9 ms·

A proposal for upgrading these “safe use sites” (if we’re going to have them, might as well have good ones): The use site has a (24/7 guarded) attached pharmac

by fwlr 4y ago

A proposal for upgrading these “safe use sites” (if we’re going to have them, might as well have good ones): The use site has a (24/7 guarded) attached pharmacy with government-produced clean heroin, meth, etc. Users can trade in their drug, the pharmacist runs it through a mass spec analyzer and dispenses back to them an amount of pharmaceutical-grade drug of interest, the amount dispensed being equal to the fraction that is present in whatever cut/mixed drug sample they handed in. In addition to the obvious safety benefits of only consuming guaranteed-pure drugs, the drug user gets an on-the-spot and very salient piece of information about the quality of the drug they purchased. This creates a lot of precise and accurate drug quality information and feeds it back into the drug abuse cycle. A user buys from a dealer, and right before their first hit they get a purity score to evaluate their dealer with - and maybe some information about what other drugs their dealer just tried to poison them with. (To avoid some obvious risks: the tested drug sample should be immediately ejected from the analyzer into a denaturing bath and regularly incinerated, so that handed-in drugs are not a theft or recycling target. You probably need to mandate they can trade in only the dose they are about take, and they have to take it on the spot, so that government supplies do not leak back into the streets. There are certainly other failure modes too, a close eye should be kept on this and further processes brought in as needed.)

JumpCrisscross 4y ago
> dispenses back to them an amount of pharmaceutical-grade drug of interest, the amount dispensed being equal to the fraction that is present in whatever cut/mixed drug sample they handed in If you're distributing drugs just distribute the drugs. Why cut in the dealers and cartels?
- Tiktaalik 4y ago
  Yep. Create a safe supply of drugs. It destroys the criminal economy and ends deaths. It's really the only way forward. Everything else within the naïve prohibition framework has been tried again and again and has continuously failed.
  - junofan 4y ago
    Also reduces a lot of problem behaviors of street addicts like smashing and stealing property and congregating for access to suppliers.
    - Tiktaalik 4y ago
      omg yes. Arguably the cycle of police aggressively confiscating drugs from users induces more petty theft as the police confiscations become a new sink to drain drug user wealth. Those chemically addicted to drugs need to replace the confiscated drugs, which creates a new need to find something to sell to get enough money to once again buy drugs on the illegal market. A safe supply of regulated drugs breaks this cycle.
  - clnq 4y ago
    There is no such thing as "a safe supply of drugs". Whether the street drugs are produced in a quality-controlled way or not, it is well-known that use of the substances has negative outcomes in health and occupational functioning. Direct sale of street narcotics would only be another harm reduction practice, similar to "safe use sites". But no harm reduction practice makes the harm "safe". The political double-speak around this is very similar to "clean coal"; it implies a strong position ("coal is clean") while offering an escape hatch if challenged ("coal pollution mitigation, otherwise known as clean coal, reduces greenhouse emissions when coal is used as a fuel"). Similarly as there is no "clean coal" in reality, there is no "safe supply of drugs". When we take deceiving loaded words like "safe" out of the equation, it becomes harder to argue against substance control, even if seen as prohibition. While it is evident that street drug crisis in the US has been mishandled, if restricting the access of these substances (or "prohibition") was done correctly, it would benefit society. Particularly, the prohibition would benefit society more if it was not mainly enforced through criminalization of street drugs, but instead through teaching, rehabilitation, and prevention. In contrast, "safe" drug harm is an oxymoron. And it's very ineffective to even discuss anything on a double-speak premise. We should instead focus on fixing the root problem of drug use, rather than be distracted by harm reduction, especially when it's been politicized so much.
- fwlr 4y ago
  Replacing individual drug doses with clean versions at the point of consumption is not “distributing drugs” in any sense except rhetorical, so I should simply reject that comparison. But in the spirit of discussion, I will instead say: why compete when you could regulate? This proposal would essentially introduce a tax on cutting drugs that is exactly proportionate to the amount of cutting done. Further processes could emulate other forms of regulation: if the drug dose contains enough of some adulterant that it would have been acutely lethal (for example, way too much fentanyl accidentally mixed in), you could withhold the dose or otherwise induce the user to give up the dealer to the police - not as hard of a sell as you might think, given that the pharmacist literally just saved the user from dying in the next 30 minutes - and now you have something sort of like safety and QA regulations that impose jail time penalties for improper manufacturing.
  - JumpCrisscross 4y ago
    > Replacing individual drug doses with clean versions at the point of consumption is not “distributing drugs” in any sense except rhetorical, so I should simply reject that comparison I pay a dealer for a ticket. I take it to the dispensary. They clip the ticket and give me new drugs. Now replace “ticket” with “tainted drugs.” The street-purchase requirement is totally performative. The dispensary is selling drugs with extra steps, with the bonus of sending their revenue to the dealers.
    - fwlr 4y ago
      The street purchase requirement is not totally performative. It requires dealers to be standing around on the street carrying books of tickets that are highly illegal to possess, thus allowing police intervention. Under the extra step proposal, police can continue to arrest ticket-sellers, hypothetically reducing the ticket availability towards zero. Without the extra steps, there is just the user and the dispensary, there’s nobody for the police to arrest and law enforcement loses their lever for pressuring and reducing the illicit drug trade.
      - JumpCrisscross 4y ago
- sergiomattei 4y ago
  The government also can't compete on potency. We'd be dispensing safe drugs, but the street dealers always win: they're always going to have stronger, riskier stuff. Addicts want the stronger stuff. An example is the supply arms race with research chemicals/designer drugs (RC). Every month, a new RC hits the streets with greater potency and skirting any previously-established regulations. The drug dealers will always be winning the potency race because they're on the bleeding edge, using the latest formulas and cutting it with experimental/unsafe/word-of-mouth additives. The only way to win is making them free. And even then, the potency race continues. It's a ginormous value edge that the dealers have, and sadly, it preys on the most vulnerable sufferers.
  - htfu 4y ago
    You have it backwards. The only reason for novel compounds is their lack of regulation or that their potency makes smuggling easier. It's definitely not a demand-side thing.
  - krispyfi 4y ago
    Potency only means that you need a smaller quantity of a substance to attain the same effect. It has nothing to do with the maximum attainable effect. Users don't care about potency. If anything, users care about speed of crossing the blood-brain barrier, which causes the pleasurable "rush" of rapidly increasing effects. The major drugs like heroin and methamphetamine are already pretty optimal in this regard. On the other hand, drug suppliers care about potency because they can transport more doses in the same weight. The only people who care about RCs are people trying to skirt the law, and drug nerds. https://en.m.wikipedia.org/wiki/Potency_(pharmacology) https://en.m.wikipedia.org/wiki/Potency_(pharmacology)
    - sergiomattei 4y ago
      > Potency only means that you need a smaller quantity of a substance to attain the same effect. Semantics, misused a term there. > The major drugs like heroin and methamphetamine are already pretty optimal in this regard. In a world where this was true, cutting drugs with fentanyl wouldn’t be a thing. It’s not just a cost optimization, it’s also because it gets you the best high on the block. > The only people who care about RCs are people trying to skirt the law, and drug nerds. “Spice”, as one example, has destroyed many communities. Legal highs and designer drugs are everywhere as of the past decade. “Bath salts” (cathinones), synthetic cannabinoids, etc. Not exactly designer, but the isomerization process to extract delta-8 from hemp is a novel technique that’s being done underground by labs everywhere and distributed widely across America. We have no idea what’s in this stuff, even testing labs usually report XX% of unknown substances, reaction residues and cannabinoids in samples. Research chemicals are everywhere. This arms race has touched millions. These are real problems that affect real people.
asynchronous 4y ago
This reads like a dystopian novel.
- fwlr 4y ago
  (In case it’s not clear, I’m not actually a fan of illicit drug use. I view this proposal as roughly about as dystopian as the current practice of safe injection sites where trained professionals watch users inject whatever tainted drugs they bring with them, and try to treat overdoses without knowing what the person put in their system. I see it as proposing Brave New World vs the current 1984.)
bigbillheck 4y ago
> mass spec analyzer Just how cheap do you think mass spec is?
- dannyw 4y ago
  DEA budget: $2.4 billion annually.
- Metacelsus 4y ago
  Also it's going to be a real pain to get the calibration right
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- Teknoman117 4y ago
  My high school in a not-wealthy part of Alabama had a dozen of them in their chemistry lab 15 years ago. Can't be that expensive...
  - refurb 4y ago
    A dozen of them? Are you sure they aren't gas chromatographers? I worked in a well funded private lab and we didn't have "a dozen" of them.
    - fbdab103 4y ago
      Significantly depends on what kind of MS we are talking. Single quad can be had for well under $100k. Top of the line Orbitrap is ~$1.2 million. Depending on the analytical constraints, I think you could get by with a mid-range triple quad for $200-300k. Although, if you need to do exploratory work, I think everyone should just buy a QE as it is a solid workhorse that can fit most any role. When a lot of that equipment gets aged out from industrial uses it will be given to universities in still-working order. Biotechs going bust can also be a boon to the second-hand market where state of the art equipment can be had for a song. I know one lab which acquired a piece of equipment that had been used in a background shot of a Jurassic Park movie.
argc 4y ago
If the government is going to give out drugs, then they should just run some pharmacies similar to state run liquor stores. No need to force users to buy from dealers, that makes no sense at all.
- notch898b 4y ago
  I've always said anyone who likes should be offered the choice of a free ticket to Swain's Island, which could be stocked with barrel fulls of absolutely pure and pharmaceutical grade hard drugs to the heart's delight of the new resident.
  - agentwiggles 4y ago
    Let anyone who wants it buy fentanyl, and let natural selection do its work. This is suggested semi-facetiously, but at the same time, feels like there's something to it. Decriminalize, tax, regulate, and focus enforcement efforts on black market dealers. The waste of human effort and life that has gone into the last 60 years of drug policy is insane to consider. We have got to try _something_ other than what we're doing now with prohibition.
    - 6438y44y4u 4y ago
      I think the framing of "let natural selection do the work" is self sabotaging if you're really trying to make the argument persuasive. It makes your position sound on some level likes it's casually dismissing the loss of life when what is really being argued, to me when I read your post at least, is that we need to accept that in dealing with this kind of topic lives are going to be ruined/lost either way and that when we/governments take responsibility as distributors that at least allows us more control over the situation and from that position we might at least be able to diminish the risk/harm to addicts even if we can't actually convert them into non-addicts. I'd add that I think more explanation around the black market angle could probably help the argument further since atm the state of legalization advocacy in the US tends to be "But think about the tax revenue!" which is fine for less problematic drugs like weed but which is going to stall fast when you get to things like heroine. Emphasizing legalization and government regulation/distribution as a way to take money out of the hands of gangs and street dealers would be compelling to a lot of people imo if framed in the right way.
dsabanin 4y ago
And the next stop is to start teaching kids how to safely shoot/snort/smoke drugs in public school curriculum? /s
- krispyfi 4y ago
  I was taught how to drink safely in school. (Things like, "don't drink on an empty stomach.") How is that any different?
pedalpete 4y ago
This was debated when Vancouver first introduced safe injection sites, but was not put into place, as I understand it, because the government didn't want to become the drug dealer. However, while searching for a source to back up my above statement, all I could find is https://www.nytimes.com/2022/07/26/health/fentanyl-vancouver-drugs.html https://www.nytimes.com/2022/07/26/health/fentanyl-vancouver... from Aug '22. So apparently they are supplying now.
- notch898b 4y ago
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- pedalpete 4y ago
  Just so you know Notch, I keep seeing your comments being killed, but I'm not killing or flagging them.
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canadianfella 4y ago
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herbst 4y ago
In Switzerland junkies can just get their clean heroin from the state without handing in dirty drugs before. We are doing this for many years now and seems that new opiods rarely really hit the market at all.
scythe 4y ago
The problem with this approach is that it is impossible. There is no "general chemical analyzer" that can consistently detect the quantity of a substance in any sample. You may as well suggest that a wizard uses his magic wand to purify the heroin. Not to mention that users will begin to bring in all kinds of crap to see if they can get heroin from it — notably, their own excrement. Drug sellers likewise may decide it is unnecessary to recrystallize their products to remove solvents, since your suggestion makes no distinction between the sample contaminated with acetic anhydride and the one that was cut with mannitol. So there is still plenty of moral hazard.
- fwlr 4y ago
  I’m pretty sure a mass spectrometer will actually do what we want here, we don’t need a magic wand. Drug dealers leaving solvents in because this suggestion makes no distinction between different cutting compounds? I propose that we do draw a distinction, then. Drug users trying to hand us a baggie of their shit and call it heroin? I propose that, uh, we say no? To be frank, none of your objections seem like very difficult obstacles to overcome.

by fwlr 4y ago

JumpCrisscross 4y ago

> dispenses back to them an amount of pharmaceutical-grade drug of interest, the amount dispensed being equal to the fraction that is present in whatever cut/mixed drug sample they handed in If you're distributing drugs just distribute the drugs. Why cut in the dealers and cartels?

Tiktaalik 4y ago
Yep. Create a safe supply of drugs. It destroys the criminal economy and ends deaths. It's really the only way forward. Everything else within the naïve prohibition framework has been tried again and again and has continuously failed.
- junofan 4y ago
  Also reduces a lot of problem behaviors of street addicts like smashing and stealing property and congregating for access to suppliers.
  - Tiktaalik 4y ago
    omg yes. Arguably the cycle of police aggressively confiscating drugs from users induces more petty theft as the police confiscations become a new sink to drain drug user wealth. Those chemically addicted to drugs need to replace the confiscated drugs, which creates a new need to find something to sell to get enough money to once again buy drugs on the illegal market. A safe supply of regulated drugs breaks this cycle.
- clnq 4y ago
  There is no such thing as "a safe supply of drugs". Whether the street drugs are produced in a quality-controlled way or not, it is well-known that use of the substances has negative outcomes in health and occupational functioning. Direct sale of street narcotics would only be another harm reduction practice, similar to "safe use sites". But no harm reduction practice makes the harm "safe". The political double-speak around this is very similar to "clean coal"; it implies a strong position ("coal is clean") while offering an escape hatch if challenged ("coal pollution mitigation, otherwise known as clean coal, reduces greenhouse emissions when coal is used as a fuel"). Similarly as there is no "clean coal" in reality, there is no "safe supply of drugs". When we take deceiving loaded words like "safe" out of the equation, it becomes harder to argue against substance control, even if seen as prohibition. While it is evident that street drug crisis in the US has been mishandled, if restricting the access of these substances (or "prohibition") was done correctly, it would benefit society. Particularly, the prohibition would benefit society more if it was not mainly enforced through criminalization of street drugs, but instead through teaching, rehabilitation, and prevention. In contrast, "safe" drug harm is an oxymoron. And it's very ineffective to even discuss anything on a double-speak premise. We should instead focus on fixing the root problem of drug use, rather than be distracted by harm reduction, especially when it's been politicized so much.
fwlr 4y ago
Replacing individual drug doses with clean versions at the point of consumption is not “distributing drugs” in any sense except rhetorical, so I should simply reject that comparison. But in the spirit of discussion, I will instead say: why compete when you could regulate? This proposal would essentially introduce a tax on cutting drugs that is exactly proportionate to the amount of cutting done. Further processes could emulate other forms of regulation: if the drug dose contains enough of some adulterant that it would have been acutely lethal (for example, way too much fentanyl accidentally mixed in), you could withhold the dose or otherwise induce the user to give up the dealer to the police - not as hard of a sell as you might think, given that the pharmacist literally just saved the user from dying in the next 30 minutes - and now you have something sort of like safety and QA regulations that impose jail time penalties for improper manufacturing.
- JumpCrisscross 4y ago
  > Replacing individual drug doses with clean versions at the point of consumption is not “distributing drugs” in any sense except rhetorical, so I should simply reject that comparison I pay a dealer for a ticket. I take it to the dispensary. They clip the ticket and give me new drugs. Now replace “ticket” with “tainted drugs.” The street-purchase requirement is totally performative. The dispensary is selling drugs with extra steps, with the bonus of sending their revenue to the dealers.
  - fwlr 4y ago
    The street purchase requirement is not totally performative. It requires dealers to be standing around on the street carrying books of tickets that are highly illegal to possess, thus allowing police intervention. Under the extra step proposal, police can continue to arrest ticket-sellers, hypothetically reducing the ticket availability towards zero. Without the extra steps, there is just the user and the dispensary, there’s nobody for the police to arrest and law enforcement loses their lever for pressuring and reducing the illicit drug trade.
    - JumpCrisscross 4y ago
sergiomattei 4y ago
The government also can't compete on potency. We'd be dispensing safe drugs, but the street dealers always win: they're always going to have stronger, riskier stuff. Addicts want the stronger stuff. An example is the supply arms race with research chemicals/designer drugs (RC). Every month, a new RC hits the streets with greater potency and skirting any previously-established regulations. The drug dealers will always be winning the potency race because they're on the bleeding edge, using the latest formulas and cutting it with experimental/unsafe/word-of-mouth additives. The only way to win is making them free. And even then, the potency race continues. It's a ginormous value edge that the dealers have, and sadly, it preys on the most vulnerable sufferers.
- htfu 4y ago
  You have it backwards. The only reason for novel compounds is their lack of regulation or that their potency makes smuggling easier. It's definitely not a demand-side thing.
- krispyfi 4y ago
  Potency only means that you need a smaller quantity of a substance to attain the same effect. It has nothing to do with the maximum attainable effect. Users don't care about potency. If anything, users care about speed of crossing the blood-brain barrier, which causes the pleasurable "rush" of rapidly increasing effects. The major drugs like heroin and methamphetamine are already pretty optimal in this regard. On the other hand, drug suppliers care about potency because they can transport more doses in the same weight. The only people who care about RCs are people trying to skirt the law, and drug nerds. https://en.m.wikipedia.org/wiki/Potency_(pharmacology) https://en.m.wikipedia.org/wiki/Potency_(pharmacology)
  - sergiomattei 4y ago
    > Potency only means that you need a smaller quantity of a substance to attain the same effect. Semantics, misused a term there. > The major drugs like heroin and methamphetamine are already pretty optimal in this regard. In a world where this was true, cutting drugs with fentanyl wouldn’t be a thing. It’s not just a cost optimization, it’s also because it gets you the best high on the block. > The only people who care about RCs are people trying to skirt the law, and drug nerds. “Spice”, as one example, has destroyed many communities. Legal highs and designer drugs are everywhere as of the past decade. “Bath salts” (cathinones), synthetic cannabinoids, etc. Not exactly designer, but the isomerization process to extract delta-8 from hemp is a novel technique that’s being done underground by labs everywhere and distributed widely across America. We have no idea what’s in this stuff, even testing labs usually report XX% of unknown substances, reaction residues and cannabinoids in samples. Research chemicals are everywhere. This arms race has touched millions. These are real problems that affect real people.

asynchronous 4y ago

This reads like a dystopian novel.

fwlr 4y ago
(In case it’s not clear, I’m not actually a fan of illicit drug use. I view this proposal as roughly about as dystopian as the current practice of safe injection sites where trained professionals watch users inject whatever tainted drugs they bring with them, and try to treat overdoses without knowing what the person put in their system. I see it as proposing Brave New World vs the current 1984.)

bigbillheck 4y ago

> mass spec analyzer Just how cheap do you think mass spec is?

dannyw 4y ago
DEA budget: $2.4 billion annually.
Metacelsus 4y ago
Also it's going to be a real pain to get the calibration right
- deleted 4y ago
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Teknoman117 4y ago
My high school in a not-wealthy part of Alabama had a dozen of them in their chemistry lab 15 years ago. Can't be that expensive...
- refurb 4y ago
  A dozen of them? Are you sure they aren't gas chromatographers? I worked in a well funded private lab and we didn't have "a dozen" of them.
  - fbdab103 4y ago
    Significantly depends on what kind of MS we are talking. Single quad can be had for well under $100k. Top of the line Orbitrap is ~$1.2 million. Depending on the analytical constraints, I think you could get by with a mid-range triple quad for $200-300k. Although, if you need to do exploratory work, I think everyone should just buy a QE as it is a solid workhorse that can fit most any role. When a lot of that equipment gets aged out from industrial uses it will be given to universities in still-working order. Biotechs going bust can also be a boon to the second-hand market where state of the art equipment can be had for a song. I know one lab which acquired a piece of equipment that had been used in a background shot of a Jurassic Park movie.

argc 4y ago

If the government is going to give out drugs, then they should just run some pharmacies similar to state run liquor stores. No need to force users to buy from dealers, that makes no sense at all.

notch898b 4y ago
I've always said anyone who likes should be offered the choice of a free ticket to Swain's Island, which could be stocked with barrel fulls of absolutely pure and pharmaceutical grade hard drugs to the heart's delight of the new resident.
- agentwiggles 4y ago
  Let anyone who wants it buy fentanyl, and let natural selection do its work. This is suggested semi-facetiously, but at the same time, feels like there's something to it. Decriminalize, tax, regulate, and focus enforcement efforts on black market dealers. The waste of human effort and life that has gone into the last 60 years of drug policy is insane to consider. We have got to try _something_ other than what we're doing now with prohibition.
  - 6438y44y4u 4y ago
    I think the framing of "let natural selection do the work" is self sabotaging if you're really trying to make the argument persuasive. It makes your position sound on some level likes it's casually dismissing the loss of life when what is really being argued, to me when I read your post at least, is that we need to accept that in dealing with this kind of topic lives are going to be ruined/lost either way and that when we/governments take responsibility as distributors that at least allows us more control over the situation and from that position we might at least be able to diminish the risk/harm to addicts even if we can't actually convert them into non-addicts. I'd add that I think more explanation around the black market angle could probably help the argument further since atm the state of legalization advocacy in the US tends to be "But think about the tax revenue!" which is fine for less problematic drugs like weed but which is going to stall fast when you get to things like heroine. Emphasizing legalization and government regulation/distribution as a way to take money out of the hands of gangs and street dealers would be compelling to a lot of people imo if framed in the right way.

dsabanin 4y ago

And the next stop is to start teaching kids how to safely shoot/snort/smoke drugs in public school curriculum? /s

krispyfi 4y ago
I was taught how to drink safely in school. (Things like, "don't drink on an empty stomach.") How is that any different?

pedalpete 4y ago

This was debated when Vancouver first introduced safe injection sites, but was not put into place, as I understand it, because the government didn't want to become the drug dealer. However, while searching for a source to back up my above statement, all I could find is https://www.nytimes.com/2022/07/26/health/fentanyl-vancouver-drugs.html https://www.nytimes.com/2022/07/26/health/fentanyl-vancouver... from Aug '22. So apparently they are supplying now.

notch898b 4y ago
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pedalpete 4y ago
Just so you know Notch, I keep seeing your comments being killed, but I'm not killing or flagging them.
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canadianfella 4y ago

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herbst 4y ago

In Switzerland junkies can just get their clean heroin from the state without handing in dirty drugs before. We are doing this for many years now and seems that new opiods rarely really hit the market at all.

scythe 4y ago

The problem with this approach is that it is impossible. There is no "general chemical analyzer" that can consistently detect the quantity of a substance in any sample. You may as well suggest that a wizard uses his magic wand to purify the heroin. Not to mention that users will begin to bring in all kinds of crap to see if they can get heroin from it — notably, their own excrement. Drug sellers likewise may decide it is unnecessary to recrystallize their products to remove solvents, since your suggestion makes no distinction between the sample contaminated with acetic anhydride and the one that was cut with mannitol. So there is still plenty of moral hazard.

fwlr 4y ago
I’m pretty sure a mass spectrometer will actually do what we want here, we don’t need a magic wand. Drug dealers leaving solvents in because this suggestion makes no distinction between different cutting compounds? I propose that we do draw a distinction, then. Drug users trying to hand us a baggie of their shit and call it heroin? I propose that, uh, we say no? To be frank, none of your objections seem like very difficult obstacles to overcome.