There are a lot of contributing factors for the massive problems, but unfortunately step 1 of making things better is getting blamed: the decriminalization. You know what happened when no fault...
There are a lot of contributing factors for the massive problems, but unfortunately step 1 of making things better is getting blamed: the decriminalization.
You know what happened when no fault divorce became a thing? A massive spike in divorces. It sparked talk about how it was the end of marriage. It turned out there were just a ton of women stuck in unhappy marriages, and the spike levelled off after the backlog was through. The baseline was higher than before, but that's because nobody needed to hide their unhappiness forever.
So we see the same with decriminalization. The problems associated were exacerbated by things like:
Allowing street dealers instead of pharmacists
Drug tourism because it was only decriminalized in one tiny spot.
Not having an equivalent "no drunk in public" rule.
I think those three would have gone a long way toward mitigating the problem. "No street dealers" would have eased up a lot of the tourism and kept prices high. Legal sales would have raised tax dollars to further fund mitigation programs. Punishing unruly behavior appropriately would keep danger levels down.
Portland's problems would get better if more areas decriminalized, not less. Because all prison adds to the equation is making it even harder for the addicts to be functional members of society.
Recriminalizing is like taking away no fault divorce because the divorce rate is higher now.
I don't want to assume too much but I think that you might be getting confused with other decriminalization efforts. Drugs were actually decriminalized in the entire state of Oregon by ballot...
I don't want to assume too much but I think that you might be getting confused with other decriminalization efforts. Drugs were actually decriminalized in the entire state of Oregon by ballot measure and, aside from a highly publicized drug market that temporarily popped up at the Lloyd Center area, the explosion in drug use and associated homelessness and mental health disorders affected not only the entirery of downtown but the entire city. Drug tourism in the sense of San Francisco's tenderloin was not really a general thing in Portland, in this case the state's famous camping laws allowed a problematic homeless drug using culture to become permanently entrenched.
As a very frequent visitor to Portland for over a decade, I have unfortunately been a witness to the acute ills facing the city and the relatively frequent gaps in my exposure have meant that my experience was more noticeable as I was not dulled by the blindness to change that comes with constant exposure over long periods of time.
The problems with Oregon's approach is mostly attributed to the fact that social support systems were not in place before decriminalization and that the approach was backwards. This and ill fated timing, both the COVID pandemic and a general national rise in drug use occurred on the very heels of the decriminalization, doomed the good intentions of voters.
I don't think it's necessarily fair to compare decriminalization and tolerance efforts, as seen on the West Coast, to no-fault divorce. Divorce doesn't directly destroy communities and disrupt the daily lives of citizens. This is difficult for me to square because I am generally against the criminalization of drugs and believe in social support to ease homelessness and treat addiction but I have also seen first hand what uncontrolled drug and mental health crises can do to a city. It's very sad in Portland's case where a vibrant downtown was almost entirely destroyed and where more than 80% of the population felt scared to go and it's only now, after recriminalization, where the downtown is recovering. I've begrudgingly come to the conclusion that the best results probably result from a good mix of tolerance, treatment, and enforcement.
Sleeping rough and using drugs are very sadly facts of life and, in my opinion, people's prerogatives but there is still a need to be civil in a society. If that is the life that has either been dealt to you or one that was chosen, however tacitly, then be discreet about it. Find somewhere to camp and consume that is not so public. But people's rights do end when they are making their fellow citizens unsafe and literally terrorizing large swaths of cities. If your mental health issues or irresponsible public drug use are dramatically affecting those around you, then you need to be removed one way or the other - either by involuntary commitment until you can be stabilized and offered treatment or by the justice system if your behavior is becoming criminal. I've stayed in downtown Portland, walked through the city and ridden on the Max, and even though I'm a fully grown adult male, I'll admit that at times it was legitimately scary even though I logically knew that homeless people generally are not dangerous but having someone literally acting like a walking dead character because they can't handle mixing fentanyl with amphetamines leaves one on edge because of the unpredictability of it all. That's no way to have a functioning society.
I just don't think that pure decriminalization is the right fit for America anymore. Social support services should be increased and basic possession and use should not subject people to the criminal justice system but I think that laws will sadly be needed to protect civil society from users who become criminal or habitually disruptive and that includes feeling free to consume hard drugs in the open.
There’s a better mechanism for intransigent users than criminal punishment: involuntary commitment to psych treatment. Punishing people for being sick is a sign of a sick society, and at least 99%...
There’s a better mechanism for intransigent users than criminal punishment: involuntary commitment to psych treatment. Punishing people for being sick is a sign of a sick society, and at least 99% of users (at least) are that as far as I can tell. Yes, we need to set boundaries around their behaviors, and as you say, we need to have adequate support for them at the same time we stop punishing them. But turning criminalizing them isn’t helping anyone but a small number of profiteers.
Not an expert but as I understand it, a problem with involuntary commitment is that it’s pretty squishy - a medical professional is making the decision based at least partially on vibes. And it’s...
Not an expert but as I understand it, a problem with involuntary commitment is that it’s pretty squishy - a medical professional is making the decision based at least partially on vibes. And it’s still locking someone up, which might not formally be punishment, but often is under conditions that most people would consider punishment.
Having worked both personally and professionaly with both jail and IVC, I can promise IVC is almost always preferable. It serves a better purpose for the mentally ill and the addicted: it gives...
Having worked both personally and professionaly with both jail and IVC, I can promise IVC is almost always preferable. It serves a better purpose for the mentally ill and the addicted: it gives them a consequence, it gives them a chance at a break in a supportive environment, and, under the best of circumstances, lets them connect with people they can learn to trust.
It's not implement well, it needs way more resources. But imagine if we diverted prison/jail/justice resources to the acute psychiatric world?
On the other hand, when a judge or jury sends someone to jail or prison, you have . . . a person or group of people making a decision based at least partially on vibes.
a medical professional is making the decision based at least partially on vibes.
On the other hand, when a judge or jury sends someone to jail or prison, you have . . . a person or group of people making a decision based at least partially on vibes.
True, but it seems like when there’s a specific crime that people can give evidence for or against, it’s usually more concrete than testimony about someone’s state of mind. (State of mind plays...
True, but it seems like when there’s a specific crime that people can give evidence for or against, it’s usually more concrete than testimony about someone’s state of mind.
(State of mind plays some role in jury decisions, such in which murder charges to use, but there’s also evidence about who did what that’s not about state of mind.)
There are specific, non-ambiguous things we can make subcriminal but still grounds for involuntary mental health confinement though. Like (comically, really) stealing things — in Vancouver this is...
There are specific, non-ambiguous things we can make subcriminal but still grounds for involuntary mental health confinement though. Like (comically, really) stealing things — in Vancouver this is literally not punished if the perpetrator is a drug addict. Even assault is basically ignored. And the problem here is that in the case of drug addicts, there are a number of individuals whose recidivism rate is basically 100%. And it’s not a small number of people —
“Approximately 200 individuals are responsible for a disproportionate amount of repeat offending in the province.”
If someone is a drug addict, is not interested in getting clean, and also steals things and commits assaults, maybe they should not be allowed on the street until they decide that being clean is a better option. And if they never choose that? Maybe they stay confined for life. We confine people for life for murder, why not confine them for life for dozens of assaults and thefts? Especially if release is something they can achieve through determined work at sobriety.
I'm not sure if you read the article but criminalization does not mean locking up and punishing users just for using. I think Portland is doing it right, firm compassion or however they worded it....
I'm not sure if you read the article but criminalization does not mean locking up and punishing users just for using. I think Portland is doing it right, firm compassion or however they worded it. People are offered mental health and addiction support but criminal penalties are reserved for those who refuse or who become recurring problems. It's not punishing people for being sick, it's removing people from exposure to civil society for refusing to accept help. At some point one has to admit that you can only do so much to try and help people and that normal citizens need to be protected if one is unable or unwilling to be helped. While I agree with your stance on involuntary commitment, in the US only very limited holds are allowed to balance against individual civil rights - it will never be a viable solution for constitutional reasons. In light of that I see no real alternative to reserving criminal penalties for highly problematic individuals.
I don't think you're entirely wrong, however (quoting from your prior post in thread): That sounds a lot like "We're pushing the problem under the rug. We don't care if it exists, we just don't...
I don't think you're entirely wrong, however (quoting from your prior post in thread):
It's not punishing people for being sick, it's removing people from exposure to civil society for refusing to accept help
That sounds a lot like "We're pushing the problem under the rug. We don't care if it exists, we just don't want to have to look at it." Don't know if you've ever been in a psych ward before....it's not a pretty place. I'd just as soon take my chances with prison after having spent several stays there.
This is a problem in a lot of areas. Like that time Rudy Guiliani's solution to New York's homeless problem was to throw them all on busses to Atlantic City. It was pretty popular in the 90's. It's still popular today, but it was popular then too.
The addicts are addicts for a reason. The mentally ill are ill for a reason. There are many homeless that are one, the other, both, or neither. Society mostly only cares about the symptoms, not the cause. And if the symptoms can't be managed, they must be hidden or suppressed.
Every one of those perpetual addicts in Portland would have been addicts somewhere else. But we musn't let the problem be visible. We must criminalize the symptom lest it be too inconvenient for the people whom don't suffer from it.
I'll emphasize my own quote: That is the exact opposite of what you've written here: People are actively being offered help, not confinement. That means beds in a sobering facility, that means...
I'll emphasize my own quote:
It's not punishing people for being sick, it's removing people from exposure to civil society for refusing to accept help
That is the exact opposite of what you've written here:
"We're pushing the problem under the rug. We don't care if it exists, we just don't want to have to look at it."
People are actively being offered help, not confinement. That means beds in a sobering facility, that means treatment options for addicts. And regardless of what a psych ward is like, prisons are not equipped to stabilize acute mental health crises and offer longer term care - conditions of facilities is an entirely different argument.
The addicts are addicts for a reason. The mentally ill are ill for a reason.
I agree. Homelessness and addiction are human conditions, you can reduce them but never eliminate them. While I completely agree with your sentiments to treat the cause, I can't agree with, what to me is blind reverse utopianism, where one believes that unchecked drug use and mental health problems should be allowed to disrupt communities.
Every one of those perpetual addicts in Portland would have been addicts somewhere else.
I don't think that's a claim that can be backed up. Sure, addiction is a nationwide problem in the US but I can guarantee almost the opposite, that Portland's ill-instituted decriminalization allowed even more people to fall victim to addiction than otherwise would have. I know the nature of addiction very well and every eliminated barrier would only serve to enable abuse. We can debate harm reduction all we want (which I actually support) but drug free-for-alls only fuel these problems in the absence of rigorous treatment and prevention systems.
I'm not sure if you've ever been to downtown Portland, especially before and after decriminalization. The entire area was gutted. Businesses large and small closed down, night life never recovered after COVID, residents are scared and have to contend with literal biohazards on their doorsteps. Do you even understand how bad things have to be when over 80%(!) of a cities residents feel afraid to step foot in a very large downtown area? And we're talking about a rapid decline in only the span of three to four years. Combined with Oregon's liberal camping ordinances the situation was a powder keg that I really don't think is comparable to any other city in the entire US, not San Francisco, not New York, not Philadelphia, not Baltimore, and on and on.
We can never prevent anyone from becoming mentally ill (including addiction), but we can certainly do a great deal more to help those who are, now and in the future. And you are right that it is a...
you can reduce them but never eliminate them.
We can never prevent anyone from becoming mentally ill (including addiction), but we can certainly do a great deal more to help those who are, now and in the future. And you are right that it is a human condition, meaning the solution needs happen at the level of humanity, that is, culture. It's not enough just offer addicts as stay in a "sobering facility."
addiction is a nationwide problem in the US but I can guarantee almost the opposite, that Portland's ill-instituted decriminalization allowed even more people to fall victim to addiction than otherwise would have
What guarantee can you make? The incidence of mental health (including addiction) is the same across nearly every social and economic stratum, it just shows up differently among the less well resourced. Especially so, since they are often denied access to early treatment, so their conditions and concomitant symptoms are often far more prounounced. This is a social failure, and should be addressed socially.
Portland and similar places probably suffer from an in-migration of the already quite sick, sometimes voluntarily, sometimes bussed in like immigrants are bussed to "sanctuary cities," which exacerbates the problem for them and imposes an unfair cost of their more humane approach. Some day perhaps we will see a truly pro-life party arise that is willing to work toward a real soulotion (a typo, but I like it so I'm leaving it) to this problem.
I think, what I am saying, is best summed up by The Butthole Surfers, in "The Weird Revolution." You might see it as a sidestep, but I see it as an artistic explanation for our disagreement about...
I think, what I am saying, is best summed up by The Butthole Surfers, in "The Weird Revolution." You might see it as a sidestep, but I see it as an artistic explanation for our disagreement about methods. Maybe someday I'll write up a blog post with a more details, nuance, and clarity.
The so-called weirdos in this country stand as completely freaked out by the normal man as the normal man is completely freaked out by the weird masses reaction to him
Which came first - you may ask - chicken or egg; you may ask. Well, the chicken of course; and it's time to break this weird-ass chain
The weird masses don't want to be normalized
Weirdos want to be abnormal
The freaks can't be formally normalized nor can we be normally formalized
What we want is complete weirdification
Basically, we don't want weirdness from the normal man
We don't want to be freaked out by the normal man
We want to outfreak the normal man
The normal man entices and prostitutes and performs surgery on our weird women
Yes, even your brother could be a victim of his plastic fantasies
And if you weird out his daughter he'll plast your ass
What's good for the goose is good for the gander
Are you freaking with me?
What is good for the goose is good for the gander
So you can pluck out his feathers and smile because you are defending our weird women from the freaky-ass thoughts of the bug-eyed, bow-legged normal man
What the normal man calls "help" the weird man calls "subjugation." This could be seen from so many angles, and explains so much of society. From the schizophrenic to the autistic. From the LGBTQ+ folks to black folks.
The gay man does not wish to conform to straightness. The black man does not wish to conform to whiteness. They wish to be who they are, and these particular cases are seen as acceptable to the empathetic normal man. Because, by and large, the gay man and the black man are still seen as mostly normal.
The schizophrenic does not necessarily want to be medicated. The autist does not wish to be "normal": they wish to be accepted for who they are and be permitted to thrive as they are. And to the so-called "normal," it is virtually inconceivable that the answer is to foster an environment where the schizophrenic can thrive, rather than to medicate the schizophrenic until he can tolerate the environment of the normal man.
Many, many, many of the addicts are merely people whom cannot thrive or be happy in the only environment that is available to them. And the answer from the normal man is not to alter the environment: It is to suppress those whom cannot thrive in it.
(not the one you're replying to) I emphatize with that, but your argument also clearly implies the other side: the environment these addicts live in was established by the normal man and its...
Many, many, many of the addicts are merely people whom cannot thrive or be happy in the only environment that is available to them. And the answer from the normal man is not to alter the environment: It is to suppress those whom cannot thrive in it.
(not the one you're replying to)
I emphatize with that, but your argument also clearly implies the other side: the environment these addicts live in was established by the normal man and its written and unwritten rules exist to maintain it. And they are choosing to profit from many of the upsides of living in this environment but at the same time destroy it instead of creating their own.
I don't think this is a way to accurately sum up the situation, but I do think it is just as legitimate as what you describe if not more.
I also think you're getting a bit too close to looking at someone who's doing violent crime and saying "well he's just a weirdo". I understand that's not specifically what you're saying and most addicts aren't violent, but the line beyond which we say "I don't care about your personal history and what caused you to do this, it's wrong and we're going to stop you and punish you" has to be drawn somewhere. For most people violence is beyond that. But I also understand people for whom "just" shooting up in the street in front of kids or verbally harrassing others is beyond that line. Society continually has to find a balance about where to draw the line, but when a person gets beyond it, yeah, repression (though there's a ton of space for improving how specifically it's applied) is the obvious answer and I don't think it's wrong despite anything you describe, that's just the reality of maintaining functional society.
I agree that violence should not be permitted. But I think that is somewhat orthogonal to the problem. It is not the addiction or the drug that is causing the violence: it is the failure of the...
I agree that violence should not be permitted. But I think that is somewhat orthogonal to the problem. It is not the addiction or the drug that is causing the violence: it is the failure of the system.
Do many people think about how addiction and homelessness could be solved better by fixing the foster system? I don't think so, because society is mostly concerned about fixing the symptom.
Regarding the normal/weird dynamic: Remember it is a spectrum. Think of it as an Nth dimensional scatter plot formed by infinite one-dimensional spectrums. Sexuality, Gender, Empathy, Aggressiveness, Visual learners, auditory learners, blindness, deafness, etc. Every dimension that could possibly describe humanity mapped onto an indescribable chart, with normal defined as 'whichever cluster dominates in a given geographic boundary.'
The ruling class sees themselves as normal, and the commoners weird, and vice versa.
I would support this, I also support Housing First programmes and other projects aiming at fixing the cause. But at the same time there's a line beyond which it's normal and expected to want to...
One other important facet that hasn't been brought up (part of the whole nuance and clarity in blog thing): There is a common thread for a large majority of the violent, perceptually homeless drug addicts. They're more likely than not to be children who aged out of the foster system.
Do many people think about how addiction and homelessness could be solved better by fixing the foster system? I don't think so, because society is mostly concerned about fixing the symptom.
I would support this, I also support Housing First programmes and other projects aiming at fixing the cause. But at the same time there's a line beyond which it's normal and expected to want to cut down on the symptoms as well to get immediate relief for other people living and working in the area who likely did nothing to get into this situation. And to me this situation seems to be beyond that line.
Criminal penalties are a punishment, pretty much by definition Additionally, 'refusal' of treatment is a symptom of the disease of addiction; in the case of mental illness it is often an inability...
Criminal penalties are a punishment, pretty much by definition
Additionally, 'refusal' of treatment is a symptom of the disease of addiction; in the case of mental illness it is often an inability to understand what's happening. In both cases, there is no real moral justification for punishment. And if one takes the stance that criminal justice is purely a utilitarian mechanism, involuntary commitment is still a far preferable outcome.
The exception I would make is for predatory dealers at every level. Criminal prosecution is definitely justified for them, they have choices. License dispenseries. In UK, doctors can prescribe heroin for addiction, why should it be any different here?
Protecting other citizens (I find it somewhat offensive to describe them as "normal" in this context) is a valid concern, but privileging the healthy over the sick, aka the empowered over the vulnerable, is morally reprehensible. The sick, especially the sick who lack any resources to help themselves, deserve at least as much protection as the healthy, probably more.
I don't think anybody has mentioned yet in the thread: Most addicts, for most drugs, are self-medicating for a condition that they don't realize they have. We should also all remember the social...
I don't think anybody has mentioned yet in the thread: Most addicts, for most drugs, are self-medicating for a condition that they don't realize they have.
We used established models of drug addiction, relapse, and craving to demonstrate that operant access to social reward prevented ‘compulsive’ self-administration of heroin and methamphetamine in addicted rats, as well as preventing incubation of methamphetamine craving and relapse. These observations highlight the importance of incorporating social factors into neuroscientific studies of addiction and illustrate the profound impact of positive social interactions on both addictive behavior and brain responses to drug-associated cues. From a clinical perspective, our findings support wider implementation of social-based behavioral treatments, which include not only CRA but also innovative social-media approaches, like those being implemented for other psychiatric disorders to provide social support before and during drug-seeking episodes.
Or to sum up even more: Positive social interaction is what prevents and cures addicts. Regardless of the drug class or how addictive the drug itself is.
Fent addiction is a symptom of societal rot. Not a cause.
There's a legal reason for criminalization in the US. It's illegal to compel treatment for anything that's not a crime. The exception is 24 hour psych holds for threats of bodily harm, and those...
But turning criminalizing them isn’t helping anyone but a small number of profiteers.
There's a legal reason for criminalization in the US. It's illegal to compel treatment for anything that's not a crime. The exception is 24 hour psych holds for threats of bodily harm, and those are very strictly limited (as anyone with severely mentally ill family can tell you).
If it's not a crime, the legal system can't be used to force someone to go to treatment. Offering addicts optional, voluntary treatment hasn't worked out very well as many big cities can tell you.
This is simply not true. In all the states I know about, which is several, you can be held involuntarily for as long as you remain a threat to self and others. That decision is often driven by...
This is simply not true. In all the states I know about, which is several, you can be held involuntarily for as long as you remain a threat to self and others. That decision is often driven by money: a lack of beds forcing good doctors to release those who need to stay, and unscrupulous doctors compelling needless stays.
Those subject to commitment may appeal their stays (I worked as an atty on many of these cases), but courts rarely override doctor opinion.
And in many cases it’s necessary and saves lives and families, and could certainly be used for those who currently lack the wherewithal to seek or accept treatment voluntarily.
Right, if someone is an immediate threat to self or others, it's usually possible to get a court to order them into treatment, but my point was that outside of that situation it's basically...
Right, if someone is an immediate threat to self or others, it's usually possible to get a court to order them into treatment, but my point was that outside of that situation it's basically impossible.
A non-violent, schizophrenic family member that becomes nonfunctional won't be involuntarily committed. Courts can't order a nonviolent person to take their meds unless there's another crime involved, and even then it's usually only possible to compel them while they're in the hospital.
Uninformed hot take incoming... I'd be curious if anyone has tried automatic involuntary commitment for OD cases. It seems like clear evidence of self-harm tantamount to a suicide attempt - the...
Uninformed hot take incoming...
I'd be curious if anyone has tried automatic involuntary commitment for OD cases. It seems like clear evidence of self-harm tantamount to a suicide attempt - the inability to prioritize survival over getting a fix?
Self harm and suicide attempts are different. It could indeed be one or the other but rarely would it be both. Now you have someone going through withdrawal in the hospital designed for mental...
Self harm and suicide attempts are different. It could indeed be one or the other but rarely would it be both. Now you have someone going through withdrawal in the hospital designed for mental health, they don't want to be withdrawing, they're still physically or psychologically addicted to their drug and they lack the insurance or compliance for long term psychiatric treatment.
There's a lot of research coming out right now that overdoses are potentially tied to doing the drug in a different environment, so your body doesn't anticipate it (by kicking your heart rate up in advance for example) and then the same amount that would have been fine due to your tolerance is now (potentially or actually) deadly. They weren't trying to die, they survived the same amount multiple times.
The biggest thing about suicide attempts is most people don't want to do it again. At least not right away and often never. That's not the case with the drugs.
There are specific inpatient drug rehabilitation options, they're also not great places to be. But forcing someone through it does not improve their outcomes. You're basically back to prisons with extra steps and sedatives.
Thank you for the thoughtful explanation. I was under the impression that most OD cases were due to either a) resuming a former dose size after a period of abstinence, i.e. addiction relapse; or...
Thank you for the thoughtful explanation. I was under the impression that most OD cases were due to either a) resuming a former dose size after a period of abstinence, i.e. addiction relapse; or b) malformulated street drugs with excessive doses. In both situations, you could argue that the person has exposed themselves to unreasonable dangers they're no longer capable of avoiding without external intervention.
I agree that there are better environments for treatment than the mental health system, but "voluntary" is a hard boundary to reach when an addiction interferes with volition.
I just attended a presentation on the topic just in the past few months and I can't say how strong the research is compared to other possibilities. What you described per your other methods is a)...
I just attended a presentation on the topic just in the past few months and I can't say how strong the research is compared to other possibilities.
What you described per your other methods is a) relapse, a part of addiction and recovery and b) being lied to and taken advantage of by dealers. You can't solve the first part without leaving someone locked up forever. And the latter would be actually solved by selling them clean drugs rather than locking up the user.
You could argue a lot of things but there are far too many people walking around with caffeine addictions who are awfully high and mighty about how "those people" can't make independent choices. Taking away more autonomy is rarely a good solution and it's almost never one for lasting sobriety.
What puts people at risk of addictions is a mix of genetics, family history, personal traits, financial security, trauma, certain MH conditions, and a ton of things people had no control over. Forced treatment does very little except make someone sober up, and typically solves none of the surrounding causes. You don't unmake addiction by forcing sobriety.
I mean will we be locking up cigarette smokers too? They're obviously also self-harming to the point of long term physical damage. The alcoholics? Not just the DUIs, but the barflies and the people that pick up a case of beer every night?
Nearly every parolee I worked with picked smoking up or back up right after getting out of prison (if they weren't getting cigarettes in prison too), and many started drinking alcohol and using cannabis, meth or cocaine again too. Because their lives were typically worse than before prison, not better. Some stayed sober, because they wanted it, and a very few needed something like prison to get sober - but if they didn't want it, it wouldn't stick.
I wasn't advocating for indefinite involuntary commitment. Rather, a means of assessing for underlying psychiatric conditions and treating them before release to a structured rehab program. I know...
I wasn't advocating for indefinite involuntary commitment. Rather, a means of assessing for underlying psychiatric conditions and treating them before release to a structured rehab program. I know you're the expert, but it seems like this would be a better approach than the choice of jail or rehab only.
That's not what psych holds do, and if someone's not willing it's essentially going to be an involuntary inpatient treatment. It's hard to make a schizophrenic person take their medication legally...
That's not what psych holds do, and if someone's not willing it's essentially going to be an involuntary inpatient treatment. It's hard to make a schizophrenic person take their medication legally too, and it should be. But it should (and does) require a court order.
I don't think the only options are the two you offered. I do support diversion programs to keep folks out of jail for folks wanting to gain sobriety. The good ones will include psychiatric services. But mostly you have to solve the underlying social issues with wrap around support and that doesn't really work without consent.
You address this tangentially and by implication in your other post, but I want to draw it out explicitly. While it is true (imo) that forced drug tx rarely results in immediate abatement of using...
You address this tangentially and by implication in your other post, but I want to draw it out explicitly.
While it is true (imo) that forced drug tx rarely results in immediate abatement of using or anything like recovery, sending an addict to prison almost always makes their life worse.
Forced tx is therefore better than criminalization. And sometimes, usually not the first time and often not ever, but sometimes that brief moment of sobriety opens a door to valuable insight down the road, leading to a willingness to get better.
Functionally I'd argue that forced, necessarily inpatient, drug treatment will basically have almost all of the negative effects on a person as prison. Everything short of the record which someone...
Functionally I'd argue that forced, necessarily inpatient, drug treatment will basically have almost all of the negative effects on a person as prison. Everything short of the record which someone is also likely to have at that point anyway. And yes, as few folks will have the revelations but I don't believe the balance of pro/con there weighs out on the pro-side.
My re-entry program included case management, moral reconation therapy*, anger management, substance abuse treatment, and "career"/employment support. It was not inpatient but it was mandated and it was incredibly ineffective. (Especially because GEO Group cared more about money and saying the words "evidence based practices" than they did about following said practices). I am highly skeptical of holding people with addictions on functionally mental health holds, and also have bad news for people that think that most suicidal folks get effective treatment during those holds.
*Essentially it's "How to not be a criminal" therapy. It's theoretically effective but see above about following EBP.
If it's not too much to ask, are you able to compare it to 2018 for me? I've only been to Portland once and I remember a large amount of homeless drug users at that time, but it sounds like a...
If it's not too much to ask, are you able to compare it to 2018 for me? I've only been to Portland once and I remember a large amount of homeless drug users at that time, but it sounds like a different experience now. I remember the downtown areas being quite safe then, aside from a handful of spots, but we were 5 adult men.
It's difficult for me to really quantify that, although I'm sure we could come up with statistics. Portland is one of the, if not the, most liberal cities in the US and has always had a higher...
It's difficult for me to really quantify that, although I'm sure we could come up with statistics. Portland is one of the, if not the, most liberal cities in the US and has always had a higher amount of drug use going on. Oregon also has extremely liberal camping laws that basically allow anyone to camp on public property, this is why the city attracts so many homeless. All I can say is imagine whatever you experienced in 2018 and multiply it many times. The police largely gave up policing around the time of George Floyd and the decriminalization efforts were done in tandem, as part of a new approach to "crime." The amount of visible homelessness has seen a stark uptick, drug use became completely open, and people having acute mental health crises became a very common sight around downtown. People stopped crossing the river into downtown and due to petty crime, a lot of businesses left, even longstanding staples like REI. I don't really know the true statistics of safety downtown, my impression is that it is still a relatively safe place to be but that the perception of safety is at tragic lows and perception is still a valid metric as humans have a need to feel safe where they live and conduct business.
As has already been pointed out, divorce is a terrible analogy. You don't get addicted to no fault divorces. You don't leverage your house so you can get yet another no fault divorce because it's...
As has already been pointed out, divorce is a terrible analogy.
You don't get addicted to no fault divorces. You don't leverage your house so you can get yet another no fault divorce because it's been a rough week. You don't strip the copper from everything in the community. You don't steal from people. You don't sit at home all day because of the high of a no fault divorce and come crashing down when it's been too long since your last one.
Fent is extremely potent, hyper dangerous, debilitating, and very easy to make. Oh and you can drop it into just about anything to make it more appealing (not just drugs designed to get you high. Hell you can put it in food technically.)
Pretty much a worse case scenario for any drug. Fent is roughly the equivalent societal problem as opium wars were but massively harder to solve because you can't limit the supply nearly as easily. I'm all for treatment first and not sticking to punishment just for use, but a common issue with drugs as destructive as fent is that they can very easily lead to straight up criminal behavior (theft, harassment, assault) and that's before you consider the very real "people will fucking die" problem that fent poses. Even legalized and regulated it's a trivial drug to OD on because it's not that hard for an addict to get enough to harm themselves.
Oh and from a corporate standpoint dear god what an ideal product. Repeat customers guaranteed, just get a good chemist to make sure you don't kill them. Obviously I don't think any "legalization" method is treating fent like weed where we're getting bakeries, but if i'm wrong about that you'd see that done in a heartbeat.
My point being, not only can you not easily compare fent to divorce, i'm not sure you can easily compare it to any other drug in the history of human drug abuse. It is uniquely awful and thus requires some very different approaches in how it's handled.
I do agree that decriminalization of use needs to be a starting point, but I do think some middle ground (while yes it's own problem) of forced treatment may be required as it's far far too easy for it to lead to brutal outcomes. Actual allowing of the production of and selling of fent outside of healthcare though is always going to be a problem. I see 0 way you can allow a product so potent and dangerous on the market unless you're some "it'll sort itself out" libertarian.
To be clear, I wasn't specifically comparing fent to divorce, rather decriminalization itself, regardless of the thing. The pattern of "spike, then drop, then plateau at higher level than before"...
To be clear, I wasn't specifically comparing fent to divorce, rather decriminalization itself, regardless of the thing. The pattern of "spike, then drop, then plateau at higher level than before" will apply to the decriminalization (or properly legalization) of anything. I chose divorce because it is also championed as one of the worst things ever by the same people who want all abortions banned.
Would it be better if I said marijuana, which does not have nearly the same problems as fent in that vein?
Criminalization does not help addiction in any sense. Heavily regulated distribution and manufacturing, while not punishing the addicts, does.
Not really because again the spike is not the same in the slightest. There's an initial "oh neat new thing" spike for weed or something of the sort, but its not nearly as cripplingly addictive and...
Not really because again the spike is not the same in the slightest. There's an initial "oh neat new thing" spike for weed or something of the sort, but its not nearly as cripplingly addictive and dangerous as fent.
Criminalization does not help addiction in any sense. Heavily regulated distribution and manufacturing, while not punishing the addicts, does.
You can completely remove the punishment for consuming fent, and you're still going to have trouble with addicts breaking the laws because they're addicted. So again, theft, assault, harassment, and DUI at the minimum. Fent is a totally different tier of problem and I don't think it's productive to compare it to previous situations.
Drug laws have basically always sucked throughout history, but a big part of them does stem from "so we have to wait for this addict to rob/harm us?" complaints from the community, or "so i have to wait for my child to OD?".
So sure, lets do treatment, and lets not punish addicts if they haven't committed a crime, but seeing as how you said:
I think those three would have gone a long way toward mitigating the problem. "No street dealers" would have eased up a lot of the tourism and kept prices high. Legal sales would have raised tax dollars to further fund mitigation programs. Punishing unruly behavior appropriately would keep danger levels down.
I don't think I can remotely agree. You cannot have a legal avenue for purchase for a drug like this. It should only be through very very tightly controlled prescription in helping to treat addiction. You must keep distribution illegal, and yes that sucks because sadly drug sales are an obvious route for the disadvantaged to try and fix things, but fent is so destructive.
I am consistently saddened that even in ostensibly progressive spaces, cause and symptom are so readily confused in the context of addiction. While there is certainly an issue with physical...
not nearly as cripplingly addictive and dangerous as fent.
I am consistently saddened that even in ostensibly progressive spaces, cause and symptom are so readily confused in the context of addiction.
While there is certainly an issue with physical dependency which varies among drugs, addiction is a disease of which drug use is a symptom. There are many symptoms of addiction, and some addicts seem very high functioning, as their symptom is seeking interpersonal validation, and so they get very good at wresting that from the people around them. This, in part, is why so many entertainers go through drug use, as all the symptoms of addiction hit the same root cause, and drugs tend to be the most effective.
Another implication of this truth: not all users are addicts, even of harder drugs (it’s possible to experiment or be susceptible to peer pressure, e.g.).
No other disease (except other forms of Mental Health) does society criminalize. Why do we do it with this one? Probably because it takes a lot of effort to overcome bias and truly understand an issue?
I think you're touching on some good points, but I think you're also underselling the physical dependency. Part of what makes narcotics so dangerous is that it's very possible to establish a...
I think you're touching on some good points, but I think you're also underselling the physical dependency. Part of what makes narcotics so dangerous is that it's very possible to establish a strong physical dependency in one use. That dependency compels increasingly destructive behavior.
You are way understating the level of physical dependency an opioid as strong as fentanyl can cause. Further we do criminalize a ton of other mental illness. Most often either because of some mix...
You are way understating the level of physical dependency an opioid as strong as fentanyl can cause.
Further we do criminalize a ton of other mental illness. Most often either because of some mix of ignorant/bigoted views and because the illness is straight up dangerous to those around them.
People who’ve been robbed by drug addicts aren’t likely to be empathetic to their plight.
Further saying that drug use is only a symptom of addiction is just not accurate when dealing with physical addiction. The “disease” is your completely fucked opioid receptors and the cause is absolutely opioids. Yes human chemistry varies tremendously from person to person but just as there’s people who can shrug off a lethal bender there’s others who can become cripplingly addicted just from the physical symptoms.
I don’t feel it promotes a better understanding to just try and treat every drug the same, and not respecting why things like fentanyl are so dangerous is also why it’s still disturbingly easy to get it prescribed in some areas (and impossible in others)
I think that's where we're at basically. With fent and opioids this whole decriminalizing and letting it happen thing isn't exactly working. This is maybe going to sound pretty...
forced treatment may be required
I think that's where we're at basically. With fent and opioids this whole decriminalizing and letting it happen thing isn't exactly working.
This is maybe going to sound pretty authoritarian/harsh, but I think we also should be taking some sort of extreme hard line on people selling fentanyl. Like, get caught selling fent laced drugs: 20 years in jail. Get caught with over some arbitrary quantity: life.
I see 0 way you can allow a product so potent and dangerous on the market unless you're some "it'll sort itself out" libertarian.
As in, "just let them die".
I don't know the exact details or if its still going on, but my city low key started that. They stopped buying narcan for bylaw officers and I think police. So if you OD and you don't have your own then you're waiting for an ambulance. There's no way to view this policy as anything other than trying to let drug addicts die off. Well, to be blunt, I don't think I see a reduction in clearly drugged out homeless people. Either new addicts are replacing the dead ones or they're all packing their own narcan now. Probably a bit of both.
Edit: I know not all people that overdose are homeless, but they're kind of a visible indicator.
My family visited Portland a few months back, and we really enjoyed the zoo, public transit, and walkable downtown! The drug use was honestly worse than we expected though. We've travelled a fair...
My family visited Portland a few months back, and we really enjoyed the zoo, public transit, and walkable downtown!
The drug use was honestly worse than we expected though. We've travelled a fair bit including San Francisco, LA, NYC, Seattle, etc, and it was certainly up there for urban poverty and public drug use. There were streets we didn't feel comfortable even walking as a group. I logically understand I'm more likely to be murdered walking around downtown Little Rock, but drugged out people randomly screaming at you gets the adrenaline pumping even if you're sorta used to it.
I mean, there's also just the fact that the spectrum of unwanted behaviors that are directed against you span more than "nothing" and "MURDER DEATH KILL". There's a variety of ways to be harassed...
I logically understand I'm more likely to be murdered walking around downtown Little Rock, but drugged out people randomly screaming at you gets the adrenaline pumping even if you're sorta used to it.
I mean, there's also just the fact that the spectrum of unwanted behaviors that are directed against you span more than "nothing" and "MURDER DEATH KILL".
There's a variety of ways to be harassed by drugged out people that are incredibly uncomfortable, especially if you are a woman, and will never be reflected in the murder rate.
I find the over-emphasis on the murder rate silly when people are talking about city-safety. It's like, "So what if you're being assaulted? You're not being MURDERED, you should be grateful you're not DEAD, deal with it bucko".
Add things like vehicle accidents and disease to the pile of things that should not be measured by deaths alone. It's like arguing rape isn't that bad because only a few people die from it.
Add things like vehicle accidents and disease to the pile of things that should not be measured by deaths alone.
It's like arguing rape isn't that bad because only a few people die from it.
This is an off topic side note. I usually hate telling people to avoid certain language, but I recommend against using the word "accidents" for any car wrecks or collisions. Safety experts...
vehicle accidents
This is an off topic side note. I usually hate telling people to avoid certain language, but I recommend against using the word "accidents" for any car wrecks or collisions.
Safety experts discourage usage of "accident" because it implies nothing could've been done or there was an innocent mistake. There are safety measures we could take to avoid almost 100% of wrecks, and making sure people don't think of them as minor accidents (like the automotive industry propaganda promotes) is a small thing individuals can do to help people take them seriously.
That's a great point. Although, that could well and truely be said about most any accident. My child knocking over a glass of water after telling them to move it so it wouldn't be an accident in...
That's a great point. Although, that could well and truely be said about most any accident.
My child knocking over a glass of water after telling them to move it so it wouldn't be an accident in my mind. But to them, they never meant to knock over that glass of water and resent that you implied it could happen.
Having driven around in PA in deer season though, the only way to prevent collision for them 100% is not to drive.
The Oregon state government didn’t want this to succeed and set it up to fail, exactly so they could say “look we tried and it didn’t work, so clearly we have to recriminalize it.” The voters...
Exemplary
The Oregon state government didn’t want this to succeed and set it up to fail, exactly so they could say “look we tried and it didn’t work, so clearly we have to recriminalize it.” The voters passed this expecting the state to take it seriously, but they left thousands of dollars unspent and ignored the advice of professionals on how to implement it successfully. I blame the mishandling by the state far more than I blame the voters for passing this. It’s still a good idea, but only if the people in charge of making it work are acting in good faith, which the Oregon government clearly wasn’t.
I think many in the state government wanted it to succeed, but to fully copy something like the Portuguese model is very expensive, and most voters/taxpayers really want to have their cake and eat...
I think many in the state government wanted it to succeed, but to fully copy something like the Portuguese model is very expensive, and most voters/taxpayers really want to have their cake and eat it too. Hence recurring issues with deficit spending: people hate taxes, but they don’t want their benefits/amenities cut.
I don’t think anyone was expecting to fully copy Portugal. But the state didn’t even invest in basic things like police training. (This article links to a Oregon Secretary of State audit, but the...
I don’t think anyone was expecting to fully copy Portugal. But the state didn’t even invest in basic things like police training. (This article links to a Oregon Secretary of State audit, but the link is broken, I think this is it. It’s unfortunate, because this could have worked if it was taken seriously.
From the article: After a failed experiment with legal leniency, Oregon’s liberal stronghold tries to chart a path out of the fentanyl crisis. Can the city find a balance between care and coercion?
From the article: After a failed experiment with legal leniency, Oregon’s liberal stronghold tries to chart a path out of the fentanyl crisis. Can the city find a balance between care and coercion?
There are a lot of contributing factors for the massive problems, but unfortunately step 1 of making things better is getting blamed: the decriminalization.
You know what happened when no fault divorce became a thing? A massive spike in divorces. It sparked talk about how it was the end of marriage. It turned out there were just a ton of women stuck in unhappy marriages, and the spike levelled off after the backlog was through. The baseline was higher than before, but that's because nobody needed to hide their unhappiness forever.
So we see the same with decriminalization. The problems associated were exacerbated by things like:
I think those three would have gone a long way toward mitigating the problem. "No street dealers" would have eased up a lot of the tourism and kept prices high. Legal sales would have raised tax dollars to further fund mitigation programs. Punishing unruly behavior appropriately would keep danger levels down.
Portland's problems would get better if more areas decriminalized, not less. Because all prison adds to the equation is making it even harder for the addicts to be functional members of society.
Recriminalizing is like taking away no fault divorce because the divorce rate is higher now.
I don't want to assume too much but I think that you might be getting confused with other decriminalization efforts. Drugs were actually decriminalized in the entire state of Oregon by ballot measure and, aside from a highly publicized drug market that temporarily popped up at the Lloyd Center area, the explosion in drug use and associated homelessness and mental health disorders affected not only the entirery of downtown but the entire city. Drug tourism in the sense of San Francisco's tenderloin was not really a general thing in Portland, in this case the state's famous camping laws allowed a problematic homeless drug using culture to become permanently entrenched.
As a very frequent visitor to Portland for over a decade, I have unfortunately been a witness to the acute ills facing the city and the relatively frequent gaps in my exposure have meant that my experience was more noticeable as I was not dulled by the blindness to change that comes with constant exposure over long periods of time.
The problems with Oregon's approach is mostly attributed to the fact that social support systems were not in place before decriminalization and that the approach was backwards. This and ill fated timing, both the COVID pandemic and a general national rise in drug use occurred on the very heels of the decriminalization, doomed the good intentions of voters.
I don't think it's necessarily fair to compare decriminalization and tolerance efforts, as seen on the West Coast, to no-fault divorce. Divorce doesn't directly destroy communities and disrupt the daily lives of citizens. This is difficult for me to square because I am generally against the criminalization of drugs and believe in social support to ease homelessness and treat addiction but I have also seen first hand what uncontrolled drug and mental health crises can do to a city. It's very sad in Portland's case where a vibrant downtown was almost entirely destroyed and where more than 80% of the population felt scared to go and it's only now, after recriminalization, where the downtown is recovering. I've begrudgingly come to the conclusion that the best results probably result from a good mix of tolerance, treatment, and enforcement.
Sleeping rough and using drugs are very sadly facts of life and, in my opinion, people's prerogatives but there is still a need to be civil in a society. If that is the life that has either been dealt to you or one that was chosen, however tacitly, then be discreet about it. Find somewhere to camp and consume that is not so public. But people's rights do end when they are making their fellow citizens unsafe and literally terrorizing large swaths of cities. If your mental health issues or irresponsible public drug use are dramatically affecting those around you, then you need to be removed one way or the other - either by involuntary commitment until you can be stabilized and offered treatment or by the justice system if your behavior is becoming criminal. I've stayed in downtown Portland, walked through the city and ridden on the Max, and even though I'm a fully grown adult male, I'll admit that at times it was legitimately scary even though I logically knew that homeless people generally are not dangerous but having someone literally acting like a walking dead character because they can't handle mixing fentanyl with amphetamines leaves one on edge because of the unpredictability of it all. That's no way to have a functioning society.
I just don't think that pure decriminalization is the right fit for America anymore. Social support services should be increased and basic possession and use should not subject people to the criminal justice system but I think that laws will sadly be needed to protect civil society from users who become criminal or habitually disruptive and that includes feeling free to consume hard drugs in the open.
There’s a better mechanism for intransigent users than criminal punishment: involuntary commitment to psych treatment. Punishing people for being sick is a sign of a sick society, and at least 99% of users (at least) are that as far as I can tell. Yes, we need to set boundaries around their behaviors, and as you say, we need to have adequate support for them at the same time we stop punishing them. But turning criminalizing them isn’t helping anyone but a small number of profiteers.
Not an expert but as I understand it, a problem with involuntary commitment is that it’s pretty squishy - a medical professional is making the decision based at least partially on vibes. And it’s still locking someone up, which might not formally be punishment, but often is under conditions that most people would consider punishment.
Having worked both personally and professionaly with both jail and IVC, I can promise IVC is almost always preferable. It serves a better purpose for the mentally ill and the addicted: it gives them a consequence, it gives them a chance at a break in a supportive environment, and, under the best of circumstances, lets them connect with people they can learn to trust.
It's not implement well, it needs way more resources. But imagine if we diverted prison/jail/justice resources to the acute psychiatric world?
On the other hand, when a judge or jury sends someone to jail or prison, you have . . . a person or group of people making a decision based at least partially on vibes.
True, but it seems like when there’s a specific crime that people can give evidence for or against, it’s usually more concrete than testimony about someone’s state of mind.
(State of mind plays some role in jury decisions, such in which murder charges to use, but there’s also evidence about who did what that’s not about state of mind.)
There are specific, non-ambiguous things we can make subcriminal but still grounds for involuntary mental health confinement though. Like (comically, really) stealing things — in Vancouver this is literally not punished if the perpetrator is a drug addict. Even assault is basically ignored. And the problem here is that in the case of drug addicts, there are a number of individuals whose recidivism rate is basically 100%. And it’s not a small number of people —
https://news.gov.bc.ca/files/Prolific_Offender_Report_BCFNJC_submission.pdf#page89
If someone is a drug addict, is not interested in getting clean, and also steals things and commits assaults, maybe they should not be allowed on the street until they decide that being clean is a better option. And if they never choose that? Maybe they stay confined for life. We confine people for life for murder, why not confine them for life for dozens of assaults and thefts? Especially if release is something they can achieve through determined work at sobriety.
I'm not sure if you read the article but criminalization does not mean locking up and punishing users just for using. I think Portland is doing it right, firm compassion or however they worded it. People are offered mental health and addiction support but criminal penalties are reserved for those who refuse or who become recurring problems. It's not punishing people for being sick, it's removing people from exposure to civil society for refusing to accept help. At some point one has to admit that you can only do so much to try and help people and that normal citizens need to be protected if one is unable or unwilling to be helped. While I agree with your stance on involuntary commitment, in the US only very limited holds are allowed to balance against individual civil rights - it will never be a viable solution for constitutional reasons. In light of that I see no real alternative to reserving criminal penalties for highly problematic individuals.
I don't think you're entirely wrong, however (quoting from your prior post in thread):
That sounds a lot like "We're pushing the problem under the rug. We don't care if it exists, we just don't want to have to look at it." Don't know if you've ever been in a psych ward before....it's not a pretty place. I'd just as soon take my chances with prison after having spent several stays there.
This is a problem in a lot of areas. Like that time Rudy Guiliani's solution to New York's homeless problem was to throw them all on busses to Atlantic City. It was pretty popular in the 90's. It's still popular today, but it was popular then too.
The addicts are addicts for a reason. The mentally ill are ill for a reason. There are many homeless that are one, the other, both, or neither. Society mostly only cares about the symptoms, not the cause. And if the symptoms can't be managed, they must be hidden or suppressed.
Every one of those perpetual addicts in Portland would have been addicts somewhere else. But we musn't let the problem be visible. We must criminalize the symptom lest it be too inconvenient for the people whom don't suffer from it.
I'll emphasize my own quote:
That is the exact opposite of what you've written here:
People are actively being offered help, not confinement. That means beds in a sobering facility, that means treatment options for addicts. And regardless of what a psych ward is like, prisons are not equipped to stabilize acute mental health crises and offer longer term care - conditions of facilities is an entirely different argument.
I agree. Homelessness and addiction are human conditions, you can reduce them but never eliminate them. While I completely agree with your sentiments to treat the cause, I can't agree with, what to me is blind reverse utopianism, where one believes that unchecked drug use and mental health problems should be allowed to disrupt communities.
I don't think that's a claim that can be backed up. Sure, addiction is a nationwide problem in the US but I can guarantee almost the opposite, that Portland's ill-instituted decriminalization allowed even more people to fall victim to addiction than otherwise would have. I know the nature of addiction very well and every eliminated barrier would only serve to enable abuse. We can debate harm reduction all we want (which I actually support) but drug free-for-alls only fuel these problems in the absence of rigorous treatment and prevention systems.
I'm not sure if you've ever been to downtown Portland, especially before and after decriminalization. The entire area was gutted. Businesses large and small closed down, night life never recovered after COVID, residents are scared and have to contend with literal biohazards on their doorsteps. Do you even understand how bad things have to be when over 80%(!) of a cities residents feel afraid to step foot in a very large downtown area? And we're talking about a rapid decline in only the span of three to four years. Combined with Oregon's liberal camping ordinances the situation was a powder keg that I really don't think is comparable to any other city in the entire US, not San Francisco, not New York, not Philadelphia, not Baltimore, and on and on.
We can never prevent anyone from becoming mentally ill (including addiction), but we can certainly do a great deal more to help those who are, now and in the future. And you are right that it is a human condition, meaning the solution needs happen at the level of humanity, that is, culture. It's not enough just offer addicts as stay in a "sobering facility."
What guarantee can you make? The incidence of mental health (including addiction) is the same across nearly every social and economic stratum, it just shows up differently among the less well resourced. Especially so, since they are often denied access to early treatment, so their conditions and concomitant symptoms are often far more prounounced. This is a social failure, and should be addressed socially.
Portland and similar places probably suffer from an in-migration of the already quite sick, sometimes voluntarily, sometimes bussed in like immigrants are bussed to "sanctuary cities," which exacerbates the problem for them and imposes an unfair cost of their more humane approach. Some day perhaps we will see a truly pro-life party arise that is willing to work toward a real soulotion (a typo, but I like it so I'm leaving it) to this problem.
I think, what I am saying, is best summed up by The Butthole Surfers, in "The Weird Revolution." You might see it as a sidestep, but I see it as an artistic explanation for our disagreement about methods. Maybe someday I'll write up a blog post with a more details, nuance, and clarity.
What the normal man calls "help" the weird man calls "subjugation." This could be seen from so many angles, and explains so much of society. From the schizophrenic to the autistic. From the LGBTQ+ folks to black folks.
The gay man does not wish to conform to straightness. The black man does not wish to conform to whiteness. They wish to be who they are, and these particular cases are seen as acceptable to the empathetic normal man. Because, by and large, the gay man and the black man are still seen as mostly normal.
The schizophrenic does not necessarily want to be medicated. The autist does not wish to be "normal": they wish to be accepted for who they are and be permitted to thrive as they are. And to the so-called "normal," it is virtually inconceivable that the answer is to foster an environment where the schizophrenic can thrive, rather than to medicate the schizophrenic until he can tolerate the environment of the normal man.
Many, many, many of the addicts are merely people whom cannot thrive or be happy in the only environment that is available to them. And the answer from the normal man is not to alter the environment: It is to suppress those whom cannot thrive in it.
(not the one you're replying to)
I emphatize with that, but your argument also clearly implies the other side: the environment these addicts live in was established by the normal man and its written and unwritten rules exist to maintain it. And they are choosing to profit from many of the upsides of living in this environment but at the same time destroy it instead of creating their own.
I don't think this is a way to accurately sum up the situation, but I do think it is just as legitimate as what you describe if not more.
I also think you're getting a bit too close to looking at someone who's doing violent crime and saying "well he's just a weirdo". I understand that's not specifically what you're saying and most addicts aren't violent, but the line beyond which we say "I don't care about your personal history and what caused you to do this, it's wrong and we're going to stop you and punish you" has to be drawn somewhere. For most people violence is beyond that. But I also understand people for whom "just" shooting up in the street in front of kids or verbally harrassing others is beyond that line. Society continually has to find a balance about where to draw the line, but when a person gets beyond it, yeah, repression (though there's a ton of space for improving how specifically it's applied) is the obvious answer and I don't think it's wrong despite anything you describe, that's just the reality of maintaining functional society.
I agree that violence should not be permitted. But I think that is somewhat orthogonal to the problem. It is not the addiction or the drug that is causing the violence: it is the failure of the system.
One other important facet that hasn't been brought up (part of the whole nuance and clarity in blog thing): There is a common thread for a large majority of the violent, perceptually homeless drug addicts. They're more likely than not to be children who aged out of the foster system.
Do many people think about how addiction and homelessness could be solved better by fixing the foster system? I don't think so, because society is mostly concerned about fixing the symptom.
Regarding the normal/weird dynamic: Remember it is a spectrum. Think of it as an Nth dimensional scatter plot formed by infinite one-dimensional spectrums. Sexuality, Gender, Empathy, Aggressiveness, Visual learners, auditory learners, blindness, deafness, etc. Every dimension that could possibly describe humanity mapped onto an indescribable chart, with normal defined as 'whichever cluster dominates in a given geographic boundary.'
The ruling class sees themselves as normal, and the commoners weird, and vice versa.
I would support this, I also support Housing First programmes and other projects aiming at fixing the cause. But at the same time there's a line beyond which it's normal and expected to want to cut down on the symptoms as well to get immediate relief for other people living and working in the area who likely did nothing to get into this situation. And to me this situation seems to be beyond that line.
Criminal penalties are a punishment, pretty much by definition
Additionally, 'refusal' of treatment is a symptom of the disease of addiction; in the case of mental illness it is often an inability to understand what's happening. In both cases, there is no real moral justification for punishment. And if one takes the stance that criminal justice is purely a utilitarian mechanism, involuntary commitment is still a far preferable outcome.
The exception I would make is for predatory dealers at every level. Criminal prosecution is definitely justified for them, they have choices. License dispenseries. In UK, doctors can prescribe heroin for addiction, why should it be any different here?
Protecting other citizens (I find it somewhat offensive to describe them as "normal" in this context) is a valid concern, but privileging the healthy over the sick, aka the empowered over the vulnerable, is morally reprehensible. The sick, especially the sick who lack any resources to help themselves, deserve at least as much protection as the healthy, probably more.
I don't think anybody has mentioned yet in the thread: Most addicts, for most drugs, are self-medicating for a condition that they don't realize they have.
We should also all remember the social aspects of addiction.
Or to sum up even more: Positive social interaction is what prevents and cures addicts. Regardless of the drug class or how addictive the drug itself is.
Fent addiction is a symptom of societal rot. Not a cause.
There's a legal reason for criminalization in the US. It's illegal to compel treatment for anything that's not a crime. The exception is 24 hour psych holds for threats of bodily harm, and those are very strictly limited (as anyone with severely mentally ill family can tell you).
If it's not a crime, the legal system can't be used to force someone to go to treatment. Offering addicts optional, voluntary treatment hasn't worked out very well as many big cities can tell you.
This is simply not true. In all the states I know about, which is several, you can be held involuntarily for as long as you remain a threat to self and others. That decision is often driven by money: a lack of beds forcing good doctors to release those who need to stay, and unscrupulous doctors compelling needless stays.
Those subject to commitment may appeal their stays (I worked as an atty on many of these cases), but courts rarely override doctor opinion.
And in many cases it’s necessary and saves lives and families, and could certainly be used for those who currently lack the wherewithal to seek or accept treatment voluntarily.
Right, if someone is an immediate threat to self or others, it's usually possible to get a court to order them into treatment, but my point was that outside of that situation it's basically impossible.
A non-violent, schizophrenic family member that becomes nonfunctional won't be involuntarily committed. Courts can't order a nonviolent person to take their meds unless there's another crime involved, and even then it's usually only possible to compel them while they're in the hospital.
Uninformed hot take incoming...
I'd be curious if anyone has tried automatic involuntary commitment for OD cases. It seems like clear evidence of self-harm tantamount to a suicide attempt - the inability to prioritize survival over getting a fix?
Self harm and suicide attempts are different. It could indeed be one or the other but rarely would it be both. Now you have someone going through withdrawal in the hospital designed for mental health, they don't want to be withdrawing, they're still physically or psychologically addicted to their drug and they lack the insurance or compliance for long term psychiatric treatment.
There's a lot of research coming out right now that overdoses are potentially tied to doing the drug in a different environment, so your body doesn't anticipate it (by kicking your heart rate up in advance for example) and then the same amount that would have been fine due to your tolerance is now (potentially or actually) deadly. They weren't trying to die, they survived the same amount multiple times.
The biggest thing about suicide attempts is most people don't want to do it again. At least not right away and often never. That's not the case with the drugs.
There are specific inpatient drug rehabilitation options, they're also not great places to be. But forcing someone through it does not improve their outcomes. You're basically back to prisons with extra steps and sedatives.
Thank you for the thoughtful explanation. I was under the impression that most OD cases were due to either a) resuming a former dose size after a period of abstinence, i.e. addiction relapse; or b) malformulated street drugs with excessive doses. In both situations, you could argue that the person has exposed themselves to unreasonable dangers they're no longer capable of avoiding without external intervention.
I agree that there are better environments for treatment than the mental health system, but "voluntary" is a hard boundary to reach when an addiction interferes with volition.
I just attended a presentation on the topic just in the past few months and I can't say how strong the research is compared to other possibilities.
What you described per your other methods is a) relapse, a part of addiction and recovery and b) being lied to and taken advantage of by dealers. You can't solve the first part without leaving someone locked up forever. And the latter would be actually solved by selling them clean drugs rather than locking up the user.
You could argue a lot of things but there are far too many people walking around with caffeine addictions who are awfully high and mighty about how "those people" can't make independent choices. Taking away more autonomy is rarely a good solution and it's almost never one for lasting sobriety.
What puts people at risk of addictions is a mix of genetics, family history, personal traits, financial security, trauma, certain MH conditions, and a ton of things people had no control over. Forced treatment does very little except make someone sober up, and typically solves none of the surrounding causes. You don't unmake addiction by forcing sobriety.
I mean will we be locking up cigarette smokers too? They're obviously also self-harming to the point of long term physical damage. The alcoholics? Not just the DUIs, but the barflies and the people that pick up a case of beer every night?
Nearly every parolee I worked with picked smoking up or back up right after getting out of prison (if they weren't getting cigarettes in prison too), and many started drinking alcohol and using cannabis, meth or cocaine again too. Because their lives were typically worse than before prison, not better. Some stayed sober, because they wanted it, and a very few needed something like prison to get sober - but if they didn't want it, it wouldn't stick.
I wasn't advocating for indefinite involuntary commitment. Rather, a means of assessing for underlying psychiatric conditions and treating them before release to a structured rehab program. I know you're the expert, but it seems like this would be a better approach than the choice of jail or rehab only.
That's not what psych holds do, and if someone's not willing it's essentially going to be an involuntary inpatient treatment. It's hard to make a schizophrenic person take their medication legally too, and it should be. But it should (and does) require a court order.
I don't think the only options are the two you offered. I do support diversion programs to keep folks out of jail for folks wanting to gain sobriety. The good ones will include psychiatric services. But mostly you have to solve the underlying social issues with wrap around support and that doesn't really work without consent.
You address this tangentially and by implication in your other post, but I want to draw it out explicitly.
While it is true (imo) that forced drug tx rarely results in immediate abatement of using or anything like recovery, sending an addict to prison almost always makes their life worse.
Forced tx is therefore better than criminalization. And sometimes, usually not the first time and often not ever, but sometimes that brief moment of sobriety opens a door to valuable insight down the road, leading to a willingness to get better.
Functionally I'd argue that forced, necessarily inpatient, drug treatment will basically have almost all of the negative effects on a person as prison. Everything short of the record which someone is also likely to have at that point anyway. And yes, as few folks will have the revelations but I don't believe the balance of pro/con there weighs out on the pro-side.
My re-entry program included case management, moral reconation therapy*, anger management, substance abuse treatment, and "career"/employment support. It was not inpatient but it was mandated and it was incredibly ineffective. (Especially because GEO Group cared more about money and saying the words "evidence based practices" than they did about following said practices). I am highly skeptical of holding people with addictions on functionally mental health holds, and also have bad news for people that think that most suicidal folks get effective treatment during those holds.
*Essentially it's "How to not be a criminal" therapy. It's theoretically effective but see above about following EBP.
If it's not too much to ask, are you able to compare it to 2018 for me? I've only been to Portland once and I remember a large amount of homeless drug users at that time, but it sounds like a different experience now. I remember the downtown areas being quite safe then, aside from a handful of spots, but we were 5 adult men.
It's difficult for me to really quantify that, although I'm sure we could come up with statistics. Portland is one of the, if not the, most liberal cities in the US and has always had a higher amount of drug use going on. Oregon also has extremely liberal camping laws that basically allow anyone to camp on public property, this is why the city attracts so many homeless. All I can say is imagine whatever you experienced in 2018 and multiply it many times. The police largely gave up policing around the time of George Floyd and the decriminalization efforts were done in tandem, as part of a new approach to "crime." The amount of visible homelessness has seen a stark uptick, drug use became completely open, and people having acute mental health crises became a very common sight around downtown. People stopped crossing the river into downtown and due to petty crime, a lot of businesses left, even longstanding staples like REI. I don't really know the true statistics of safety downtown, my impression is that it is still a relatively safe place to be but that the perception of safety is at tragic lows and perception is still a valid metric as humans have a need to feel safe where they live and conduct business.
As has already been pointed out, divorce is a terrible analogy.
You don't get addicted to no fault divorces. You don't leverage your house so you can get yet another no fault divorce because it's been a rough week. You don't strip the copper from everything in the community. You don't steal from people. You don't sit at home all day because of the high of a no fault divorce and come crashing down when it's been too long since your last one.
Fent is extremely potent, hyper dangerous, debilitating, and very easy to make. Oh and you can drop it into just about anything to make it more appealing (not just drugs designed to get you high. Hell you can put it in food technically.)
Pretty much a worse case scenario for any drug. Fent is roughly the equivalent societal problem as opium wars were but massively harder to solve because you can't limit the supply nearly as easily. I'm all for treatment first and not sticking to punishment just for use, but a common issue with drugs as destructive as fent is that they can very easily lead to straight up criminal behavior (theft, harassment, assault) and that's before you consider the very real "people will fucking die" problem that fent poses. Even legalized and regulated it's a trivial drug to OD on because it's not that hard for an addict to get enough to harm themselves.
Oh and from a corporate standpoint dear god what an ideal product. Repeat customers guaranteed, just get a good chemist to make sure you don't kill them. Obviously I don't think any "legalization" method is treating fent like weed where we're getting bakeries, but if i'm wrong about that you'd see that done in a heartbeat.
My point being, not only can you not easily compare fent to divorce, i'm not sure you can easily compare it to any other drug in the history of human drug abuse. It is uniquely awful and thus requires some very different approaches in how it's handled.
I do agree that decriminalization of use needs to be a starting point, but I do think some middle ground (while yes it's own problem) of forced treatment may be required as it's far far too easy for it to lead to brutal outcomes. Actual allowing of the production of and selling of fent outside of healthcare though is always going to be a problem. I see 0 way you can allow a product so potent and dangerous on the market unless you're some "it'll sort itself out" libertarian.
To be clear, I wasn't specifically comparing fent to divorce, rather decriminalization itself, regardless of the thing. The pattern of "spike, then drop, then plateau at higher level than before" will apply to the decriminalization (or properly legalization) of anything. I chose divorce because it is also championed as one of the worst things ever by the same people who want all abortions banned.
Would it be better if I said marijuana, which does not have nearly the same problems as fent in that vein?
Criminalization does not help addiction in any sense. Heavily regulated distribution and manufacturing, while not punishing the addicts, does.
Not really because again the spike is not the same in the slightest. There's an initial "oh neat new thing" spike for weed or something of the sort, but its not nearly as cripplingly addictive and dangerous as fent.
You can completely remove the punishment for consuming fent, and you're still going to have trouble with addicts breaking the laws because they're addicted. So again, theft, assault, harassment, and DUI at the minimum. Fent is a totally different tier of problem and I don't think it's productive to compare it to previous situations.
Drug laws have basically always sucked throughout history, but a big part of them does stem from "so we have to wait for this addict to rob/harm us?" complaints from the community, or "so i have to wait for my child to OD?".
So sure, lets do treatment, and lets not punish addicts if they haven't committed a crime, but seeing as how you said:
I don't think I can remotely agree. You cannot have a legal avenue for purchase for a drug like this. It should only be through very very tightly controlled prescription in helping to treat addiction. You must keep distribution illegal, and yes that sucks because sadly drug sales are an obvious route for the disadvantaged to try and fix things, but fent is so destructive.
I am consistently saddened that even in ostensibly progressive spaces, cause and symptom are so readily confused in the context of addiction.
While there is certainly an issue with physical dependency which varies among drugs, addiction is a disease of which drug use is a symptom. There are many symptoms of addiction, and some addicts seem very high functioning, as their symptom is seeking interpersonal validation, and so they get very good at wresting that from the people around them. This, in part, is why so many entertainers go through drug use, as all the symptoms of addiction hit the same root cause, and drugs tend to be the most effective.
Another implication of this truth: not all users are addicts, even of harder drugs (it’s possible to experiment or be susceptible to peer pressure, e.g.).
No other disease (except other forms of Mental Health) does society criminalize. Why do we do it with this one? Probably because it takes a lot of effort to overcome bias and truly understand an issue?
I think you're touching on some good points, but I think you're also underselling the physical dependency. Part of what makes narcotics so dangerous is that it's very possible to establish a strong physical dependency in one use. That dependency compels increasingly destructive behavior.
You are way understating the level of physical dependency an opioid as strong as fentanyl can cause.
Further we do criminalize a ton of other mental illness. Most often either because of some mix of ignorant/bigoted views and because the illness is straight up dangerous to those around them.
People who’ve been robbed by drug addicts aren’t likely to be empathetic to their plight.
Further saying that drug use is only a symptom of addiction is just not accurate when dealing with physical addiction. The “disease” is your completely fucked opioid receptors and the cause is absolutely opioids. Yes human chemistry varies tremendously from person to person but just as there’s people who can shrug off a lethal bender there’s others who can become cripplingly addicted just from the physical symptoms.
I don’t feel it promotes a better understanding to just try and treat every drug the same, and not respecting why things like fentanyl are so dangerous is also why it’s still disturbingly easy to get it prescribed in some areas (and impossible in others)
I think that's where we're at basically. With fent and opioids this whole decriminalizing and letting it happen thing isn't exactly working.
This is maybe going to sound pretty authoritarian/harsh, but I think we also should be taking some sort of extreme hard line on people selling fentanyl. Like, get caught selling fent laced drugs: 20 years in jail. Get caught with over some arbitrary quantity: life.
As in, "just let them die".
I don't know the exact details or if its still going on, but my city low key started that. They stopped buying narcan for bylaw officers and I think police. So if you OD and you don't have your own then you're waiting for an ambulance. There's no way to view this policy as anything other than trying to let drug addicts die off. Well, to be blunt, I don't think I see a reduction in clearly drugged out homeless people. Either new addicts are replacing the dead ones or they're all packing their own narcan now. Probably a bit of both.
Edit: I know not all people that overdose are homeless, but they're kind of a visible indicator.
My family visited Portland a few months back, and we really enjoyed the zoo, public transit, and walkable downtown!
The drug use was honestly worse than we expected though. We've travelled a fair bit including San Francisco, LA, NYC, Seattle, etc, and it was certainly up there for urban poverty and public drug use. There were streets we didn't feel comfortable even walking as a group. I logically understand I'm more likely to be murdered walking around downtown Little Rock, but drugged out people randomly screaming at you gets the adrenaline pumping even if you're sorta used to it.
I mean, there's also just the fact that the spectrum of unwanted behaviors that are directed against you span more than "nothing" and "MURDER DEATH KILL".
There's a variety of ways to be harassed by drugged out people that are incredibly uncomfortable, especially if you are a woman, and will never be reflected in the murder rate.
I find the over-emphasis on the murder rate silly when people are talking about city-safety. It's like, "So what if you're being assaulted? You're not being MURDERED, you should be grateful you're not DEAD, deal with it bucko".
Add things like vehicle accidents and disease to the pile of things that should not be measured by deaths alone.
It's like arguing rape isn't that bad because only a few people die from it.
This is an off topic side note. I usually hate telling people to avoid certain language, but I recommend against using the word "accidents" for any car wrecks or collisions.
Safety experts discourage usage of "accident" because it implies nothing could've been done or there was an innocent mistake. There are safety measures we could take to avoid almost 100% of wrecks, and making sure people don't think of them as minor accidents (like the automotive industry propaganda promotes) is a small thing individuals can do to help people take them seriously.
That's a great point. Although, that could well and truely be said about most any accident.
My child knocking over a glass of water after telling them to move it so it wouldn't be an accident in my mind. But to them, they never meant to knock over that glass of water and resent that you implied it could happen.
Having driven around in PA in deer season though, the only way to prevent collision for them 100% is not to drive.
The Oregon state government didn’t want this to succeed and set it up to fail, exactly so they could say “look we tried and it didn’t work, so clearly we have to recriminalize it.” The voters passed this expecting the state to take it seriously, but they left thousands of dollars unspent and ignored the advice of professionals on how to implement it successfully. I blame the mishandling by the state far more than I blame the voters for passing this. It’s still a good idea, but only if the people in charge of making it work are acting in good faith, which the Oregon government clearly wasn’t.
I think many in the state government wanted it to succeed, but to fully copy something like the Portuguese model is very expensive, and most voters/taxpayers really want to have their cake and eat it too. Hence recurring issues with deficit spending: people hate taxes, but they don’t want their benefits/amenities cut.
I don’t think anyone was expecting to fully copy Portugal. But the state didn’t even invest in basic things like police training. (This article links to a Oregon Secretary of State audit, but the link is broken, I think this is it. It’s unfortunate, because this could have worked if it was taken seriously.
From the article: After a failed experiment with legal leniency, Oregon’s liberal stronghold tries to chart a path out of the fentanyl crisis. Can the city find a balance between care and coercion?
What a mess