreigners often seem to take the
| laws as a license to consume, some becoming unable to work and
| spending their days smoking pot. And their older counterparts
| similarly fall into alcoholism, wine and beer being very cheap
| here.
|
| My point is that Portuguese laws are made for Portuguese
| people, who tend to do things in moderation. There is no
| universal solution, and no guarantee that the Portuguese model
| would work anywhere else.
| akira2501 wrote:
| > "If we stopped arrests and did nothing else, that's a positive
| intervention because of the well-documented harms of
| incarceration [on people with addiction]," said Morgan Godvin, a
| former heroin user who now studies drug policy in Portland, Ore.
|
| "Instead of fixing the system, let's just ignore it, then pretend
| it's actually a greater good to just degrade these people and let
| them die in the gutter."
|
| I also don't buy that the Portuguese alternative is really any
| different:
|
| > Experts here say people who use drugs are constantly nudged
| toward health care and addiction treatment, including methadone
| programs and housing.
|
| Yet, they don't describe their conversion rate or their results
| in "successfully" getting people to trade one addiction for
| another and then accept welfare.
|
| Meanwhile, drugs are the obvious issue in and of themselves. If
| you don't want to criminalize people for possession then you need
| to openly confiscate drugs and do as much as you can to prevent
| people from possessing and using them.
| copx wrote:
| Are drugs really the issue though?
|
| In my experience people who ruin their life with drugs have
| underlying mental health issues which are the cause of their
| self-destructive usage patterns.
|
| What is the difference between a Wall Street banker and a
| homeless junkie? Not the regular use of hard drugs..
|
| Pure addiction therapy thus almost never works. The homeless
| junkies have PTSDs, personality disorders, bipolar disorder,
| severe cases of ADHS etc. all of that needs to be treated
| together with the addiction for a reasonable chance of success.
| johnea wrote:
| Its funny you mention this.
|
| While working for some years in the south bay tech hub (san
| jose), I knew a guy who was a VP at a tech company.
|
| Everyday he would lock his office door at lunch and do a shot
| of heroin. He'd lay back at his desk and zone out for an hour
| or so, then wash his face and go back to work.
|
| When I left the bay area and lost track of him, he was still
| in the same cycle and not spiraling into destruciton.
|
| A big difference in outcomes is dictated by WHY a person is
| using drugs. Someone with mental health problems (and/or
| major life problems in general) is going to do far worse than
| someone who just wants a little temporary escape.
|
| After growning up in the US souteast, I can athoritatively
| say that a big part of the US situation is due to the
| uneducated, uninformed, hateful, religous population that
| mmakes up a significant part of the total...
| akira2501 wrote:
| Do you have experiences which would give you good perspective
| and the wide range of drug abuse that occurs within our
| society? Do you have a sense of how much of it goes
| unnoticed? Who do you think paid rehabilitation clinics are
| for exactly?
|
| I think drugs are the issue. People have plenty of other
| problems outside of the scope you mention. These typically
| provide negative feedback which leads the person towards
| solutions.
|
| Drugs interfere with this and turn them into positive
| feedback loops which just drags the person further into
| addiction. And these problems are most definitely commonly
| experienced outside of the "homeless junkie" caste, which is
| a very recent problem in the grand scheme of this issue and
| _seems_ to be correlated with recent changes in drug policy
| and resulting availability.
|
| I am with you though in that treating the _addiction_ is
| insane. The drugs are just a response to other conditions and
| unless you treat and examine those you stand no chance of
| improving someones life. The best you can hope for is they
| hurt themselves badly enough that the trauma causes them to
| recognize their circumstances for what they really are.
|
| Which is why I think criminalization is also insane; however,
| that doesn't mean the state just has to stand by while
| massive quantities of illicit substances change hands freely
| across our country. That's a problem you can address without
| even having to jail anyone other than dealers and
| traffickers.
|
| And at the end of the day, even this minor action would bring
| massive improvements, by preventing people from prolonging
| their problems with addictions that destroy their lives,
| health and wealth.
| wonderwonder wrote:
| To the best of my knowledge, Europe does not have a fentanyl
| problem comparable to that of the US with last I checked 50+% of
| overdoses in the US having traces of it in their system. Our wide
| open southern border [not a comment on immigration] allows this
| poison to spread far and wide.
|
| OxyContin and similar prescription drug addictions are
| widespread, at one time (still?) heavily pushed by deep pocketed
| pharmaceutical companies. I think that was a uniquely American
| situation. I wonder how many of the people now addicted to other
| opioids in the US were initially exposed via these prescription
| drugs.
| spamizbad wrote:
| Fentanyl is smuggled into the United States by US citizens[1]
| and by closing the border may have accelerated its adoption.
| And yes, while it does come from our southern border, data
| suggests it's being carried over by US citizens who have the
| right to come and go across the border legally.
|
| Or are we using the term "open border" to suggest freedom of US
| citizens to leave (and re-enter) the country?
|
| [1] https://www.cato.org/blog/fentanyl-smuggled-us-citizens-
| us-c...
| pineaux wrote:
| This fentanyl is produced in china. It comes from factories
| producing it in large quantities, then smuggled to Mexico and
| into the us.
| op00to wrote:
| Why smuggle into Mexico first? Why not directly import
| where it could be hidden in plain sight?
| hef19898 wrote:
| Could be that it is easier and less risky to get into
| Mexico. Plus, the cartels there are a wholesale buyer and
| have established supply and distribution networks from
| Mexico into the US and within the US.
| lazyasciiart wrote:
| But the difference in drug laws predates the arrival of
| fentanyl in the US black market.
| herbst wrote:
| Ive seen plenty of European drug culture and heroin is only a
| last resort drug for lost souls, fentanyl is basically still
| unheard of as a street drug as far as I can tell.
|
| Junkies even test their heroin more often because they don't
| want that dirty stuff to be here.
|
| I for one don't understand at all what goes wrong in America.
| But those images are scary.
| levocardia wrote:
| Didn't both Seattle and Portland try Portugal-style
| decriminalization + treatment incentives, only to see a massive
| spike in drug overdose deaths, even compared to similar US cities
| which did not pass such policies?
|
| It seems relevant that the background and current context in the
| US is much different: we are fresh off two decades or so of big
| pharma and consulting firms attempting to "turbocharge"
| prescription opiate sales (and succeeding). The current turn to
| heroin adulterated with fentanyl is certainly downstream of that.
| twisteriffic wrote:
| This is worth a watch if you want some background into why
| those type of measures have been less successful in the US and
| Canada, and how grifters have been taking advantage.
|
| https://youtu.be/o6dAkkqE5XE?si=pBHVORAFzIiVOpx4
| macspoofing wrote:
| >Didn't both Seattle and Portland try Portugal-style
| decriminalization + treatment incentives, only to see a massive
| spike in drug overdose deaths
|
| They didn't do 'Portugal-style' decriminalization/treatment
| because in Portugal a drug addict can be forced into drug
| treatment, fined or mandated community service. Open drug use
| is also not allowed.
| nonethewiser wrote:
| > a drug addict can be forced into drug treatment, fined or
| mandated community service. Open drug use is also not
| allowed.
|
| Was this always the case ( I would assume so), or did it come
| with the decriminalization changes?
|
| These policies seem not only reasonable but obvious. But I
| don't think the motivations in the US for decriminalizing are
| consistent with committing addicts and stopping open drug
| use. And unfortunately they arent standards in Portland,
| Seattle, or anywhere else with this problem in the US really.
|
| So basically, i dont see that happening in the US. Its the
| same story for mental and behavioral health. People that were
| dangers to themselves and society used to be committed to
| institutions but we decided it was more humane to empty these
| institutions out on the streets.
| bobthepanda wrote:
| We also decided it was cheaper. It was expensive to keep
| whole institutional systems, and it was expensive to keep
| them in jail.
|
| A lot of recent sentencing reform was motivated by the
| desire to lower the cost of running prisons, and started
| off Republican-led. Whenever people talk about solving
| mental health crises with jail time, no one is willing to
| put up the money.
| WarOnPrivacy wrote:
| > because in Portugal a drug addict can be forced into drug
| treatment, fined or mandated community service.
|
| Each of these things seems more reasonable than US's two
| options 1) ignore them or 2) dispense varying lengths of the
| same punishment that brutally awful convicts get.
| zeroCalories wrote:
| The problem, and why we will never get these programs, is
| that no one actually wants to put up the resources to help
| drug addicts. If you've actually talked to the gen-x
| population that has control over these cities, you'll find
| someone that likes to pretend they're an enlightened
| progressive hippie, that scoffs at southern and middle
| american conservatives, but is just as selfish and careless.
| They harbour deep resentment at having to pay so much in
| taxes, and sabotage any policy that could move resources away
| from them. This kind of hands-off policy is exactly the kind
| that the gen-x Hillary loving house wives can trick
| themselves into feeling good about, while not costing them
| anything substantial.
| turkey99 wrote:
| Portland closed mental health institutions before (unrelated
| to) decriminalisation.
|
| The west US just isn't the same as Portugal in terms of care.
| It's not there.
| abirch wrote:
| The US doesn't allow for manufacturer of hard drugs. Any drug
| can be laced with fentanyl these days and lead to an OD.
| 15457345234 wrote:
| The US and Europe opiate situations can never be compared
| because in Europe opiates have always been drugs of last
| resort, used in palliative care or inpatient scenarios only.
|
| Self-administered opiates just aren't part of the treatment
| regime, much as they weren't part of the US treatment regime in
| the 70s and 80s.
|
| It's an entirely US problem created by the doctors-are-salesmen
| paradigm that is US healthcare, and it's only a problem because
| of the way the 'product' was 'marketed.'
| hn72774 wrote:
| Portugal refers criminal cases to drug treatment.
|
| Seattle took a hands off approach. The prosecutor can't be
| bothered with drug related arrests, so the police don't bother
| responding. There is no diversion opportunity.
| lazyasciiart wrote:
| That's garbage PR from the campaign of the current city
| attorney, who loved yelling that the incumbent never
| prosecuted drug felonies. Unfortunately she and her voters
| were all so flat ignorant that they didn't know the city
| attorney cannot prosecute felonies, only misdemeanors - so
| she hasn't done so either. But she has cancelled drug court
| programs and cut options for rehab and services! And she
| claims to have caught up on a backlog of cases, without
| mentioning that she did so by throwing all of them out.
| INTPenis wrote:
| You can't compare Portugal to Seattle or Portland. First of all
| it's a country, but more importantly they have free public
| health care and safety nets for homeless and jobless people.
|
| Imho the number one driving factor of the US opioid epidemic is
| the stress of living in a country where you can literally end
| up on the streets if you don't have a job. A country where you
| can go bankrupt if you get sick.
|
| You can't put band aids over the opioid epidemic, it's a
| systemic issue.
| mbgerring wrote:
| No, they didn't -- we can't build safe consumption sites in the
| US because of Federal law, neither city built the necessary
| treatment infrastructure to do "Portugal-style" treatment, and
| police in these US cities seem to resent the approach and don't
| take it seriously enough to achieve Portugal's outcomes.
|
| We can't just stop addressing drug use and not build the care
| and treatment infrastructure on the other end. People
| instinctively understand this, which is why "defund the police"
| failed as a _slogan_ , but the abolitionist program was always
| meant to include _building social infrastructure as an
| alternative to police_.
|
| Those alternative programs in the US are always an underfunded
| afterthought, even in cities where they have political support.
| For example, I _still_ can't call San Francisco's crisis
| intervention team directly -- I have to call the cops if I see
| someone on the street experiencing a crisis, and they still
| _might_ send a poorly trained goon with a gun to deal with it,
| because the crisis intervention team doesn't operate 24 /7.
|
| In other words, these policies haven't failed, they've barely
| even been tried.
| ruined wrote:
| supportive services are fairly minimal here. for instance the
| article opens with an interview at a safe consumption site,
| which is one of the most necessary and effective features of
| portugese policy that prevents overdose deaths - but such
| facilities are illegal in america
| rainbowzootsuit wrote:
| I think it was more like Hampsterdam from _The Wire_.
| latency-guy2 wrote:
| Opinion pieces should present all their counters if they want to
| present themselves as unobjective, and not just the ones they
| think they have an answer for.
|
| USA is not Portugal, transport, production, and distribution of
| drugs is not from the same sources. Wide scale economics are not
| the same either. People are also quite different.
|
| For example, Portugal "solved" their problem, but their rates are
| annually far beyond what Singapore has in accumulation over
| decades. Why not aspire to be more like Singapore rather than
| Portugal, NPR's Brian Mann?
| spamizbad wrote:
| Singapore is a police state whereas Portugal is a Liberal
| democracy.
| lkdfjlkdfjlg wrote:
| This. It blows my mind that people have to be explained this.
| latency-guy2 wrote:
| What explanation, precisely?
| lkdfjlkdfjlg wrote:
| If you don't see what's objectionable with saying "lets
| be more like that police state in how they deal with
| drugs", then the things we're striving for are so
| fundamentally different that we probably won't have a
| very productive conversation. I was replying to the other
| guy. Have a nice day.
| joemazerino wrote:
| Are less overdose deaths better than more?
| lkdfjlkdfjlg wrote:
| Does this problem have only one dimension?
| noduerme wrote:
| This is a specious argument. Singapore puts drug users to
| death. Are fewer executions better than more?
| overstay8930 wrote:
| Nobody asks to die from a fentanyl overdose, while the
| risks of drug trafficking in Singapore are told to you
| the moment you arrive in the country.
|
| I do not feel bad for anyone caught with drugs in
| Singapore, but I sympathize with the addicts in America
| who have been constantly lied to by people who pretend to
| care about them.
| layer8 wrote:
| Does the end justify the means?
| latency-guy2 wrote:
| > I was replying to the other guy.
|
| I see, so that gives you full credentials to insult me.
| Either way, there's more than 3 people here.
|
| > "lets be more like that police state in how they deal
| with drugs", then the things we're striving for are so
| fundamentally different that we probably won't have a
| very productive conversation.
|
| If that's how you solve problems then I agree, no
| discussion should ever be had when you're in the room.
| Singapore, Portugal, and USA, which two are similar than
| the other combination?
|
| I also do not think Singapore is a "police state", and
| their government and people would also firmly disagree
| with you.
| lazyasciiart wrote:
| So you don't think being a police state is bad, but you
| also don't think Singapore is one? What aspect do you
| think they are missing?!
| lkdfjlkdfjlg wrote:
| He makes vague statements that insinuate an idea in your
| mind, you assume that's what he meant and respond to
| that, but then he claims that's not what he meant but
| doesn't clarify. He's just a bored troll, stop feeding
| him.
| noduerme wrote:
| The governments of China, Myanmar, Russia, and Iran would
| also like to firmly disagree that they are police states.
| Oh, and North Korea would like to remind you that it's a
| Democratic Republic. It's in the name, see?
| latency-guy2 wrote:
| And?
| baxtr wrote:
| One naive question, since I have no contact to anyone taking
| opioids: what is it that people get from the drug? For what is it
| used for exactly?
|
| If it's regular pain, then why not "simply" prescribe Aspirin or
| Ibuprofen instead?
| badpun wrote:
| Aspirin or Ibupofren have their limits.
| herbst wrote:
| That's where opiads (and other substances come in) just not
| before you hit those limits.
| carlmr wrote:
| Ibuprofen is basically the German strategy. It's not super
| strong, but everything else is only for extreme pain.
|
| Get your wisdom teeth pulled? Ibuprofen. Broke some bones?
| Ibuprofen.
|
| Burn victim? Maybe some opiates.
|
| The strategy works. Better to have some pain, than to get
| hooked on opiates.
| hef19898 wrote:
| You do get opiods after surgery so, if you want. Only for
| limited periods of time so.
| overstay8930 wrote:
| German doctors will unironically tell people to drink tea and
| go on a walk to treat mental illnesses.
| bloopernova wrote:
| I was in a serious road accident decades ago. I have been in
| pain ever since. This pain is not lessened by over the counter
| painkillers. Plus over the counter painkillers are harmful to
| take large doses long term.
|
| My nerves are damaged by something in my back. (it hasn't been
| determined what, just that the damage occurs) I am in a
| debilitating amount of pain.
|
| So I take an opioid several times a day. Before the opioid
| crisis I was taking 10mg morphine twice a day. Now I take
| Suboxone, I'm in more pain but not a paralyzing amount.
|
| To your question about what it's like: strong opioids bring a
| euphoric numb lightness. If you're in a vulnerable place in
| your life where you are not well supported and don't experience
| much joy, then that euphoria can be overwhelming. You might
| want to feel that again ASAP because compared to being in pain,
| depressed, anxious, you felt pretty good for a while.
| fragmede wrote:
| the way I've heard it described, faced with the ills of the
| world, heroin/opiate users just wanna crawl back into the womb.
| methamphetamine/stimulant users want to fix the world/their
| world.
| TillE wrote:
| There are tons of occasional recreational oxy users, and at
| that level the effect is basically a pure euphoria, blissful
| happiness.
|
| Ironically addiction risk is also low if your usage pattern
| is 1-2 times per month, much much lower than someone who has
| been prescribed a small daily dose.
| copx wrote:
| ..and benzodiazepine users just don't want to care anymore.
| zac23or wrote:
| After years of lies from anti-drug and pro-drug guys, I simply
| don't believe this type of article with data to back it up.
|
| For example, the opioid crisis in America is very different from
| drug use in Portugal. Do opioids in America kill more easily than
| the drugs used in Portugal?
|
| The article contains a lot of feelings and no data.
| fragmede wrote:
| > I simply believe this type of article with data to back it
| up.
|
| (don't?)
| zac23or wrote:
| yes, don't! Thank you.
| ElonsNightmare wrote:
| are we ready to talk about 'culture' yet?
| overstay8930 wrote:
| Who still believes this crap? Clearly it doesn't actually work
| even in Portugal, drug use has been going up a lot.
|
| Turns out executing drug dealers actually works, who knew people
| didn't want to die trafficking fentanyl.
| johnea wrote:
| I wonder how effective executing the executioners would be?
|
| Once we have mandatory machine gun ownership in the US, like
| the little baby jesus intended, then we can move on to
| executing _those_ people.
|
| > "There's an impression in the U.S. that if you decriminalize
| drugs, it's a Wild West where everyone uses drugs," Moniz said.
| "That hasn't been the case in Portugal."
|
| This is mostly because of the amazing level of stupidity of the
| us population. With a huge factor in that stupidity being the
| practice of stone age mythology, with it's emphasis on
| retribution and punishment instead of recovery and progress.
| overstay8930 wrote:
| "Everyone else is stupid but me" is not an actual argument,
| dude. I'm talking about the uptick in drug abuse in Portugal
| while the article is just completely ignoring it.
|
| By the way, the proposal excludes increase police
| enforcement. So yea, it is the Wild West even if it says it's
| not.
|
| Like all "drug reform" plans, there's no actual plan for the
| people who don't want to stop using drugs.
| neither_color wrote:
| I just wish westerners who visit Asian cities like Singapore
| would stop gushing over the cleanliness and orderliness there
| while bashing the US/west if they're not willing to adopt
| Singaporean drug laws. You can't have it both ways. "Freedom"
| means accepting the consequences of people exercising it. Some
| people experiment and tap into massive creative potential(even
| Steve Jobs went through a phase), others fall into addictive
| traps.
| overstay8930 wrote:
| I said nothing of what you're saying, you don't have to be a
| dictatorship to enforce the laws we have.
|
| Crime has dropped every single year for the last 30 years
| until 2017. It's like how progressives said the war on drugs
| failed but only as long as you ignore how well it did at
| reducing crime and drug use.
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