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Blanket legalization without any supporting infrastructure seems dicey. Portugal had fairly promising results early on when they had funding for all of the assi

Blanket legalization without any supporting infrastructure seems dicey. Portugal had fairly promising results early on when they had funding for all of the assistance programs, etc., but this money ran out and the taxes raised as part of the change did not provide enough funding to support them. The PNW implementations are scattershot messes, so no surprise things are going poorly there. (Though I don't think as poorly of harm reduction practices as many do) I think there are quite a few things we could broadly legalize, like marijuana, lsd, shrooms, dmt, etc., and have little cause for concern. Opioids, amphetamines, cocaine, etc. have enough abuse potential that we do probably need real programs to help people get clean and away from the situation that led them to begin abusing in the first place before we make them broadly legal. Though, at the same time there are legitimate arguments that we would see significant benefits in some areas by legalizing, if only because we could bundle naloxone with opioids and ensure consistent dosages and purity, which would save a lot of lives.

fasthands9 3y ago
I agree for the most part. I used to be more pro legalization of everything. It definitely seems like if you do the cost benefit analysis for individual cases it is better to not punish people for ingesting a substance voluntarily. That said, I've lost two friends to heroin overdoses (one intentional, one not). They were both relatively successful. I find the call for better programs a bit empty - would these programs be voluntary if you are on decriminalized drugs? If so, do they have any chance of success? My friends were both financially fine so they could have opted for rehab and (as far as I know) did not. Perhaps if legal there'd be better harm reduction practices, though I'm still skeptical this would overcome the increase in ubiquity. The data also makes things hard. California and Oregon have far few overdoses than West Virginia. But Texas and North Dakota beat the west coast states by a lot.
- cthalupa 3y ago
  I've also lost a friend to a heroin overdose, and as best we can tell it was unintentional and the result of a significant difference in purity/dose from what he was expecting. It's the sort of thing legalization and regulation would go a long way to fixing. Naloxone being readily available and using with others capable of dosing you with it to stop an OD would also be a huge deal. But yes, I imagine any rehabilitation programs would be voluntary, though I think it would be reasonable to force them in situations where people are doing other illegal things while on the drug - DWI, the sort of public abuse you see in some cities (though lots of this is tied to a larger homelessness issue), etc. Bundle it up with programs for the homeless and you probably take care of a lot of the worst situations for people. I don't think we'll ever get to perfect, but I hope everyone believes we can get to a better spot than we're at today.
- BobaFloutist 3y ago
  If they're legalized it's possible it would be easier to track usage, and stage interventions if someone's demonstrating dangerous patterns. If it's illegal than maybe fewer people are exposed, but it can be harder to know when it's a problem.
  - fasthands9 3y ago
    I am skeptical that libertarians who want legalized drugs would be okay with tracking. For progressive-minded people I'm skeptical too, most harm reduction programs I see emphasize anonymity. The link below is framework for harm reduction policies which seems pretty clear that tracking usage is not part of the practice "Participation in services is always voluntary, confidential (or anonymous), self-directed, and free from threats, force, and the concept of compliance. Any data collection requires informed consent and participants should not be denied services for not providing information. This means using low-threshold evaluation and data collection systems to measure the effectiveness of harm reduction programs." https://www.samhsa.gov/sites/default/files/harm-reduction-framework.pdf https://www.samhsa.gov/sites/default/files/harm-reduction-fr...
cyberax 3y ago
Fentanyl has changed everything. The only "old" drug comparable with it is heroin, and it has always been pretty expensive and required "dedication" (intravenous use) from abusers. Fentanyl is cheap, so a daily dose even for a heavy user is apparently less than $30 now ( https://sfstandard.com/2024/01/22/cheap-street-fentanyl-san-francisco/ https://sfstandard.com/2024/01/22/cheap-street-fentanyl-san-... ). It's also easy to get into, you just smoke it off a foil, no need for scary syringes. And once you get addicted, you're a walking dead. The success rate for fentanyl addiction treatment is apparently less than 1%. ONE PERCENT. Even for heroin, it's around 5%. So yeah, drugs are just different. Europe has not yet been hit with fentanyl, but it's starting to appear ( https://www.economist.com/europe/2023/11/16/fentanyl-kills-thousands-every-year-in-america-will-europe-be-next https://www.economist.com/europe/2023/11/16/fentanyl-kills-t... ). We'll see what happens.

fasthands9 3y ago

I agree for the most part. I used to be more pro legalization of everything. It definitely seems like if you do the cost benefit analysis for individual cases it is better to not punish people for ingesting a substance voluntarily. That said, I've lost two friends to heroin overdoses (one intentional, one not). They were both relatively successful. I find the call for better programs a bit empty - would these programs be voluntary if you are on decriminalized drugs? If so, do they have any chance of success? My friends were both financially fine so they could have opted for rehab and (as far as I know) did not. Perhaps if legal there'd be better harm reduction practices, though I'm still skeptical this would overcome the increase in ubiquity. The data also makes things hard. California and Oregon have far few overdoses than West Virginia. But Texas and North Dakota beat the west coast states by a lot.

cthalupa 3y ago
I've also lost a friend to a heroin overdose, and as best we can tell it was unintentional and the result of a significant difference in purity/dose from what he was expecting. It's the sort of thing legalization and regulation would go a long way to fixing. Naloxone being readily available and using with others capable of dosing you with it to stop an OD would also be a huge deal. But yes, I imagine any rehabilitation programs would be voluntary, though I think it would be reasonable to force them in situations where people are doing other illegal things while on the drug - DWI, the sort of public abuse you see in some cities (though lots of this is tied to a larger homelessness issue), etc. Bundle it up with programs for the homeless and you probably take care of a lot of the worst situations for people. I don't think we'll ever get to perfect, but I hope everyone believes we can get to a better spot than we're at today.
BobaFloutist 3y ago
If they're legalized it's possible it would be easier to track usage, and stage interventions if someone's demonstrating dangerous patterns. If it's illegal than maybe fewer people are exposed, but it can be harder to know when it's a problem.
- fasthands9 3y ago
  I am skeptical that libertarians who want legalized drugs would be okay with tracking. For progressive-minded people I'm skeptical too, most harm reduction programs I see emphasize anonymity. The link below is framework for harm reduction policies which seems pretty clear that tracking usage is not part of the practice "Participation in services is always voluntary, confidential (or anonymous), self-directed, and free from threats, force, and the concept of compliance. Any data collection requires informed consent and participants should not be denied services for not providing information. This means using low-threshold evaluation and data collection systems to measure the effectiveness of harm reduction programs." https://www.samhsa.gov/sites/default/files/harm-reduction-framework.pdf https://www.samhsa.gov/sites/default/files/harm-reduction-fr...

cyberax 3y ago

Fentanyl has changed everything. The only "old" drug comparable with it is heroin, and it has always been pretty expensive and required "dedication" (intravenous use) from abusers. Fentanyl is cheap, so a daily dose even for a heavy user is apparently less than $30 now ( https://sfstandard.com/2024/01/22/cheap-street-fentanyl-san-francisco/ https://sfstandard.com/2024/01/22/cheap-street-fentanyl-san-... ). It's also easy to get into, you just smoke it off a foil, no need for scary syringes. And once you get addicted, you're a walking dead. The success rate for fentanyl addiction treatment is apparently less than 1%. ONE PERCENT. Even for heroin, it's around 5%. So yeah, drugs are just different. Europe has not yet been hit with fentanyl, but it's starting to appear ( https://www.economist.com/europe/2023/11/16/fentanyl-kills-thousands-every-year-in-america-will-europe-be-next https://www.economist.com/europe/2023/11/16/fentanyl-kills-t... ). We'll see what happens.