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America’s syringe exchanges kill drug users
- ryzvonusef 4y ago> Decades of research prove that these programmes curtail disease. Junkies are in fact less prone to sharing needles when they get free ones. That sharply decreases rates of blood-borne illnesses. In 2014 an analysis found that every dollar spent on syringe exchanges spares the government around $7 in HIV-related health-care costs. Needle exchanges opened across America and Europe. For years no one detected the feared rise in substance abuse. > That was before the opioid crisis plagued America and economists started looking into the trade-offs. A new study by Analisa Packham published in the Journal of Public Economics uncovers an uncomfortable truth: this particular harm-reduction tool does lots of harm. Ms Packham compares how drug users fared in counties that opened syringe exchanges between 2008 and 2016 with those in counties that did not. Before the clinics opened, upticks in HIV diagnoses or overdoses in one set of counties were mirrored in the other. Once a syringe exchange came to town, outcomes diverged. Rates of HIV fell by 15% in counties with the new programme. But deaths soared. On average syringe-exchange programmes led to a 22% spike in opioid-related mortality. > Simply lowering the risks of getting sick—and the costs of paraphernalia, as Flaco from the Bronx articulated—could also incentivise drug use. Distributing PrEP, an HIV-prevention medication, has been shown to make gay men less inclined to use condoms during sex. So too could harm-reduction tools make addicts use drugs more incautiously. In a study published in 2018 Jennifer Doleac and Anita Mukherjee found that when states legalised naloxone, a medication that reverses overdoses, opioid abuse increased. Though lauded by public-health advocates, naloxone did not save lives as intended. In some regions, fewer addicts died; in others, more did.
- ryzvonusef 4y agoseems like people would rather suppress the truth rather than let research be allowed to stand scrutiny on it's own merit > These works have been met with anger. Their findings upset harm-reduction defenders who consider their efforts already besieged by critics. The experience was so miserable that Ms Doleac, who studies crime, has decided never to write another health paper. > Leo Beletsky, a former drug dealer, now at Northeastern University, deems Ms Packham’s findings “nonsensical” and thinks her paper should not have been published. Don Des Jarlais, at New York University, argues that addicts do not respond to incentives like others do, making the moral-hazard effect inconceivable. Susan Sherman of Johns Hopkins University says she doubts that new evidence that harm reduction does more bad than good would convince her to disregard previous research demonstrating otherwise. > A barrage of complaints led the editors of the International Journal of Drug Policy to retract a meta-analysis that found that safe-injection sites, where users do drugs in supervised settings, did not decrease rates of deadly overdose. “Retractions used to be reserved for fraud,” says Keith Humphreys of Stanford University, a former drug-policy adviser for the Obama administration. No longer, it seems.
- slowmovintarget 4y ago> “Retractions used to be reserved for fraud,” says Keith Humphreys of Stanford University... Science denial has many forms. This appears to be one of the older ones.
- version_five 4y agoPeople are really bad at accepting information that superficially contradicts something they want, and react by disputing the information instead of taking it into consideration while still pushing for the ends they want to achieve. In this case, I'd speculate that harm reduction advocates aim is to (tautologically) reduce the (physical/health) harm of drug use so that it's one less problem users face. One aspect of this may be safe consumption, which this article says doesn't work on it's own. Another aspect is overdoses form Fentanyl et al, (which I would argue is largely a byproduct of a drug war that has made heroin too hard to import, and no safe medical supply options for treatment). So the focus could shift to addressing this (which in tandem with safe injection sites could still produce better overall outcomes). My point is that it's not productive to dispute the studies, better to accept on balance of probabilities and look at how it fits with your overall aim. (Climate change is very similar. People dispute the studies because they don't like the political rhetoric about how we should react, not because deep down they think all the research is flawed)
- hooverd 4y agoI think some drug warriors become harm advocates. If drug users can't overcome their moral failures, before they suffocate on their vomit than be resuscitated with naloxone.
- the_only_law 4y agoWhat? This isn’t even a sentence. It’s a collection of sentence fragments and I can’t tell what the hell it’s trying to say.
- hooverd 4y ago
- f38zf5vdt 4y agoIn terms of burdening the already dysfunctional healthcare and criminal justice systems of the US, it sounds like it works great. If the junkies no longer exist and less frequently get HIV, their cost to society is less than if they were alive, disease spreading, and committing crime.
- giraffe_lady 4y agoThis comment is an excellent example of how you can openly call for violence against the vulnerable on HN without censure or consequence as long as you do it in a certain tone.
- throwayyy479087 4y agoSaying that we shouldn’t enable certain behavior is not violence. Violence is violence, stop messing with the meaning of words.
- giraffe_lady 4y agoWhat is the meaningful difference between killing someone yourself and letting them die when it's in your power to prevent it? Saying that a certain population should die because of their criminal nature and high "cost to society" is straight up nazi shit. What's the policy implementation of that opinion just curious? It really doesn't get more clear than this.
- ROTMetro 4y agoI am sure you currently work with or have family members who secretly are addicts. Labeling them as a cost to society, disease spreading, and committing crime and justifying their death instead of talking about them as people in pain is definitely disgusting and not the type of discourse I would have expected from this site. But hey, keep on with your reductionism as justification for complicity in peoples deaths. Also remember, they can't get needles not because they don't want to buy them but because it is illegal to sell them.
- moistly 4y ago
- aqme28 4y agoThe article is paywalled, but this suggests to me we go further in harm-reduction. The problem is specifically opioid overdoses, so we should have more supervised-injection sites.
- dmix 4y agoYeah there’s still plenty of solutions here within the current system.
- the-printer 4y agoHelping the drug users get off the drugs could reduce plenty of harm, I reckon, but when that fails why is the alternative helping them stay on?
- cwmma 4y agoEasy because if you fail to get them to quit, then the goal is to keep them alive so you can help them quit latter.
- aqme28 4y agoWhy are those mutually exclusive? We should help drug users get off drugs, but we shouldn't make it deadlier for them if we fail.
- the-printer 4y agoBecause making it “less deadly” somehow equates to enabling them. I think that people are more concerned with opioid death statistics than opioid addiction itself. And there is a shattering sense of defeat, which is normal, that is associated with realizing that you cannot help anyone who doesn’t want to help themselves. And if they don’t want to help themselves, then they may go down a collision course that will be their undoing. In this case that often means death.
- aqme28 4y ago> people are more concerned with opioid death statistics than opioid addiction itself. I feel strongly this way, or maybe I'm missing your point. Addiction is terrible, but death is clearly worse than addiction. Addiction is survivable.
- croes 4y agoAnd how many are these 15% and 22%?
- tinus_hn 4y agoPaywall bypass: https://archive.ph/fzBoE https://archive.ph/fzBoE
- rhaway84773 4y agoThe study mentioned makes no effort to show causation. And the correlation can very easily be backwards. In fact, its more likely backwards. Counties which are facing an increasing barrage of opioids and all the issues related to it, especially spread of disease and an increase in deaths due to unsafe use are almost certainly more likely to create safe needle exchanges. For the economist to write this article as if causation is established, and further to moralize is insane. Especially since the Economist famously doesn’t provide bylines so this becomes the official view of the magazine as opposed to a specific editor’s. And finally, even if the causation is correct, all it indicates is that needle exchange programs need to also provide drug testing capabilities so the presence of fentanyl can easily be identified.
- vorpalhex 4y agoYou're assuming the fentanyl is accidental, not intended.
- htag 4y agoI agree with most of what you said, but I think one line is out of touch. > And finally, even if the causation is correct, all it indicates is that needle exchange programs need to also provide drug testing capabilities so the presence of fentanyl can easily be identified. This assumes that there are no individuals that are knowingly injecting fentanyl or that a drug user would not take drugs in their possession if they knew it contained fentanyl. Yes, there are individuals that unknowingly take a fentanyl containing substance but I am doubtful that those deepest in opioid addiction avoid it.
- ThrowawayTestr 4y agoFentanyl is not a pleasurable drug. Someone buying heroin wants heroin, not a drug that will just knock them out or kill them.
- xyzzyz 4y agoThis is wrong. There is no heroin anymore, only fentanyl. The addicts know what they are getting.
- googlryas 4y agoDo exchanges even require an exchange? Here in Boulder city funded groups will just give junkies needles for free. And then you end up with needles littered all over the place. At least with an exchange junkies would keep their needles if they can manage. A few years ago 4 year old was pricked multiple times by a used needle that they found in a park.
- OmahaBoy69 4y agoWhere in Boulder are you finding needles? I'm yet to see one after ~4 years here, but I've mostly stuck around CU campus and Pearl and the surrounding areas. Plenty of discarded vapes everywhere, though.
- googlryas 4y agoBoulder Creek is the most glaring spot, but you might have trouble finding them until the homeless campers tents are forcibly removed once every 9 months. Scott Carpenter is another good spot. Park East Park is where the aforementioned kid was pricked.
- sacnoradhq 4y agoI drove through Boulder and Boulder Creek.. it didn't seem like a happy place. Denver, OTOH, seemed quite cheerful. Did I get a proper impression of each or anecdotal anecdotes?
- deleted 4y ago[deleted]
- davesque 4y agoAnecdotal I'm afraid.
- PaulHoule 4y agoI am definitely seeing them on the ground within a few blocks of the needle exchange in Ithaca, NY and this is something that's become noticeable in the last few years. It's part of a general coarsening of urban life, where it is not unusual to hear gunshots at night, you hear about fatal stabbings just a few blocks from where a friend of mine lives downtown, etc.
- jpm_sd 4y agoNo, fentanyl kills drug users.
- at-w 4y agoJust like fentanyl doesn't "kill" anyone either, respiratory arrest does.
- ahoy 4y agoNo way, The Economist, a right wing publication, is against non-carceral drug policy. Who could have predicted that.
- slavik81 4y agoThe Economist favours legalization. No, they are not against non-carceral drug policy.
- wisemang 4y agoThe case for legalisation (2001, but still): https://www.economist.com/leaders/2001/07/26/the-case-for-legalisation https://www.economist.com/leaders/2001/07/26/the-case-for-le...
- vorpalhex 4y agoTheir front page is a sex positive article and an anti-Musk twitter article. Just because they say something you dislike doesn't make them "right wing".
- edgyquant 4y agoBecause the economist (a left liberal organization) is evidence based all far leftists will see it as right wing even though it never endorsed conservative candidates.
- foldr 4y agohttps://www.economist.com/leaders/2015/05/02/who-should-govern-britain https://www.economist.com/leaders/2015/05/02/who-should-gove...
- foldr 4y agoThey are pretty clearly right-leaning from a British point of view. For example, they endorsed David Cameron and supported austerity.
- boeingUH60 4y ago
- jupp0r 4y agohttps://archive.ph/fzBoE https://archive.ph/fzBoE
- jeffbee 4y agoI used to live in San Francisco at the corner of Guerrero and Market, about 200m from where some do-gooders operated the needle exchange on Duboce between Market and Church. On the day after the needle exchange I always had to 1) remove some unconscious drug addict from my stoop, either by just shoving him out of the way or by calling an ambulance in extreme cases, then 2) put on a disposable Tyvek suit and pressure-bleach all the feces and vomit off my porch. Meanwhile the "harm reduction" perpetrators were at their own homes which were evidently in far-away neighborhoods. The only way needle exchange fits into civilized life is as one aspect of a shelter-first treatment scheme that gets these people to a place where they can vomit in their own rooms for a change.
- ROTMetro 4y agoThis. A shelter first scheme is where taxes on legalized drugs should go. Gas tax funds the highways, drug taxes should fund mitigating drug's harmful effects on society first, with any other use secondary.
- gusgus01 4y agoFor those interested, the study from Ms. Packham: https://apackham.github.io/mywebsite/opioidpaper_webcopy.pdf https://apackham.github.io/mywebsite/opioidpaper_webcopy.pdf
- rhaway84773 4y agoThat’s interesting. I read the approach details. Nothing in there indicates why the results should reflect causation versus correlation. Before reading that I thought that maybe the SEP groups were wrong to call the publishing of the paper a mistake, but now having read it and seeing that it presents correlational data as causational data I understand why those groups were criticizing the research itself. I’m not an expert in this field so I would appreciate if others can also read the actual paper and explain to me why the author is correct to claim causation instead of correlation.
- psychphysic 4y agoI think most of the lay public have the wrong end of the stick. Proving causation is the cherry on the top of research. Most of the time correlation and mechanism is all that can be found in a timely manner. This data is really quite good. Correlation between smoking and poor health was shown decades before causation was considered proven. It'd be ridiculous to tell someone don't worry keep smoking, all the data we have this far shows only correlation! Right up until the 50s, when in the 20s it became apparent smokers died young. What we see here is people moving thresholds depending on their bias. This is the root cause of confirmation bias.
- its-obvious 4y agoLegalize opium and the number of overdoses would plummet, as well as blood-transmissible diseases like these. It's at the point that if you're not aware of and advocating for obvious solutions like this, the blood is on your hands.
- TylerE 4y agoPart of the problem, ironically is the war on opioids. I’ve read many accounts of people with legit chronic pain being cut off by the doctor… which simply results in them getting relief wherever they can find it.
- ROTMetro 4y agoMany dudes I knew in prison on drug charges were ex-military recent vets who picked up a pill habit from their service related injuries/chronic pain. That pill habit needed to be fed and pills got harder to find leading to dealing/importing fentanyl analogs from China.
- vorpalhex 4y agoWould opium deaths be then on your hands?
- its-obvious 4y ago
- edgyquant 4y agoSmoked opium is not gonna cut it for heroin junkies. Save your condescension for after you have actual points.
- standardUser 4y agoWhy downvote this? It's plainly true. Most drug-related deaths are from disease, contamination (fentanyl), improper dosing and black market violence. Those issues all virtually vanish with legal access to drugs. So we can choose to a) change our obviously failed policies and start saving lives or b) keep doing what we're doing and keep paying the cost in taxes, personal liberty and lost human lives. If you need data, look at Portugal.
- throwawayoaky 4y agoHorrifying pull quote: "Simply lowering the risks of getting sick—and the costs of paraphernalia, as Flaco from the Bronx articulated—could also incentivise drug use."
- wwarner 4y agoCigarettes are taxed at $4.35/pack to discourage smoking. But you can get syringes for free.
- tonyarkles 4y agoI get the point you’re trying to make, but there’s a bit of nuance here and there. Long-term I agree with you: - smoking has long-term negative health outcomes - drug abuse also has long-term negative health outcomes Short term: - I can’t even really think of a dirty-needle equivalent for smoking - using a dirty needle has a large number of short-term/acute/immediate outcomes: infection, incurable disease (Hepatitis, HIV, etc) and spreads between users It’s not as if we’re taxing cigarettes and giving away fentanyl for free to everyone. Yes, we even do give some drugs out for free (e.g., methadone and suboxone), but only to people who have already ruined their reward systems and become addicted. I couldn’t go to a doctor or a clinic and say “the last time I consumed an opiate was 12 years ago after my knee surgery but please sign me up for free methadone!”
- maxerickson 4y agoHepatitis C is often curable these days. The treatments aren't effective 100% of the time, but much of the time the virus is cleared completely.
- theptip 4y agoA general point in drug harm reduction - the “classic” drugs are mostly surprisingly safe. MDMA, LSD, cocaine, even heroin (when pure) have quite favorable safety profiles compared to, say, alcohol as a benchmark. Also, the long-term health effects are well understood, and treatments for overdose established. For example, it’s safe to take (pure) heroin regularly (though I wouldn’t personally advocate for this of course). On the other hand, the new families of synthetic drugs (Cathinones that replaced MDMA, random novel psychedelics, and fentanyl replacing heroin) all have far worse safety profiles. When you make drugs illegal, the market responds by finding the cheapest illegal substitute, with little concern for safety. On the other hand, if we made heroin legal, then nobody would mess with fentanyl. Ditto with MDMA over m-cat or whatever. And while drug use would increase a bit at the margin, harm to society would dramatically decrease. Most people don’t actually want to be junkies it turns out! The money saved from not criminalizing drugs could provide extremely good addiction counseling for anyone that wanted it, further reducing the harm. And lots of crime is just stealing to buy drugs; it’s plausible that overall crime would go down substantially if we gave heroin prescriptions to addicts. I’d rather prescribe heroin (with free access to good addiction counseling) to someone who is addicted than have them breaking into cars stealing stuff to fund their habit. Finally, another related argument - the geopolitical harm of the drug trade is immense. Drugs flow north to the US, and money and weapons flow south to the cartels. If we legalized cocaine, then we’d stabilize many regimes (eg Mexico, Columbia) that are currently struggling with cartel violence. On net you’d see a massive flourishing of humanity under this policy. A little bit more drug addiction in countries that can afford to treat it, and way less murder and kidnapping in countries that are trying to catch up. (Surprisingly, the Economist recently advocated for legalizing cocaine: https://www.economist.com/leaders/2022/10/12/joe-biden-is-too-timid-it-is-time-to-legalise-cocaine https://www.economist.com/leaders/2022/10/12/joe-biden-is-to...)
- sacnoradhq 4y agoHeroin isn't anywhere close to "safe" due to the addiction dependency cycle it induces and the devastating, permanent effects it has, especially tooth loss and skeletal deformations of the hips and spine. The issue is that criminalizing drug use costs society far more than encouraging treatment. It doesn't make sense to criminalize obesity, tobacco use, or alcoholism, so why continue to outlaw certain substances other than for historically-racist/-political reasons?
- deleted 4y ago[deleted]
- puppycodes 4y agoCalling drug users "junkies" made me feel like this was written in the 80's
- rufus_foreman 4y agoObjecting to calling junkies junkies makes me wish I was living back in the 80's.
- chlorion 4y agoAll drug users are horrible criminals who want to stab you for their next hit!!! There are definitely no drug users who are regular people who don't commit any non-possession related crimes!! Fox news told me drug users are the cause of all crime so it must be true.
- DueDilligence 4y ago.. I am a Harm Reduction Counselor and this is article is woefully inaccurate, even willful misinformation. Should. Not. Have. Been. Approved. For. Publication.
- TMWNN 4y agoThe more frenzied the denunciation of the mere act of publication of something, the more I presume that the published work is accurate.
- sixo 4y agoEvery line of this Economist article is an emotional attack against Harm Reduction. It's just as frenzied, but with an editor. They may well be right here, but the article is garbage.
- EdwardDiego 4y agoSo the author(s) are implying that the risk of blood borne disease prevents addicts overdosing? Uh, would love to understand their thinking on this. Because you know, addicts are _addicted_. If needle exchanges don't exist, they steal the fit from hospitals. If they are struggling to do that, they re-use, which isn't great for your veins, and if worst comes to worst, they share. The one thing they _don't_ do is stop getting high. Because they're addicted. If they were positing that the risk of blood borne disease prevented people who weren't addicts from trying IV drugs, then it's more plausible. Source: Used to be an IV drug user, and was very glad indeed for needle exchanges. Heroin is a hell of a drug to get off, but at least I don't have HIV or HepC to remember it by.
- sacnoradhq 4y agoSimilar to Portugal, legalizing all drug use, with a focus on treatment and pretrial diversion into treatment rather than the unending failure of Prohibition 2.0: The War on Drugs is what works. Needle exchanges are a component of reducing infectious disease rates rather than addressing drug use. The problems are the US continues the costly and ineffective War on Drugs, grossly-unequal poverty, and doesn't have healthcare, mental healthcare, or drug treatment for all. Until those all happen, hating on drug users or use a strawman about efforts to reduce infections in that population won't solve the bigger problems, and don't justify criminalizing drug use.