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0 idea what to do? Switzerland [1] has implemented a successful strategy that revolves around one key point: treating the drug problem as healthcare instead of

0 idea what to do? Switzerland [1] has implemented a successful strategy that revolves around one key point: treating the drug problem as healthcare instead of criminality. The "War on Drugs" is the most ineffective strategy when it comes to dealing with addiction. [1]: https://www.opensocietyfoundations.org/publications/mountaintops https://www.opensocietyfoundations.org/publications/mountain...

yodsanklai 4y ago
Is it that simple though? There are probably other factors that make people in the US more prone to drug addiction (e.g. poverty, lack of opportunities...).
- bakuninsbart 4y ago
  Lack of healthcare coverage and over-prescription of opioids are both factors as well. People are self-medicating due to not getting the pain medication they need because they lack healthcare. Or they have untreated mental issues. or, if they do have healthcare, they might very well get prescribed super addictive drugs over a long period of time.
  - Clubber 4y ago
    >because they lack healthcare. I'm convinced the "crackdown" on pills is what led to where we are today. Many doctors won't prescribe pain medication because they're afraid to lose their license or have a DEA raid. People find what they want in heroin and now fentanyl. Why we keep fighting the drug war this way is beyond me. >if they do have healthcare, they might very well get prescribed super addictive drugs over a long period of time. I think this is also why we are here today.
- beepbooptheory 4y ago
  Having healthcare accessible in general would at least be a step towards a greater public wealth for individuals. Even a little less poverty has got to do some good.
- tough 4y ago
  Portugal did this in the 90's and they where poorer than the US for sure. It's a cultural/religious problem if you ask me.
  - madaxe_again 4y ago
    Portugal is pretty devoutly Catholic. It’s a cultural problem.
    - wil421 4y ago
      That means nothing as I assume the GP was alluding to Puritan values instead of Catholic ones.
      - AlgorithmicTime 4y ago
        Evangelicals are not Puritans, nor is there a theological ancestry from modern evangelical christianity to Puritanism.
        TorontoTheGood 4y ago
        Vladimir wants to paint a specific picture, dig?
      - deleted 4y ago
        [deleted]
      - madaxe_again 3y ago
        That’s precisely what I meant. Both have religion in spades - but only one has a toxic culture around it. It probably helps that Portugal was a neighbour to religious lunatics for much of its existence, and even had a few deeply unpopular monarchs who invited the inquisition in. It’s still there in the cultural memory - they take god seriously, but the idea of religious persecution and the involvement of church in state is pretty much anathema to the average Portuguese.
    - mandmandam 4y ago
- MavisBacon 4y ago
  I’m unsure of the situation in other countries but getting adequate treatment for substance use disorder in the U.S. is terribly difficult (nearly impossible for some) and faith-based 12 step programs such as AA/NA dominate the landscape and effectively replace mental healthcare in many situations. The poor utilize 12-steps because it’s free social support which is great, but for-profits do the same thing (because it’s very cheap to just implement 12 step thinking) and rehab patients are often handed a “big book” (AA/NA’s main text) well before they get a psych evaluation, if they get one at all In short, substance use disorder is treated as a primary condition here, there’s a massive high-profit industry built around it and specifically treating it using faith-based 12 step methodology so a lot of mentally ill people who use drugs never receive proper treatment
  - zamnos 4y ago
    Thankfully times are starting to change, with places like http://boulder.care http://boulder.care prescribing Subutex as an easier rung to reach while climbing the ladder on addressing opiate use disorder (OUD).
    - MavisBacon 4y ago
      yeah Bicycle and Ophelia are a few other U.S. suboxone telehealth startups that seem to be doing good work as well (if anyone is interested, it's worth checking each of these out as their coverage varies in terms of which states, last I checked)
  - sirsinsalot 4y ago
    Those places, let's not forget, deliver care often with a motive of indoctrination in to religion. It really is taking advantage of people who are vulnerable. Sickening that that's what is on offer in a "developed" nation. That's not even getting to the fact that the leading cause of death in children and teenagers is guns[1] I can't really understand it. [1]: https://eu.statesman.com/story/news/politics/politifact/2022/06/07/fact-check-firearms-leading-cause-death-children/7529783001/ https://eu.statesman.com/story/news/politics/politifact/2022...
- red-iron-pine 4y ago
  * lack of cheap and easy to access mental health resources * physical health resources are tied to work-provided health insurance, and are often not great * lack of the above two lead to easy fixes, like prescribing opioids aggressively * aggressive anti-drug laws that put more people away than attempting to treat them * no real safety net if any of the above screw up, driving many to poverty, jail, addiction, etc. $30 of pills might be the only joy or relief from their shitty situation, so pop em if you got em.
justinzollars 4y ago
This is SF, Portland, Seattle, Vancouver strategy - and the cities look like images from the Opium Wars. And least China had the sense to fight back - The West is in terminal decline.
- themitigating 4y ago
  No, here's the top states in 2015 and those cities aren't in them. The reason you said those cities is the same reason fox focuses on crime in nyc, republican propaganda West Virginia: 41.5 per 100,000 people New Hampshire: 34.3 per 100,000 people Kentucky: 29.9 per 100,000 people Ohio: 29.9 per 100,000 people Rhode Island: 28.2 per 100,000 people Pennsylvania: 26.3 per 100,000 people Massachusetts: 25.7 per 100,000 people New Mexico: 25.3 per 100,000 people Utah: 23.4 per 100,000 people
  - dash2 4y ago
    Those are the top states, but it's possible that the cities he mentioned are the top cities.
    - newhotelowner 4y ago
      Chicago, sf Vancouver are densely populated and high population. Number of cases of gun violence or drug overdose will also be high. But they are not the top cities % wise
    - themitigating 4y ago
      https://drexel.edu/uhc/resources/briefs/BCHC%20Drug%20Overdose/ https://drexel.edu/uhc/resources/briefs/BCHC%20Drug%20Overdo... No, San Francisco is at number 11 on the top 10 in 2020. The rest are below that.Why didn't he mention any of the top 10? Why does foxnews discuss crime in San Francisco and NY so much?
      - throwayyy479087 4y ago
        They absolutely talk about Baltimore as being a failed city: https://www.foxnews.com/search-results/search?q=Baltimore https://www.foxnews.com/search-results/search?q=Baltimore Same with every other city on that list: https://www.foxnews.com/search-results/search?q=Philadelphia https://www.foxnews.com/search-results/search?q=Philadelphia etc
piokoch 4y ago
Please do not compare a very small country with a very small and integrated population, which is also very rich to the USA. It does not make any sense.
- CogitoCogito 4y ago
  Are you saying that the US can't learn anything from Switzerland's experience? Why does the US size and population preclude it from treating drug problems as healthcare issues?
bnralt 4y ago
Did you read the report? Policing is still a major part of the Swiss approach to drug prevention (one of the four pillars) and though they try to use fines as a penalty instead of imprisonment, imprisonment for drug use still happens as well: > It is notable that by many measures, policing did not decline with the advent of the four-pillars policy. As Figure 2 shows, policing continued to be very active well after the drug policy changes occurred, though the bulk of arrests since the early 1990s have been related to cannabis use by young persons (Reuter and Schnoz 2009). Relatively few of these arrests, however, led to incarceration and many resulted in administrative fines not registered on a person’s criminal record (Ibid.; Killias 2009).
- pjc50 4y ago
  In some parts of the US, the police have entered the war on drugs on the side of drugs. https://www.nbcnews.com/news/us-news/california-police-union-executive-charged-opioid-import-case-rcna77349 https://www.nbcnews.com/news/us-news/california-police-union...
glonq 4y ago
I see the US healthcare system more as a cause for the opiod epidemic, not the solution.
not_a_shill 4y ago
This is from 2010 before fentanyl was really a thing. Like the article stated, people are dying off of cheap pressed pills made from combos of Chinese imported RCs mixed with fentanyl. These pills are MUCH cheaper/widely available than the non-"counterfeit" opioids. And much more likely to spontaneously kill you vs how people more traditionally overdosed. Addicts aren't the only ones ODing. The "war on drugs" is probably a good thing as far as this goes because making opioids more widely available is not really what we should want in society. I think greater availability of other "party" drugs like ketamine in Europe could maybe help some, but I'm not sure how much. A culture of widely available test strips + narcan + fentanyl education should be the minimum we should be doing. We definitely shouldn't be trying delusional attempts at limiting narcan availability. Ex: https://idahocapitalsun.com/2023/03/28/idaho-lawmakers-vote-to-limit-who-can-access-fentanyl-overdose-treatment-through-grant/ https://idahocapitalsun.com/2023/03/28/idaho-lawmakers-vote-...

yodsanklai 4y ago

Is it that simple though? There are probably other factors that make people in the US more prone to drug addiction (e.g. poverty, lack of opportunities...).

bakuninsbart 4y ago
Lack of healthcare coverage and over-prescription of opioids are both factors as well. People are self-medicating due to not getting the pain medication they need because they lack healthcare. Or they have untreated mental issues. or, if they do have healthcare, they might very well get prescribed super addictive drugs over a long period of time.
- Clubber 4y ago
  >because they lack healthcare. I'm convinced the "crackdown" on pills is what led to where we are today. Many doctors won't prescribe pain medication because they're afraid to lose their license or have a DEA raid. People find what they want in heroin and now fentanyl. Why we keep fighting the drug war this way is beyond me. >if they do have healthcare, they might very well get prescribed super addictive drugs over a long period of time. I think this is also why we are here today.
beepbooptheory 4y ago
Having healthcare accessible in general would at least be a step towards a greater public wealth for individuals. Even a little less poverty has got to do some good.
tough 4y ago
Portugal did this in the 90's and they where poorer than the US for sure. It's a cultural/religious problem if you ask me.
- madaxe_again 4y ago
  Portugal is pretty devoutly Catholic. It’s a cultural problem.
  - wil421 4y ago
    That means nothing as I assume the GP was alluding to Puritan values instead of Catholic ones.
    - AlgorithmicTime 4y ago
      Evangelicals are not Puritans, nor is there a theological ancestry from modern evangelical christianity to Puritanism.
      - TorontoTheGood 4y ago
        Vladimir wants to paint a specific picture, dig?
    - deleted 4y ago
      [deleted]
    - madaxe_again 3y ago
      That’s precisely what I meant. Both have religion in spades - but only one has a toxic culture around it. It probably helps that Portugal was a neighbour to religious lunatics for much of its existence, and even had a few deeply unpopular monarchs who invited the inquisition in. It’s still there in the cultural memory - they take god seriously, but the idea of religious persecution and the involvement of church in state is pretty much anathema to the average Portuguese.
  - mandmandam 4y ago
MavisBacon 4y ago
I’m unsure of the situation in other countries but getting adequate treatment for substance use disorder in the U.S. is terribly difficult (nearly impossible for some) and faith-based 12 step programs such as AA/NA dominate the landscape and effectively replace mental healthcare in many situations. The poor utilize 12-steps because it’s free social support which is great, but for-profits do the same thing (because it’s very cheap to just implement 12 step thinking) and rehab patients are often handed a “big book” (AA/NA’s main text) well before they get a psych evaluation, if they get one at all In short, substance use disorder is treated as a primary condition here, there’s a massive high-profit industry built around it and specifically treating it using faith-based 12 step methodology so a lot of mentally ill people who use drugs never receive proper treatment
- zamnos 4y ago
  Thankfully times are starting to change, with places like http://boulder.care http://boulder.care prescribing Subutex as an easier rung to reach while climbing the ladder on addressing opiate use disorder (OUD).
  - MavisBacon 4y ago
    yeah Bicycle and Ophelia are a few other U.S. suboxone telehealth startups that seem to be doing good work as well (if anyone is interested, it's worth checking each of these out as their coverage varies in terms of which states, last I checked)
- sirsinsalot 4y ago
  Those places, let's not forget, deliver care often with a motive of indoctrination in to religion. It really is taking advantage of people who are vulnerable. Sickening that that's what is on offer in a "developed" nation. That's not even getting to the fact that the leading cause of death in children and teenagers is guns[1] I can't really understand it. [1]: https://eu.statesman.com/story/news/politics/politifact/2022/06/07/fact-check-firearms-leading-cause-death-children/7529783001/ https://eu.statesman.com/story/news/politics/politifact/2022...
red-iron-pine 4y ago
* lack of cheap and easy to access mental health resources * physical health resources are tied to work-provided health insurance, and are often not great * lack of the above two lead to easy fixes, like prescribing opioids aggressively * aggressive anti-drug laws that put more people away than attempting to treat them * no real safety net if any of the above screw up, driving many to poverty, jail, addiction, etc. $30 of pills might be the only joy or relief from their shitty situation, so pop em if you got em.

justinzollars 4y ago

This is SF, Portland, Seattle, Vancouver strategy - and the cities look like images from the Opium Wars. And least China had the sense to fight back - The West is in terminal decline.

themitigating 4y ago
No, here's the top states in 2015 and those cities aren't in them. The reason you said those cities is the same reason fox focuses on crime in nyc, republican propaganda West Virginia: 41.5 per 100,000 people New Hampshire: 34.3 per 100,000 people Kentucky: 29.9 per 100,000 people Ohio: 29.9 per 100,000 people Rhode Island: 28.2 per 100,000 people Pennsylvania: 26.3 per 100,000 people Massachusetts: 25.7 per 100,000 people New Mexico: 25.3 per 100,000 people Utah: 23.4 per 100,000 people
- dash2 4y ago
  Those are the top states, but it's possible that the cities he mentioned are the top cities.
  - newhotelowner 4y ago
    Chicago, sf Vancouver are densely populated and high population. Number of cases of gun violence or drug overdose will also be high. But they are not the top cities % wise
  - themitigating 4y ago
    https://drexel.edu/uhc/resources/briefs/BCHC%20Drug%20Overdose/ https://drexel.edu/uhc/resources/briefs/BCHC%20Drug%20Overdo... No, San Francisco is at number 11 on the top 10 in 2020. The rest are below that.Why didn't he mention any of the top 10? Why does foxnews discuss crime in San Francisco and NY so much?
    - throwayyy479087 4y ago
      They absolutely talk about Baltimore as being a failed city: https://www.foxnews.com/search-results/search?q=Baltimore https://www.foxnews.com/search-results/search?q=Baltimore Same with every other city on that list: https://www.foxnews.com/search-results/search?q=Philadelphia https://www.foxnews.com/search-results/search?q=Philadelphia etc

piokoch 4y ago

Please do not compare a very small country with a very small and integrated population, which is also very rich to the USA. It does not make any sense.

CogitoCogito 4y ago
Are you saying that the US can't learn anything from Switzerland's experience? Why does the US size and population preclude it from treating drug problems as healthcare issues?

bnralt 4y ago

Did you read the report? Policing is still a major part of the Swiss approach to drug prevention (one of the four pillars) and though they try to use fines as a penalty instead of imprisonment, imprisonment for drug use still happens as well: > It is notable that by many measures, policing did not decline with the advent of the four-pillars policy. As Figure 2 shows, policing continued to be very active well after the drug policy changes occurred, though the bulk of arrests since the early 1990s have been related to cannabis use by young persons (Reuter and Schnoz 2009). Relatively few of these arrests, however, led to incarceration and many resulted in administrative fines not registered on a person’s criminal record (Ibid.; Killias 2009).

pjc50 4y ago
In some parts of the US, the police have entered the war on drugs on the side of drugs. https://www.nbcnews.com/news/us-news/california-police-union-executive-charged-opioid-import-case-rcna77349 https://www.nbcnews.com/news/us-news/california-police-union...

glonq 4y ago

I see the US healthcare system more as a cause for the opiod epidemic, not the solution.

not_a_shill 4y ago

This is from 2010 before fentanyl was really a thing. Like the article stated, people are dying off of cheap pressed pills made from combos of Chinese imported RCs mixed with fentanyl. These pills are MUCH cheaper/widely available than the non-"counterfeit" opioids. And much more likely to spontaneously kill you vs how people more traditionally overdosed. Addicts aren't the only ones ODing. The "war on drugs" is probably a good thing as far as this goes because making opioids more widely available is not really what we should want in society. I think greater availability of other "party" drugs like ketamine in Europe could maybe help some, but I'm not sure how much. A culture of widely available test strips + narcan + fentanyl education should be the minimum we should be doing. We definitely shouldn't be trying delusional attempts at limiting narcan availability. Ex: https://idahocapitalsun.com/2023/03/28/idaho-lawmakers-vote-to-limit-who-can-access-fentanyl-overdose-treatment-through-grant/ https://idahocapitalsun.com/2023/03/28/idaho-lawmakers-vote-...