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This is why harm reduction is absolutely crucial. A lot of people will recover on their own given time, but you can't recover if you're dead. A moralistic model

This is why harm reduction is absolutely crucial. A lot of people will recover on their own given time, but you can't recover if you're dead. A moralistic model based primarily or solely on abstinence-based recovery fails addicts, their families and society.

vivekd 3y ago
Without the moralism, harm reduction is a vague term. Here in Canada the government has been pushing safe supply as a part of harm reduction. We still get the same number of overdoses but our cities are now filled with tent encampments and people with addiction issues. It doesn't seem to have helped with anything it's just made things worse I don't deny that there are some forms of harm reduction which are proven to be effective. But I also think it's a vague weasel word for just give them drugs or just make it all legal. Which is not a good policy as we have seen here. Ironically just using vague terms like harm reduction without putting forward a specific strategy is a sort of moralizing of its own
- klyrs 3y ago
  No, some local governments have been doing safe injection sites. Safe supply is a political football that's scapegoated despite not being implemented anywhere in Canada. And neither is a solution to the homelessness, addictions, and mental health crises. Every time I hear a politician talking about safe supply, they say it's not a silver bullet. Which is weird because nobody claims it's a silver bullet. Know what else isn't a silver bullet? Criminalization. Or, everything else that's ever been tried. It's a hard problem, there isn't a silver bullet solution, get over it. What's harm reduction good for? Reducing harm. It isn't harm prevention, it isn't free housing, it isn't free addiction counseling, it doesn't fart roses. Safe injection sites keep users close to medical professionals so we can keep people from dying alone. Safe supply would ensure that users aren't going to accidentally OD on kerfentanyl thinking it's ordinary fentanyl. Needle exchanges keep users supplied with sterile equipment to reduce risk of injections such as HIV and hepatitis C. Each policy is an example of harm reduction. The general philosophy is to not let perfect be the enemy of good.
  - vivekd 3y ago
    No your statement is incorrect. We do have safe supply in Canada. The CBC even wrote an article defending our safe supply program. https://www.google.com/amp/s/www.cbc.ca/amp/1.7071004 https://www.google.com/amp/s/www.cbc.ca/amp/1.7071004 And this is a part of my problem with all this. I live in Toronto's downtown core and the explosion in drug issues since these policies came into effect is something I see and live with. And it's the same in our other major cities. And too often the response from the proponents of these policies is outright misinformation, accusations of moralism. As someone living in an area where I am watching a drug problem spiral out of control, this is frankly infuriating. This is my city and I see these people with addiction as neighbors I want to help. But these policies don't appear to be helping them. It looks to me like it's making things worse If it's so good, if it's so helpful, why are there tent encampments full of people with drug issues popping up. We have shelters so it's not an issue of lack of shelters. Why are there so many more people high or doing drugs on our streets, why are overdose deaths the same or higher
    - afarviral 3y ago
      Could the gradual impacts of economic downturn, unemployment and unhappiness post-pandemic be a contributing factor? From available data on drug overdoses and homelessness things appear relatively stable but some data from last year is missing. An uptick may be on the cards based on your observations. I'm curious what specifically is to blame in your view and why other factors seem unlikely? What do you suggest should change? Should the drugs be recriminalized? Or is the current strategy okay but needing some supplimentary steps?
      - vivekd 3y ago
        I mean there aren't enough quality studies to make conclusions either way. But the promise to us was that safe supply would help drug users, and this uptick in homeless drug addicts and more people suffering visibility from drug issues at least seems to run counter to that that should at least give us pause and make us re evaluate This was done because Portugal did it and people in places like hacker news started pushing it as evidence based because of self proclaimed success in Portugal. Well overdose and drug use is up in Portugal, it's up in Portland and it's up here. How long are proponents going to suggest other factors - this safe supply idea is starting to look less evidence based and more like a religious belief.
- jdietrich 3y ago
  Drug use and addiction are complex biopsychosocial phenomena with many causal factors and associated harms. It is to be expected that any effective response would likewise be complex and multifactorial. People living with drug addictions are usually living with a multitude of other problems, many of which would still remain if a magic wand were to cure their addiction instantly. A homeless schizophrenic heroin addict would still be in a dire situation if heroin didn't exist. Drug policy in North America seems to be ideologically fixated both on addiction as a singular problem, and on singular solutions to that problem. Addiction is an important and very hazardous part of someone's life, but it's only one part. Lots of people who live in tents or behave erratically in public aren't addicted to drugs; lots of people who are addicted to drugs don't live in tents or behave erratically in public. Giving someone an adequate and reliable supply of pharmaceutical opioids is quite likely to reduce their risk of overdose if it gets them away from a highly variable supply of very potent synthetic opioids, but thinking that it'll solve all of their problems is pure fantasy. Keeping people alive is a prerequisite to fixing the rest of their life, but nothing more than that.
tayo42 3y ago
Does harm reduction include safe access to drugs? Basically this is why all substances need to be legal. So it's regulated. So many needless deaths becasue of overdoses that didn't need to happen. People just need to be supported through their low points so they come out the other side. To many ignorant people have an opinion on this though, as you can see in some of these comments. If you never used drugs, don't know people that died needlessly, you don't get to have an opinion.
- jdietrich 3y ago
  >Does harm reduction include safe access to drugs? Only if it's part of an evidence-based and empirically validated strategy. We know that safe access to drugs can work as part of a harm reduction strategy, but there's also good reason to believe that thoughtless moves towards decriminalisation or legalisation can exacerbate harms. The Swiss model has worked incredibly well after a lot of difficult trial-and-error, but the Portuguese model is increasingly looking like a mistake. Even with the relatively lower-risk example of cannabis legalisation, we're seeing a very mixed picture in terms of outcomes. The devil is in the details.
  - j0057 3y ago
    The Portugal model consists of decriminalisation, harm reduction and rehabilitation, but the Portuguese government has basically defunded the rehabilitation programs. Seems to me no wonder that the approach is failing if you take away the one factor that would reduce addictions, but also disingenuous to claim that the entire approach was a mistake. It worked, and now after defending an important part of it, it no longer works. Source: https://www.washingtonpost.com/world/2023/07/07/portugal-drugs-decriminalization-heroin-crack/ https://www.washingtonpost.com/world/2023/07/07/portugal-dru...
lazide 3y ago
Alternatively, for some - most really - the real possibility of death and real consequences is what was necessary to pull out of it. To break through the delusional behavior. But even then, it may not be enough. The Issue, imo, is when death is not a certainty, but a surprise consequence (or sudden) due to bad or inconsistent supply, etc. I recently met someone who it took 6 NARCAN to revive last time he overdid it. Frankly, I’m surprised his body was able to handle it - apparently it was an extremely unpleasant experience. And, frankly, he might not come back next time. He seemed to take it seriously. We’ll see. Not letting your kid touch the hot stove at all is as bad as letting them pull a pot of boiling water down on their head.
- tanseydavid 3y ago
  >> for some - most really - the real possibility of death and real consequences is what was necessary to pull out of it This is not true at all for some significant part of this demographic. And I feel compelled to mention that I am well-aware that this is totally counter-intuitive.
  - LargeTomato 3y ago
    Consequences for my own inaction play an incredibly important motivational role for me. I don't get motivated by sunshine and rainbows, I personally get motivated by consequences. So it's great that we can provide people 6 doses of narcan and act like they're big strong adults who are down on their luck, but it's incredibly harmful to pretend that this is the only possible solution to motivating behavior.
    - sfc32 3y ago
      > Not letting your kid touch the hot stove at all is as bad as letting them pull a pot of boiling water down on their head. While kids are over-protected these days, I strongly disagree with this.
      - lazide 3y ago
        What alternative view do you propose concretely? Over protective is the definition of ‘they never get a chance to get a non-serious burn’ isn’t it?

vivekd 3y ago

Without the moralism, harm reduction is a vague term. Here in Canada the government has been pushing safe supply as a part of harm reduction. We still get the same number of overdoses but our cities are now filled with tent encampments and people with addiction issues. It doesn't seem to have helped with anything it's just made things worse I don't deny that there are some forms of harm reduction which are proven to be effective. But I also think it's a vague weasel word for just give them drugs or just make it all legal. Which is not a good policy as we have seen here. Ironically just using vague terms like harm reduction without putting forward a specific strategy is a sort of moralizing of its own

klyrs 3y ago
No, some local governments have been doing safe injection sites. Safe supply is a political football that's scapegoated despite not being implemented anywhere in Canada. And neither is a solution to the homelessness, addictions, and mental health crises. Every time I hear a politician talking about safe supply, they say it's not a silver bullet. Which is weird because nobody claims it's a silver bullet. Know what else isn't a silver bullet? Criminalization. Or, everything else that's ever been tried. It's a hard problem, there isn't a silver bullet solution, get over it. What's harm reduction good for? Reducing harm. It isn't harm prevention, it isn't free housing, it isn't free addiction counseling, it doesn't fart roses. Safe injection sites keep users close to medical professionals so we can keep people from dying alone. Safe supply would ensure that users aren't going to accidentally OD on kerfentanyl thinking it's ordinary fentanyl. Needle exchanges keep users supplied with sterile equipment to reduce risk of injections such as HIV and hepatitis C. Each policy is an example of harm reduction. The general philosophy is to not let perfect be the enemy of good.
- vivekd 3y ago
  No your statement is incorrect. We do have safe supply in Canada. The CBC even wrote an article defending our safe supply program. https://www.google.com/amp/s/www.cbc.ca/amp/1.7071004 https://www.google.com/amp/s/www.cbc.ca/amp/1.7071004 And this is a part of my problem with all this. I live in Toronto's downtown core and the explosion in drug issues since these policies came into effect is something I see and live with. And it's the same in our other major cities. And too often the response from the proponents of these policies is outright misinformation, accusations of moralism. As someone living in an area where I am watching a drug problem spiral out of control, this is frankly infuriating. This is my city and I see these people with addiction as neighbors I want to help. But these policies don't appear to be helping them. It looks to me like it's making things worse If it's so good, if it's so helpful, why are there tent encampments full of people with drug issues popping up. We have shelters so it's not an issue of lack of shelters. Why are there so many more people high or doing drugs on our streets, why are overdose deaths the same or higher
  - afarviral 3y ago
    Could the gradual impacts of economic downturn, unemployment and unhappiness post-pandemic be a contributing factor? From available data on drug overdoses and homelessness things appear relatively stable but some data from last year is missing. An uptick may be on the cards based on your observations. I'm curious what specifically is to blame in your view and why other factors seem unlikely? What do you suggest should change? Should the drugs be recriminalized? Or is the current strategy okay but needing some supplimentary steps?
    - vivekd 3y ago
      I mean there aren't enough quality studies to make conclusions either way. But the promise to us was that safe supply would help drug users, and this uptick in homeless drug addicts and more people suffering visibility from drug issues at least seems to run counter to that that should at least give us pause and make us re evaluate This was done because Portugal did it and people in places like hacker news started pushing it as evidence based because of self proclaimed success in Portugal. Well overdose and drug use is up in Portugal, it's up in Portland and it's up here. How long are proponents going to suggest other factors - this safe supply idea is starting to look less evidence based and more like a religious belief.
jdietrich 3y ago
Drug use and addiction are complex biopsychosocial phenomena with many causal factors and associated harms. It is to be expected that any effective response would likewise be complex and multifactorial. People living with drug addictions are usually living with a multitude of other problems, many of which would still remain if a magic wand were to cure their addiction instantly. A homeless schizophrenic heroin addict would still be in a dire situation if heroin didn't exist. Drug policy in North America seems to be ideologically fixated both on addiction as a singular problem, and on singular solutions to that problem. Addiction is an important and very hazardous part of someone's life, but it's only one part. Lots of people who live in tents or behave erratically in public aren't addicted to drugs; lots of people who are addicted to drugs don't live in tents or behave erratically in public. Giving someone an adequate and reliable supply of pharmaceutical opioids is quite likely to reduce their risk of overdose if it gets them away from a highly variable supply of very potent synthetic opioids, but thinking that it'll solve all of their problems is pure fantasy. Keeping people alive is a prerequisite to fixing the rest of their life, but nothing more than that.

tayo42 3y ago

Does harm reduction include safe access to drugs? Basically this is why all substances need to be legal. So it's regulated. So many needless deaths becasue of overdoses that didn't need to happen. People just need to be supported through their low points so they come out the other side. To many ignorant people have an opinion on this though, as you can see in some of these comments. If you never used drugs, don't know people that died needlessly, you don't get to have an opinion.

jdietrich 3y ago
>Does harm reduction include safe access to drugs? Only if it's part of an evidence-based and empirically validated strategy. We know that safe access to drugs can work as part of a harm reduction strategy, but there's also good reason to believe that thoughtless moves towards decriminalisation or legalisation can exacerbate harms. The Swiss model has worked incredibly well after a lot of difficult trial-and-error, but the Portuguese model is increasingly looking like a mistake. Even with the relatively lower-risk example of cannabis legalisation, we're seeing a very mixed picture in terms of outcomes. The devil is in the details.
- j0057 3y ago
  The Portugal model consists of decriminalisation, harm reduction and rehabilitation, but the Portuguese government has basically defunded the rehabilitation programs. Seems to me no wonder that the approach is failing if you take away the one factor that would reduce addictions, but also disingenuous to claim that the entire approach was a mistake. It worked, and now after defending an important part of it, it no longer works. Source: https://www.washingtonpost.com/world/2023/07/07/portugal-drugs-decriminalization-heroin-crack/ https://www.washingtonpost.com/world/2023/07/07/portugal-dru...

lazide 3y ago

Alternatively, for some - most really - the real possibility of death and real consequences is what was necessary to pull out of it. To break through the delusional behavior. But even then, it may not be enough. The Issue, imo, is when death is not a certainty, but a surprise consequence (or sudden) due to bad or inconsistent supply, etc. I recently met someone who it took 6 NARCAN to revive last time he overdid it. Frankly, I’m surprised his body was able to handle it - apparently it was an extremely unpleasant experience. And, frankly, he might not come back next time. He seemed to take it seriously. We’ll see. Not letting your kid touch the hot stove at all is as bad as letting them pull a pot of boiling water down on their head.

tanseydavid 3y ago
>> for some - most really - the real possibility of death and real consequences is what was necessary to pull out of it This is not true at all for some significant part of this demographic. And I feel compelled to mention that I am well-aware that this is totally counter-intuitive.
- LargeTomato 3y ago
  Consequences for my own inaction play an incredibly important motivational role for me. I don't get motivated by sunshine and rainbows, I personally get motivated by consequences. So it's great that we can provide people 6 doses of narcan and act like they're big strong adults who are down on their luck, but it's incredibly harmful to pretend that this is the only possible solution to motivating behavior.
  - sfc32 3y ago
    > Not letting your kid touch the hot stove at all is as bad as letting them pull a pot of boiling water down on their head. While kids are over-protected these days, I strongly disagree with this.
    - lazide 3y ago
      What alternative view do you propose concretely? Over protective is the definition of ‘they never get a chance to get a non-serious burn’ isn’t it?