10 ms·

Suboxone is handed out like candy in downtown Toronto and East Hastings Vancouver to any addict who wants it and is willing to show up at a pharmacy daily until

by dmix 4y ago

Suboxone is handed out like candy in downtown Toronto and East Hastings Vancouver to any addict who wants it and is willing to show up at a pharmacy daily until they build trust with a doctor to get it on long term prescriptions. This is part of the solution which is sorely lacking in many US states but it’s not some catch-all solution to drugs. It’s basically a better version of Methadone which has been available widely in the US since the 1980s. I recently watched Sid and Nancy about Sid Vicious and him and his girlfriend are getting Methadone at a pharmacy in 1980s NYC before he later relapsed and offed himself. https://www.imdb.com/title/tt0091954/ https://www.imdb.com/title/tt0091954/ It’s important no doubt but moving beyond the prohibition drug war approach (which is failing in places going hard as it is weak like Canada) to dealing with this requires a serious reckoning and public investment that we aren’t ready to accept yet but will be imposed on us whether we like it or not.

seanmcdirmid 4y ago
> It’s important no doubt but moving beyond the prohibition drug war approach (which is failing in places going hard as it is weak like Canada)to dealing with this requires a serious reckoning and public investment that we aren’t ready to accept yet but will be imposed on us whether we like it or not. There are lots of contradictions here. Voters don't understand how they can be asked to liberalize hard drug use (and even decriminalize dealing) on the one hand, and are asked for billions of dollars for drug addiction treatment on the other. In Seattle, we have a particularly bad mess, where the biggest thing now is trying to fentanyl smoking off of public buses and light rail. They are even talking about studying the dangers of second hand fentanyl smoke to bus drivers. Hopefully we can learn something from our neighbors up north, but frankly it doesn't seem to be that much better in Vancouver.
- lazyasciiart 4y ago
  It's pretty deliberate failure to understand, in my opinion, driven by a core belief that bad things happen to bad people and they need to be punished out of it, not helped. The goal for many people is absolutely not reducing deaths, or even getting rid of fentanyl smoke on buses. It is expelling fentanyl users from society and expecting that will stop new users appearing. That's why they don't want to spend money on treatment or services. They think enabling the existence and recovery of existing users will encourage more.
  - deleted 4y ago
    [deleted]
  - seanmcdirmid 4y ago
    > or even getting rid of fentanyl smoke on buses. The burnt peanut butter smell is pretty rancid. Voters, even in Seattle, only have a finite amount of empathy to spare on this problem, and it has mostly been expended. > It is expelling fentanyl users from society and expecting that will stop new users appearing. That's why they don't want to spend money on treatment or services. They think enabling the existence and recovery of existing users will encourage more. We (King County at least) spend around $100k/junkie per year on services. And that still isn't considered enough. So should we double our property taxes or something to spend even more money on this problem? > They think enabling the existence and recovery of existing users will encourage more. If Seattle is the only place these people can get help across the whole country, that would definitely occur. You can't fight a national problem with local resources and not expect distortions (people are mobile).
    - pstuart 4y ago
      This is a national problem and needs to be addressed (and funded) as such. The war on drugs has failed miserably (for it's ostensible purpose (to "protect" us from dangerous drugs). We need to legalize and regulate them all, and make their abuse a medical issue rather than a criminal issue. For those that have no desire or ability to quit, we can put them in camps and hand out dope to keep them sedated and "safe" from questionable supplies. If they want to get clean, they can have the support to do that but otherwise are effectively interned on work farms. This is the cheapest, safest, and most humane way of dealing with this problem.
      - eurasiantiger 4y ago
        You still fantasize about a world where everything and everyone is ”clean”. That will never exist but you will destroy the humanity of yourself and others in an attempt to delude yourself.
- kerkeslager 4y ago
  > Voters don't understand how they can be asked to liberalize hard drug use (and even decriminalize dealing) on the one hand, and are asked for billions of dollars for drug addiction treatment on the other. It's easy to communicate this: We spend billions to incarcerate people for drug crimes, and then send them out with a criminal record that pushes them right back toward drug use. OR we spend fewer billions on drug addiction treatment and housing. It's not confusing or contradictory at all. People who end up in prison don't get help, and people who get help don't end up in prison. "Voters" wouldn't be confused if certain interests didn't keep them confused. It's profitable to keep housing scarce and prisons full. Until we start prioritizing sick people over profiteers we won't fix this problem.
  - schrectacular 4y ago
    In prison or dead means they aren't on the streets and people don't have to face or interact with the problem. I would guess that many voters are much happier with "out of sight, out of mind"
    - moonchrome 4y ago
      Also not a risk to you. Most drug addicts are not the kind of people you want around. There are highly functioning ones, but it often exacerbates mental health issues. Not sure prohibition is the correct approach but let's not strawman the other side of the argument.
      - kerkeslager 4y ago
        > Most drug addicts are not the kind of people you want around. True, but how much time does the average non-addict spend in drug rehabs? Both prisons and rehab facilities isolate addicts from the general population.
  - jibe 4y ago
    California has been at the vanguard of reducing prison population, and decriminalizing drug use, and so far the results look disastrous. That’s not a policy that needs any confusion to be unappealing.
- noduerme 4y ago
  Portlander chiming in here. I think it's almost universally accepted now that decriminalization was a stupid idea - and I myself voted for it at the time. I absolutely would still vote for anything that improved the availability of treatment for addiction, regardless of cost. But I think what we've learned is that every carrot needs a stick. And where there's excess supply, demand will catch up. All of which means, go after supply and possession again until this is under control.
  - eurasiantiger 4y ago
    Or take your head our of your ass, stop enacting half-hearted measures like decriminalization and completely legalize the supply. Your prime issue is corruption, not drug use
    - tayo42 4y ago
      i don't get why decriminalization keeps getting pushed by people my cynical take, entrenched people have something to gain by the grey area decriminalization offers.
      - Jochim 4y ago
        My point of view is that locking people up for drug use: * Hasn't reduced drug use * Makes them more likely to continue their drug use * Often leads to the use of harder drugs * Is expensive * Provides funding to cartels * Causes violence Decriminalising, or legalising drug use removes one of the main motivators of gang formation/violence while allowing the state to focus on helping addicts recover and contribute to society. The money spent on enforcement can now be spent on treatment, reducing the need for further funding rather than increasing it.
        noduerme 4y ago
        There is another option, which is to leave the users alone and go hard after the suppliers.
- lostlogin 4y ago
  > Voters don't understand how they can be asked to liberalize hard drug use (and even decriminalize dealing) on the one hand, and are asked for billions of dollars for drug addiction treatment on the other We are increasingly spending more on drug treatment. The current approach has failed and <x> are dead. It's time to change our approach, and a radical change is needed for this massive problem.
- CaptainZapp 4y ago
  > Voters don't understand how they can be asked to liberalize hard drug use (and even decriminalize dealing) on the one hand, and are asked for billions of dollars for drug addiction treatment on the other. That depends on the voters. In the 90s Switzerland experienced a significant change in its drug policy. One of the pillars (arguably the most important) is harm reduction. At that time hardcore addicts could get heroin prescribed and paid for by health insurance. Getting into the program was not simple, but for those that were hopelessly addicted and not able to kick the habit it was fundamentally successful. The policy is still in place and was confirmed with significant majorities by the voters in multiple referendums.
- vintermann 4y ago
  > There are lots of contradictions here. Voters don't understand how they can be asked to liberalize hard drug use (and even decriminalize dealing) on the one hand, and are asked for billions of dollars for drug addiction treatment on the other. And understandably so. It's a textbook example of privatizing the profits, and socializing the costs. It's not enough to tax drugs. Certain products are so harmful, and their harmful use so profitable, that allowing any kind of private profit from it at all is a disaster. (Yes, the most prominent of those are tobacco, alcohol and gambling). Worse, addiction treatment is really expensive and not very effective - even the best addiction treatment programs have high relapse rates. Even the relatively cheap programs that only seek to limit the damage addicts do to themselves and others, can only be defended on humanitarian grounds, not economic ones. Yes, we need to help addicts. Yes, including in purely harm-reduction ways. But we're deluding ourselves if we think this is a solution at all, let alone one we can afford if we let private economic interests profit from addiction without obstacles.
- themitigating 4y ago
  Why can't they understand this? Criminal enforcement and crime are apparently a major concern among voters. They are just the victim of right wing propaganda
- mrguyorama 4y ago
  A lot of those voters seem more interested in just letting """bad people""" die.
refurb 4y ago
Buprenorphine is allowed in all US states and the FDA recently said even family doctors can initiate therapy. And British Colombia is have record numbers of fatal overdoses, so while a tool, its not a solution to the crisis.
- dmix 4y ago
  It’s not always just about what is “allowed in US states” but making it easy for addicts who need a solution to be locally accessible vs just as easily going on the corner with $10 for another high. I was purposefully being colourful saying Suboxone was handed out like candy in Canada but it probably needs to be to compete with the wide availability of Fentanyl and other drugs. I should also note that being in favour of harm reduction doesn’t mean tolerating Portland style appeasement of crime and public …craziness. The baby is often thrown out with the bath water with this stuff and it doesn’t have to be that way. But that overreaction goes both ways in terms of dealing with the drug problem.
  - jrumbut 4y ago
    Yeah this a key point. Buprenorphine availability is very inconsistent in practice throughout the US. I'm not just talking about rural Kansas here either, it can be a struggle in every state and many major metro areas. Especially if you have all the associated problems one might expect (no car, no money for a copay, other health problems, etc). Additionally, the actual treatment provided varies considerably between doctors. Do they give the patient enough to avoid severe withdrawal? Do they allow the patient to stay on buprenorphine long term if needed? How do they handle relapses? What sort of counseling or therapy do they provide (if any)? Do they take insurance?
  - refurb 4y ago
    Buprenorphine is available through telemedicine (even before Covid). https://www.statnews.com/2022/03/07/doctors-companies-push-to-keep-looser-pandemic-era-rules-for-prescribing-opioid-addiction-treatment-via-telemedicine/ https://www.statnews.com/2022/03/07/doctors-companies-push-t... I wont argue there are some barrier, but it’s not hard to get anywhere in the US.
bogomipz 4y ago
Are you referring to the scene where Sy Richardson admonishes them before giving them their methadone doses? That's a methadone clinic not not a pharmacy and he's a public health/social worker.
nibbleshifter 4y ago
I'd make suboxone available OTC, no questions asked. Low cost, or even just free if you register as an addict. Same for naloxone/narcan/whatever "overdose stopper" autoinjectors. Which, I'm reliably told, are the opposite of a good time. Suboxone is not a drug you can really abuse in any fun way, and a lot of folks won't engage "formally" with addiction services due to stigma, paranoia, worries about their medical records being tainted forever, etc. The addicts you see on the streets are just the tip of the iceberg. Much like alcoholism, the vast majority of users are "hidden". There are multiples more users who are still functioning within society, holding down jobs, etc.
- cudder 4y ago
  Addicts will find a way. Buprenorphine is the most abused opioid in Finland. Which by the way has the most youth drug deaths in Europe[1]. Granted it's usually Subutex (just buprenorphine) rather than Suboxone (buprenorphine + naloxone) but there's not much difference unless you're using intravenously because buprenorphine has such a high binding affinity. I agree that there's a huge problem with opiates and am in favor of legalizing everything, but it's good to realize that buprenorphine is not a magic candy that fixes everything - you're just replacing an addiction to a deadly feel-good opiate with an addiction to a slightly less feel-good opiate with a larger therapeutic index. [1]: https://www.euronews.com/2023/03/16/why-are-so-many-young-finns-dying-from-drug-abuse https://www.euronews.com/2023/03/16/why-are-so-many-young-fi...
  - nibbleshifter 4y ago
    TIL about the abuse in Finland. I was aware it was sometimes abused by prisoners, but that's new. In another comment I went into a bit more detail around ways of dealing with the issue, using Finland's homeless housing policy as part of it. Its a complex issue that certainly isn't going to be resolved through the criminal system.
  - nicoburns 4y ago
    Isn't the purpose of making opioids available to addicts to allow addicts to "find a way" (i.e. manage their addiction)? We have no easy/effective treatments for such addictions so harm reduction is the best we can hope for.

by dmix 4y ago

seanmcdirmid 4y ago

> It’s important no doubt but moving beyond the prohibition drug war approach (which is failing in places going hard as it is weak like Canada)to dealing with this requires a serious reckoning and public investment that we aren’t ready to accept yet but will be imposed on us whether we like it or not. There are lots of contradictions here. Voters don't understand how they can be asked to liberalize hard drug use (and even decriminalize dealing) on the one hand, and are asked for billions of dollars for drug addiction treatment on the other. In Seattle, we have a particularly bad mess, where the biggest thing now is trying to fentanyl smoking off of public buses and light rail. They are even talking about studying the dangers of second hand fentanyl smoke to bus drivers. Hopefully we can learn something from our neighbors up north, but frankly it doesn't seem to be that much better in Vancouver.

lazyasciiart 4y ago
It's pretty deliberate failure to understand, in my opinion, driven by a core belief that bad things happen to bad people and they need to be punished out of it, not helped. The goal for many people is absolutely not reducing deaths, or even getting rid of fentanyl smoke on buses. It is expelling fentanyl users from society and expecting that will stop new users appearing. That's why they don't want to spend money on treatment or services. They think enabling the existence and recovery of existing users will encourage more.
- deleted 4y ago
  [deleted]
- seanmcdirmid 4y ago
  > or even getting rid of fentanyl smoke on buses. The burnt peanut butter smell is pretty rancid. Voters, even in Seattle, only have a finite amount of empathy to spare on this problem, and it has mostly been expended. > It is expelling fentanyl users from society and expecting that will stop new users appearing. That's why they don't want to spend money on treatment or services. They think enabling the existence and recovery of existing users will encourage more. We (King County at least) spend around $100k/junkie per year on services. And that still isn't considered enough. So should we double our property taxes or something to spend even more money on this problem? > They think enabling the existence and recovery of existing users will encourage more. If Seattle is the only place these people can get help across the whole country, that would definitely occur. You can't fight a national problem with local resources and not expect distortions (people are mobile).
  - pstuart 4y ago
    This is a national problem and needs to be addressed (and funded) as such. The war on drugs has failed miserably (for it's ostensible purpose (to "protect" us from dangerous drugs). We need to legalize and regulate them all, and make their abuse a medical issue rather than a criminal issue. For those that have no desire or ability to quit, we can put them in camps and hand out dope to keep them sedated and "safe" from questionable supplies. If they want to get clean, they can have the support to do that but otherwise are effectively interned on work farms. This is the cheapest, safest, and most humane way of dealing with this problem.
    - eurasiantiger 4y ago
      You still fantasize about a world where everything and everyone is ”clean”. That will never exist but you will destroy the humanity of yourself and others in an attempt to delude yourself.
kerkeslager 4y ago
> Voters don't understand how they can be asked to liberalize hard drug use (and even decriminalize dealing) on the one hand, and are asked for billions of dollars for drug addiction treatment on the other. It's easy to communicate this: We spend billions to incarcerate people for drug crimes, and then send them out with a criminal record that pushes them right back toward drug use. OR we spend fewer billions on drug addiction treatment and housing. It's not confusing or contradictory at all. People who end up in prison don't get help, and people who get help don't end up in prison. "Voters" wouldn't be confused if certain interests didn't keep them confused. It's profitable to keep housing scarce and prisons full. Until we start prioritizing sick people over profiteers we won't fix this problem.
- schrectacular 4y ago
  In prison or dead means they aren't on the streets and people don't have to face or interact with the problem. I would guess that many voters are much happier with "out of sight, out of mind"
  - moonchrome 4y ago
    Also not a risk to you. Most drug addicts are not the kind of people you want around. There are highly functioning ones, but it often exacerbates mental health issues. Not sure prohibition is the correct approach but let's not strawman the other side of the argument.
    - kerkeslager 4y ago
      > Most drug addicts are not the kind of people you want around. True, but how much time does the average non-addict spend in drug rehabs? Both prisons and rehab facilities isolate addicts from the general population.
- jibe 4y ago
  California has been at the vanguard of reducing prison population, and decriminalizing drug use, and so far the results look disastrous. That’s not a policy that needs any confusion to be unappealing.
noduerme 4y ago
Portlander chiming in here. I think it's almost universally accepted now that decriminalization was a stupid idea - and I myself voted for it at the time. I absolutely would still vote for anything that improved the availability of treatment for addiction, regardless of cost. But I think what we've learned is that every carrot needs a stick. And where there's excess supply, demand will catch up. All of which means, go after supply and possession again until this is under control.
- eurasiantiger 4y ago
  Or take your head our of your ass, stop enacting half-hearted measures like decriminalization and completely legalize the supply. Your prime issue is corruption, not drug use
  - tayo42 4y ago
    i don't get why decriminalization keeps getting pushed by people my cynical take, entrenched people have something to gain by the grey area decriminalization offers.
    - Jochim 4y ago
      My point of view is that locking people up for drug use: * Hasn't reduced drug use * Makes them more likely to continue their drug use * Often leads to the use of harder drugs * Is expensive * Provides funding to cartels * Causes violence Decriminalising, or legalising drug use removes one of the main motivators of gang formation/violence while allowing the state to focus on helping addicts recover and contribute to society. The money spent on enforcement can now be spent on treatment, reducing the need for further funding rather than increasing it.
      - noduerme 4y ago
        There is another option, which is to leave the users alone and go hard after the suppliers.
lostlogin 4y ago
> Voters don't understand how they can be asked to liberalize hard drug use (and even decriminalize dealing) on the one hand, and are asked for billions of dollars for drug addiction treatment on the other We are increasingly spending more on drug treatment. The current approach has failed and <x> are dead. It's time to change our approach, and a radical change is needed for this massive problem.
CaptainZapp 4y ago
> Voters don't understand how they can be asked to liberalize hard drug use (and even decriminalize dealing) on the one hand, and are asked for billions of dollars for drug addiction treatment on the other. That depends on the voters. In the 90s Switzerland experienced a significant change in its drug policy. One of the pillars (arguably the most important) is harm reduction. At that time hardcore addicts could get heroin prescribed and paid for by health insurance. Getting into the program was not simple, but for those that were hopelessly addicted and not able to kick the habit it was fundamentally successful. The policy is still in place and was confirmed with significant majorities by the voters in multiple referendums.
vintermann 4y ago
> There are lots of contradictions here. Voters don't understand how they can be asked to liberalize hard drug use (and even decriminalize dealing) on the one hand, and are asked for billions of dollars for drug addiction treatment on the other. And understandably so. It's a textbook example of privatizing the profits, and socializing the costs. It's not enough to tax drugs. Certain products are so harmful, and their harmful use so profitable, that allowing any kind of private profit from it at all is a disaster. (Yes, the most prominent of those are tobacco, alcohol and gambling). Worse, addiction treatment is really expensive and not very effective - even the best addiction treatment programs have high relapse rates. Even the relatively cheap programs that only seek to limit the damage addicts do to themselves and others, can only be defended on humanitarian grounds, not economic ones. Yes, we need to help addicts. Yes, including in purely harm-reduction ways. But we're deluding ourselves if we think this is a solution at all, let alone one we can afford if we let private economic interests profit from addiction without obstacles.
themitigating 4y ago
Why can't they understand this? Criminal enforcement and crime are apparently a major concern among voters. They are just the victim of right wing propaganda
mrguyorama 4y ago
A lot of those voters seem more interested in just letting """bad people""" die.

refurb 4y ago

Buprenorphine is allowed in all US states and the FDA recently said even family doctors can initiate therapy. And British Colombia is have record numbers of fatal overdoses, so while a tool, its not a solution to the crisis.

dmix 4y ago
It’s not always just about what is “allowed in US states” but making it easy for addicts who need a solution to be locally accessible vs just as easily going on the corner with $10 for another high. I was purposefully being colourful saying Suboxone was handed out like candy in Canada but it probably needs to be to compete with the wide availability of Fentanyl and other drugs. I should also note that being in favour of harm reduction doesn’t mean tolerating Portland style appeasement of crime and public …craziness. The baby is often thrown out with the bath water with this stuff and it doesn’t have to be that way. But that overreaction goes both ways in terms of dealing with the drug problem.
- jrumbut 4y ago
  Yeah this a key point. Buprenorphine availability is very inconsistent in practice throughout the US. I'm not just talking about rural Kansas here either, it can be a struggle in every state and many major metro areas. Especially if you have all the associated problems one might expect (no car, no money for a copay, other health problems, etc). Additionally, the actual treatment provided varies considerably between doctors. Do they give the patient enough to avoid severe withdrawal? Do they allow the patient to stay on buprenorphine long term if needed? How do they handle relapses? What sort of counseling or therapy do they provide (if any)? Do they take insurance?
- refurb 4y ago
  Buprenorphine is available through telemedicine (even before Covid). https://www.statnews.com/2022/03/07/doctors-companies-push-to-keep-looser-pandemic-era-rules-for-prescribing-opioid-addiction-treatment-via-telemedicine/ https://www.statnews.com/2022/03/07/doctors-companies-push-t... I wont argue there are some barrier, but it’s not hard to get anywhere in the US.

bogomipz 4y ago

Are you referring to the scene where Sy Richardson admonishes them before giving them their methadone doses? That's a methadone clinic not not a pharmacy and he's a public health/social worker.

nibbleshifter 4y ago

I'd make suboxone available OTC, no questions asked. Low cost, or even just free if you register as an addict. Same for naloxone/narcan/whatever "overdose stopper" autoinjectors. Which, I'm reliably told, are the opposite of a good time. Suboxone is not a drug you can really abuse in any fun way, and a lot of folks won't engage "formally" with addiction services due to stigma, paranoia, worries about their medical records being tainted forever, etc. The addicts you see on the streets are just the tip of the iceberg. Much like alcoholism, the vast majority of users are "hidden". There are multiples more users who are still functioning within society, holding down jobs, etc.

cudder 4y ago
Addicts will find a way. Buprenorphine is the most abused opioid in Finland. Which by the way has the most youth drug deaths in Europe[1]. Granted it's usually Subutex (just buprenorphine) rather than Suboxone (buprenorphine + naloxone) but there's not much difference unless you're using intravenously because buprenorphine has such a high binding affinity. I agree that there's a huge problem with opiates and am in favor of legalizing everything, but it's good to realize that buprenorphine is not a magic candy that fixes everything - you're just replacing an addiction to a deadly feel-good opiate with an addiction to a slightly less feel-good opiate with a larger therapeutic index. [1]: https://www.euronews.com/2023/03/16/why-are-so-many-young-finns-dying-from-drug-abuse https://www.euronews.com/2023/03/16/why-are-so-many-young-fi...
- nibbleshifter 4y ago
  TIL about the abuse in Finland. I was aware it was sometimes abused by prisoners, but that's new. In another comment I went into a bit more detail around ways of dealing with the issue, using Finland's homeless housing policy as part of it. Its a complex issue that certainly isn't going to be resolved through the criminal system.
- nicoburns 4y ago
  Isn't the purpose of making opioids available to addicts to allow addicts to "find a way" (i.e. manage their addiction)? We have no easy/effective treatments for such addictions so harm reduction is the best we can hope for.