The Portugal Model for Addressing the Overdose Crisis
April 25, 2024 5:38 AM Subscribe
I am a professor of medicine and public health who researches the government’s response to addiction. I also spent more than two decades as a police officer. If cities expect to help reduce our nation’s overdose crisis and not simply ride a policy pendulum back and forth between election cycles, their leaders need to enact compassionate, effective drug policies and ensure fair access to public space at the same time.
The one party in the US has multiple voices (including TFG, unsurprisingly) who actually like the Filipino model.
posted by DirtyOldTown at 6:18 AM on April 25 [3 favorites]
posted by DirtyOldTown at 6:18 AM on April 25 [3 favorites]
maybe just maybe we have come to a plateau and the trend is downward?
posted by robbyrobs at 6:19 AM on April 25 [1 favorite]
posted by robbyrobs at 6:19 AM on April 25 [1 favorite]
The "Portugal Model" has come under fire of late, mainly because the initial enthusiasm and almost instant, largely persistent results have started to fade over time (20 years!) and now there are new & different drugs, new & different users and new & different dynamics. But there is anecdotal as well as hard evidence that the mix of non-aggressive policing, decriminalization & community care as described in the FPP dramatically reduced the number of chronic users and shifted a whole generation away from the horrors of living in the street, panhandling, shoplifting and petty crime.
Does Portugal still have homeless people? Yes.
Do people still beg in the streets? Yes.
Do people still sell & take drugs? Yes.
Still, it's nothing like it was and any rational, alert person would be hard-pressed to not consider the "Portugal Model" a success.
posted by chavenet at 6:59 AM on April 25 [15 favorites]
Does Portugal still have homeless people? Yes.
Do people still beg in the streets? Yes.
Do people still sell & take drugs? Yes.
Still, it's nothing like it was and any rational, alert person would be hard-pressed to not consider the "Portugal Model" a success.
posted by chavenet at 6:59 AM on April 25 [15 favorites]
I don’t see anything about meaningful reforms in housing and the economy. What are people supposed to look forward to after they get off drugs? Working too hard for too little and barely able to afford the rent and food? AND no drugs to soften that experience? What’s the point? This is the proverbial thing that’s pushing people into the river in the first place.
posted by toodleydoodley at 7:02 AM on April 25 [16 favorites]
posted by toodleydoodley at 7:02 AM on April 25 [16 favorites]
We've had deep and thoughtful discussions about possible future options for this park with local leaders, advocates, and representatives from our houseless community, but there are no easy answers here.
Working in a public library and dealing daily with the human wreckage of capitalism that we're expected to backstop because no one with real money or power cares (when they aren't actively expressing hatred for unhoused people or public employees) is increasingly convincing me nothing less than a total burndown would even put us at the doorstep of a real solution in the US. We just have too much baked in sadism, indifference and greed.
posted by ryanshepard at 7:04 AM on April 25 [18 favorites]
Working in a public library and dealing daily with the human wreckage of capitalism that we're expected to backstop because no one with real money or power cares (when they aren't actively expressing hatred for unhoused people or public employees) is increasingly convincing me nothing less than a total burndown would even put us at the doorstep of a real solution in the US. We just have too much baked in sadism, indifference and greed.
posted by ryanshepard at 7:04 AM on April 25 [18 favorites]
The article assumes the problem is the drugs (which are a problem to be sure, but not the one that put all those folks on the street) and implies that a measured, intelligent police response guided by thoughtful public policy toward the use of open spaces will send things in the other direction. PDX government right now is not even remotely capable of such a thing in any event. The implication seems to be that if the police hold drug users accountable then all this other stuff will recede, which is not the case. Places where drugs have not been decriminalized have the same situations with homelessness and drug use all over the place. Discussion about this issue in the NW generally leaves this inconvenient fact out.
There have been homeless camps in the PDX area since the beginning of the Great Depression, along with higher priced real estate along the west coast compared to inland. Inland cities never really had a homelessness problem until about 20 years ago. The model of churning and manipulating the rental and property markets has spread from the west coast into the inland cities via Airbnb and the cash buyers such as the private equity firms and rich independent investors and "equity locusts" from the west coast, so prices there have gone up too and so has homelessness. It is spreading into foreign countries such as Mexico and many other parts of Central America, and those places have experienced higher unaffordability and the problems that go along with that.
If people don't have a place to live, then they are homeless. If homeless for a long time, their ability to deal with things that people in a home take for granted, such as basic hygiene, medical issues, and staying warm and cool become extremely complicated and sometimes cannot be solved at all. Homelessness is trauma. Trauma that is unremitting does bad things to the human psyche, and one of the end results is increased drug use. remedying that will take generations of concerted effort. I cannot figure out why there was an expectation that in just a couple of years of half assed implementation of Measure 110 anyone would expect a quick turnaround of something that has been nearly a century in the making.
On the one hand I am interested and intrigued by hearing intelligent ideas around the use of police power to solve problems in places like PDX, which used to have (still in some ways) a horribly oppressive police force that answered to nobody but itself. On the other hand I really don't see a solution to the difficulties found in PDX in this article. You want treatment for people, we are going to have to have beds and they are too expensive to develop and staff right now because the cost of living, driven by real estate is too high. You want people sleeping in places that are not the sidewalks, freeway intersections and parks, then they have to have someplace affordable to live. We cannot find people affordable places to live now, even in the inland cities because real estate is too high.
I could go into how that might be addressed but it would derail, and I do not want to do that. I just don't see any solutions in this article that will make much difference or even really stand a chance of being implemented effectively.
posted by cybrcamper at 7:17 AM on April 25 [10 favorites]
There have been homeless camps in the PDX area since the beginning of the Great Depression, along with higher priced real estate along the west coast compared to inland. Inland cities never really had a homelessness problem until about 20 years ago. The model of churning and manipulating the rental and property markets has spread from the west coast into the inland cities via Airbnb and the cash buyers such as the private equity firms and rich independent investors and "equity locusts" from the west coast, so prices there have gone up too and so has homelessness. It is spreading into foreign countries such as Mexico and many other parts of Central America, and those places have experienced higher unaffordability and the problems that go along with that.
If people don't have a place to live, then they are homeless. If homeless for a long time, their ability to deal with things that people in a home take for granted, such as basic hygiene, medical issues, and staying warm and cool become extremely complicated and sometimes cannot be solved at all. Homelessness is trauma. Trauma that is unremitting does bad things to the human psyche, and one of the end results is increased drug use. remedying that will take generations of concerted effort. I cannot figure out why there was an expectation that in just a couple of years of half assed implementation of Measure 110 anyone would expect a quick turnaround of something that has been nearly a century in the making.
On the one hand I am interested and intrigued by hearing intelligent ideas around the use of police power to solve problems in places like PDX, which used to have (still in some ways) a horribly oppressive police force that answered to nobody but itself. On the other hand I really don't see a solution to the difficulties found in PDX in this article. You want treatment for people, we are going to have to have beds and they are too expensive to develop and staff right now because the cost of living, driven by real estate is too high. You want people sleeping in places that are not the sidewalks, freeway intersections and parks, then they have to have someplace affordable to live. We cannot find people affordable places to live now, even in the inland cities because real estate is too high.
I could go into how that might be addressed but it would derail, and I do not want to do that. I just don't see any solutions in this article that will make much difference or even really stand a chance of being implemented effectively.
posted by cybrcamper at 7:17 AM on April 25 [10 favorites]
The whole Oregon situation is so frustrating and sad. There was a great article on it in the New Yorker, and there is also some good analysis coming in May from the Journal of Law, Medicine and Ethics. The tl;dr version from those, as somewhat also covered in this editorial, is:
1. the Portugal model only works if you do the whole thing rather than selective bits.
2. there was a huge spike in fentanyl nationwide right as this took effect, which made people see a correlation where there was not one
What I appreciate about this article is that it names the third piece, which those really didn't touch on: in order for the public to truly get on board, you have to get the people with addiction issues off the streets and into some sort of housing. But, as the Washington Post covered this week, there also needs to be support for the people with addiction issues once they get into housing.
It is a problem that requires big and systemic solutions, and Americans often don't have the patience for that.
posted by rednikki at 7:19 AM on April 25 [6 favorites]
1. the Portugal model only works if you do the whole thing rather than selective bits.
2. there was a huge spike in fentanyl nationwide right as this took effect, which made people see a correlation where there was not one
What I appreciate about this article is that it names the third piece, which those really didn't touch on: in order for the public to truly get on board, you have to get the people with addiction issues off the streets and into some sort of housing. But, as the Washington Post covered this week, there also needs to be support for the people with addiction issues once they get into housing.
It is a problem that requires big and systemic solutions, and Americans often don't have the patience for that.
posted by rednikki at 7:19 AM on April 25 [6 favorites]
And hessie, I am very sorry to hear about what you folks have going on there. That's dispiriting and frustrating to say the least. I hope things get better for you and your neighbors.
posted by cybrcamper at 7:19 AM on April 25 [3 favorites]
posted by cybrcamper at 7:19 AM on April 25 [3 favorites]
On the principle that ACAB I am going to take TFA author's admission that they were a police officer for decades as an admission that they are part of the problem.
The "Portugal Model" has not failed in the US, because it has not been tried. It's more than just not busting users. It's providing services to help marginalized people survive and even become not-so-marginal. You can tell it hasn't been tried in the US because we are complaining that cops leave the users alone after citing them for public use, instead of realizing that to try the "Portugal Model" you have to hire people who aren't cops to do the interacting with the users.
I have decided, after reading the paragraph about how it's problematic that the cops have to leave the users alone, that the remainder of TFA is not worth the minutes of my life that would be required to finish reading it.
And oh amazingly, archive.ph worked for me this morning.
posted by Aardvark Cheeselog at 7:29 AM on April 25 [17 favorites]
The "Portugal Model" has not failed in the US, because it has not been tried. It's more than just not busting users. It's providing services to help marginalized people survive and even become not-so-marginal. You can tell it hasn't been tried in the US because we are complaining that cops leave the users alone after citing them for public use, instead of realizing that to try the "Portugal Model" you have to hire people who aren't cops to do the interacting with the users.
I have decided, after reading the paragraph about how it's problematic that the cops have to leave the users alone, that the remainder of TFA is not worth the minutes of my life that would be required to finish reading it.
And oh amazingly, archive.ph worked for me this morning.
posted by Aardvark Cheeselog at 7:29 AM on April 25 [17 favorites]
I heard a great piece on this on NPR a week ago with good news about deaths from overdoses and addiction.
posted by Snowishberlin at 8:41 AM on April 25 [1 favorite]
posted by Snowishberlin at 8:41 AM on April 25 [1 favorite]
We need better drugs. Make people feel good without killing them or addicting them. Sell these drugs at cost and over the counter. Offer an array so you can choose the right tool for the job. That should be the next moonshot project. More important than an actual moonshot.
posted by pracowity at 9:00 AM on April 25 [3 favorites]
posted by pracowity at 9:00 AM on April 25 [3 favorites]
…remainder of TFA is not worth the minutes of my life …
Ok I’ll save you a minute and pull a quote from a paragraph or two after where you stopped reading:
…“not all enforcement is created equal. When police remove a person from the street for drug use or the crimes that feed an addiction, an option is to link them directly to services and treatment. By doing that, they are addressing the problem with a much more effective tool than a night in jail. To truly benefit all residents, police must do much more than simply make arrests.“
I don’t see anything about meaningful reforms in housing and the economy.
Understandable, as it’s very blink-and-you’ll miss it, but this is at least gestured to here:
“True progress will therefore require balancing two needs. One is for deep and sustained investments not only in harm reduction and treatment but in things that address the reasons why people relapse or become addicted in the first place”…
I should note that I’ve met (and worked on harm reduction efforts with) the author of this piece, and think he has a valuable perspective to share. I think his approach is well informed (and indeed he has been doing a lot of research in this space to legitimize harm reduction) and strategic, but is also very much a ‘work within the system to create change’ attitude that might feel counterproductive or misguided, especially when couched in language meant to appeal to centrists and cops. I totally understand why some might not trust him and that’s fine, but I’m really glad he’s doing what he does.
posted by soy bean at 9:03 AM on April 25 [16 favorites]
Ok I’ll save you a minute and pull a quote from a paragraph or two after where you stopped reading:
…“not all enforcement is created equal. When police remove a person from the street for drug use or the crimes that feed an addiction, an option is to link them directly to services and treatment. By doing that, they are addressing the problem with a much more effective tool than a night in jail. To truly benefit all residents, police must do much more than simply make arrests.“
I don’t see anything about meaningful reforms in housing and the economy.
Understandable, as it’s very blink-and-you’ll miss it, but this is at least gestured to here:
“True progress will therefore require balancing two needs. One is for deep and sustained investments not only in harm reduction and treatment but in things that address the reasons why people relapse or become addicted in the first place”…
I should note that I’ve met (and worked on harm reduction efforts with) the author of this piece, and think he has a valuable perspective to share. I think his approach is well informed (and indeed he has been doing a lot of research in this space to legitimize harm reduction) and strategic, but is also very much a ‘work within the system to create change’ attitude that might feel counterproductive or misguided, especially when couched in language meant to appeal to centrists and cops. I totally understand why some might not trust him and that’s fine, but I’m really glad he’s doing what he does.
posted by soy bean at 9:03 AM on April 25 [16 favorites]
The author also acknowledges that activists have a different role to play. They shouldn't be expected to be balanced.
We can’t rely on activists, advocates, and reformers to strike this type of balance, because it’s not their job,...Some activists have worked their entire adult lives to stop an inhumane war against people with addiction. They need to push the limits of reform as far as they can, forcing us to expand our beliefs about what is possible. On the other side, there are residents who deserve accessible civic spaces. They aren’t wrong when they insist that reducing the harms of addiction shouldn’t come at great expense to a city’s public spaces or even, in some cases, its public safety.posted by Winnie the Proust at 9:23 AM on April 25 [6 favorites]
We need better drugs. Make people feel good without killing them or addicting them. Sell these drugs at cost and over the counter.
Sure, but in the meantime we can make the drugs we already have much safer. Despite the scare-mongering, the main problem with fentanyl is not inherent to the drug (which is used safely in medical contexts all the time), but the unsafe illicit supply of fentanyl. Just selling clean, standardized fentanyl over the counter would save tens of thousands of lives per year in the USA.
posted by ssg at 10:00 AM on April 25 [3 favorites]
Sure, but in the meantime we can make the drugs we already have much safer. Despite the scare-mongering, the main problem with fentanyl is not inherent to the drug (which is used safely in medical contexts all the time), but the unsafe illicit supply of fentanyl. Just selling clean, standardized fentanyl over the counter would save tens of thousands of lives per year in the USA.
posted by ssg at 10:00 AM on April 25 [3 favorites]
One of the fundamental problems with just send them to treatment is the US considers substance use treatment to be 100 percent voluntary. You cannot commit someone to treatment for using drugs. So jail is actually the only place right now where you can hold a person through withdrawal legally in this country on some random charge of things that happen when people are using drugs. Because substance use and mental health have been split as different things for so so so long ( which is is own lengthy discission on why there is a distinction and exactly how important is it) and there is no such thing as involuntary commitment for substance use.
Not that that forcing treatment solves all the other stuff going on. Support of substance use requires holistic approaches. It requires housing, case management., therapy, domestic violence counseling. It irequires child care and so much more.
posted by AlexiaSky at 10:26 AM on April 25 [2 favorites]
Not that that forcing treatment solves all the other stuff going on. Support of substance use requires holistic approaches. It requires housing, case management., therapy, domestic violence counseling. It irequires child care and so much more.
posted by AlexiaSky at 10:26 AM on April 25 [2 favorites]
I know the author of this piece doesn't think he's one of them, but a huge percentage of the public really seems to just want everybody who appears in public and Is Gross (homeless or not, but definitely them) to just crawl away and die (but somehow not leave a gross corpse behind.) They don't want to admit this, or at least to say it out loud, or they'd be more honest about advocating for every poor and homeless or addicted person to be euthanized and then cremated. They'd be very mad if you suggested that their position inevitably turns into "we should probably just euthanize a few million homeless and/or addicted people so we don't have to deal with them" but there's really no other logical conclusion.
I am so tired.
posted by Tomorrowful at 10:28 AM on April 25 [6 favorites]
I am so tired.
posted by Tomorrowful at 10:28 AM on April 25 [6 favorites]
> Ok I’ll save you a minute and pull a quote from a paragraph or two after where you stopped reading:
That's not responsive. I guess you skipped the part where I noted that if the person contacting the person with addiction is a cop and not somebody else, you are already Doing It Wrong and need to start over from the beginning.
One thing that's clear from the experiences of the Western European countries that have actually tried the harm-reduction approach is that many of the people who need help are not especially eager to receive it. They have to be approached on their terms, and that starts with not using cops to do the reaching out. This is not a point on which good-faith well-informed difference of opinion is really possible.
posted by Aardvark Cheeselog at 10:35 AM on April 25 [1 favorite]
That's not responsive. I guess you skipped the part where I noted that if the person contacting the person with addiction is a cop and not somebody else, you are already Doing It Wrong and need to start over from the beginning.
One thing that's clear from the experiences of the Western European countries that have actually tried the harm-reduction approach is that many of the people who need help are not especially eager to receive it. They have to be approached on their terms, and that starts with not using cops to do the reaching out. This is not a point on which good-faith well-informed difference of opinion is really possible.
posted by Aardvark Cheeselog at 10:35 AM on April 25 [1 favorite]
To me it all comes down to a lack of meaning both on the individual level (why not use to escape the horrors of being on the shit end of capitalism? What actual benefit to my life would it be to lose the one thing that gives me some measure of control over the pain, despair and hopelessness that largely defines my existence?) and on the societal level (how can we justify the immense expense and effort to save a generation or two or three of traumatized homeless substance users when we have no [apparently] unifying values beyond what’s allowed to exist within the parameters of the capitalist mandate of profit?).
Without any sort of a unifying narrative or story of why any of this matters beyond that it makes a handful of assholes even more wealthy and powerful . . . This is what precisely what we get.
posted by flamk at 10:35 AM on April 25 [1 favorite]
Without any sort of a unifying narrative or story of why any of this matters beyond that it makes a handful of assholes even more wealthy and powerful . . . This is what precisely what we get.
posted by flamk at 10:35 AM on April 25 [1 favorite]
I thought this was a very good and thoughtful piece. It unfortunately will not address or even acknowledge all the things that everyone hopes, which would probably triple its length. But I do think what it does cover, it covers well and compassionately, while acknowledging the reality of the situation and what is likely to happen should such and such an approach be taken or not taken.
I agree with the above who say, more resources! But the tug-of-war over limited city or state resources is so poisonous and contentious we can't expect durable change over anything but a decadal time period. If we do want to see that, we must also expect to see policies enacted and reversed multiple times, and backlash in every direction.
posted by BlackLeotardFront at 12:21 PM on April 25 [1 favorite]
I agree with the above who say, more resources! But the tug-of-war over limited city or state resources is so poisonous and contentious we can't expect durable change over anything but a decadal time period. If we do want to see that, we must also expect to see policies enacted and reversed multiple times, and backlash in every direction.
posted by BlackLeotardFront at 12:21 PM on April 25 [1 favorite]
Aardvark Cheeselog, if you read the New Yorker piece, there was in fact funded outreach that was not done by cops. One of the challenges in Oregon was getting the non-police outreach services up and running (especially during a pandemic). The New Yorker has the advantage of not being limited to 1000 words.
posted by rednikki at 12:32 PM on April 25 [2 favorites]
posted by rednikki at 12:32 PM on April 25 [2 favorites]
We need better drugs. Make people feel good without killing them or addicting them.
Addiction science suggests that “better drugs” = safe and comfortable housing, food, healthcare, mentally-stimulating activity, friendship, exercise. While I’m not trying to shit on this comment, my heart breaks to think of time, money, and human creativity spent on inventing Soma rather than finding ways to meet basic human needs and foster healthy communities.
posted by rrrrrrrrrt at 12:57 PM on April 25 [6 favorites]
Addiction science suggests that “better drugs” = safe and comfortable housing, food, healthcare, mentally-stimulating activity, friendship, exercise. While I’m not trying to shit on this comment, my heart breaks to think of time, money, and human creativity spent on inventing Soma rather than finding ways to meet basic human needs and foster healthy communities.
posted by rrrrrrrrrt at 12:57 PM on April 25 [6 favorites]
you are already Doing It Wrong and need to start over from the beginning
Firstly, I’m inclined to agree with you on most of this, and apologize for an ungenerous and perhaps unhelpful response earlier.
As the article notes, in Oregon ‘starting over’ means criminalizing drugs again and returning to the status quo. I think the point being made is that in this case it is probably worth ‘doing it wrong’ for a while (although in a much more compassionate manner than previous ways of doing it wrong) until the resources and support for doing it correctly can be fully established, as the alternative turns out to be a traumatic transition period that can be capitalized on by those who oppose progress. Of course, doing it correctly from the beginning would be best but that isn’t always (or even very commonly) how things work out.
I think the relevant points in the OP come from the perspective that police are necessary for society to function (debatable!), and that as long as they are interacting with people struggling with substance use disorders cops should be using tactics that might be able to help (referral to harm reduction) rather than relying on tactics that will almost inevitably lead to worse outcomes or even death (fines, harassment, drug seizures, arrests, jail). This is part of a pragmatic political strategy to build police support for harm reduction resources (and increase public support/funding for organizations doing this work) by emphasizing an alignment in their goals of public safety. It’s my view that this is a good-faith attempt at saving lives and addressing the overdose crisis, and does more harm than good. There’s decent evidence backing this approach, including Del Pozo’s impact as police chief in Burlington Vermont (admittedly not scientific but pretty compelling). That said, it doesn’t go as far as I would like towards dismantling a broken system and putting the brakes on fascism, and yeah it’s very understandable that you don’t trust where this is coming from.
Also I think the “better drug” already exists, it’s beupronephrine .
posted by soy bean at 1:18 PM on April 25
Firstly, I’m inclined to agree with you on most of this, and apologize for an ungenerous and perhaps unhelpful response earlier.
As the article notes, in Oregon ‘starting over’ means criminalizing drugs again and returning to the status quo. I think the point being made is that in this case it is probably worth ‘doing it wrong’ for a while (although in a much more compassionate manner than previous ways of doing it wrong) until the resources and support for doing it correctly can be fully established, as the alternative turns out to be a traumatic transition period that can be capitalized on by those who oppose progress. Of course, doing it correctly from the beginning would be best but that isn’t always (or even very commonly) how things work out.
I think the relevant points in the OP come from the perspective that police are necessary for society to function (debatable!), and that as long as they are interacting with people struggling with substance use disorders cops should be using tactics that might be able to help (referral to harm reduction) rather than relying on tactics that will almost inevitably lead to worse outcomes or even death (fines, harassment, drug seizures, arrests, jail). This is part of a pragmatic political strategy to build police support for harm reduction resources (and increase public support/funding for organizations doing this work) by emphasizing an alignment in their goals of public safety. It’s my view that this is a good-faith attempt at saving lives and addressing the overdose crisis, and does more harm than good. There’s decent evidence backing this approach, including Del Pozo’s impact as police chief in Burlington Vermont (admittedly not scientific but pretty compelling). That said, it doesn’t go as far as I would like towards dismantling a broken system and putting the brakes on fascism, and yeah it’s very understandable that you don’t trust where this is coming from.
Also I think the “better drug” already exists, it’s beupronephrine .
posted by soy bean at 1:18 PM on April 25
soy bean, was that “more harm than good” or the other way round (“decent evidence backing this approach”)?
posted by clew at 2:51 PM on April 25
posted by clew at 2:51 PM on April 25
Buprenorphine is a great treatment option for people who are ready to quit dope but less so for people who aren’t because it doesn’t really get you high the same way, it basically lets you feel “normal.”
I’m all for making classical opioids available for maintenance, too. But of course this still only addresses one problem for people who tend to have quite a few.
posted by atoxyl at 3:03 PM on April 25 [2 favorites]
I’m all for making classical opioids available for maintenance, too. But of course this still only addresses one problem for people who tend to have quite a few.
posted by atoxyl at 3:03 PM on April 25 [2 favorites]
These graphs from NIDA really tell a story, or several. One of those stories is that people do manage to kill themselves with pharmaceutical-grade drugs, and that the number of people falling victim to this did increase in the “pill epidemic” era. But boy did things get a lot worse after the crackdown on prescriptions.
posted by atoxyl at 3:11 PM on April 25
posted by atoxyl at 3:11 PM on April 25
One of those stories is that people do manage to kill themselves with pharmaceutical-grade drugs
What's frustrating is that these stats don't (perhaps can't?) distinguish between prescribed drugs and diverted drugs. It seems unlikely that diverted scripts cause all ODs, but I would not be surprised to learn that they cause a majority (classic dumb-ass opioid-naive teenagers raiding the medicine cabinet with no idea of their tolerance).
posted by praemunire at 9:32 PM on April 25 [1 favorite]
What's frustrating is that these stats don't (perhaps can't?) distinguish between prescribed drugs and diverted drugs. It seems unlikely that diverted scripts cause all ODs, but I would not be surprised to learn that they cause a majority (classic dumb-ass opioid-naive teenagers raiding the medicine cabinet with no idea of their tolerance).
posted by praemunire at 9:32 PM on April 25 [1 favorite]
Places where drugs have not been decriminalized have the same situations with homelessness and drug use all over the place. Discussion about this issue in the NW generally leaves this inconvenient fact out.
This. Atlanta has only decriminalized small amounts of marijuana and no other drugs, and yet the number of people living in encampments has exploded here just as it has everywhere else.
I was present for an encampment clearing in front of a downtown church. The city brought cops, sanitation workers, and the social worker from Central Atlanta Progress (primarily a marketing and tourism development organization) who promised to get folks into housing right now, except no addiction treatment was being offered--and all the housing available required no drug use--the housing available didn't cover every other circumstance (no housing was available for single women without kids, no pets), they could only bring what they could carry, and the sanitation workers threw away everything else.
I stood there to bear witness and to quietly remind the sanitation workers that they were throwing away someone's entire life when they tore down those tents and tossed the belongings inside. Ultimately the sanitation workers got fed up and left. They came back a few days later early in the morning and ran off everybody who was still left and threw the rest of their belongings away.
posted by hydropsyche at 4:16 AM on April 26 [2 favorites]
This. Atlanta has only decriminalized small amounts of marijuana and no other drugs, and yet the number of people living in encampments has exploded here just as it has everywhere else.
I was present for an encampment clearing in front of a downtown church. The city brought cops, sanitation workers, and the social worker from Central Atlanta Progress (primarily a marketing and tourism development organization) who promised to get folks into housing right now, except no addiction treatment was being offered--and all the housing available required no drug use--the housing available didn't cover every other circumstance (no housing was available for single women without kids, no pets), they could only bring what they could carry, and the sanitation workers threw away everything else.
I stood there to bear witness and to quietly remind the sanitation workers that they were throwing away someone's entire life when they tore down those tents and tossed the belongings inside. Ultimately the sanitation workers got fed up and left. They came back a few days later early in the morning and ran off everybody who was still left and threw the rest of their belongings away.
posted by hydropsyche at 4:16 AM on April 26 [2 favorites]
What's frustrating is that these stats don't (perhaps can't?) distinguish between prescribed drugs and diverted drugs. It seems unlikely that diverted scripts cause all ODs, but I would not be surprised to learn that they cause a majority (classic dumb-ass opioid-naive teenagers raiding the medicine cabinet with no idea of their tolerance).
What is the line that you are drawing between “prescribed” and “diverted” here, anyway? This is something that frustrates me about popular understanding of the whole picture of the “prescription epidemic.” Media loves the story of the guy who spiraled into addiction after his doctor prescribed him OxyContin for his back pain, because it’s the most sympathetic one, but this ends up obscuring how much of the larger story was diversion at scale.
So anyway, I certainly didn’t mean to imply those ODs were all from “legitimate prescriptions,” whatever that means, just that they were with clean drugs in known dosage units, so obviously danger isn’t reduced to zero. But at the same time those graphs suggest that the danger was considerably lower than in the heroin and fentanyl waves that followed.
(As someone with some experience in the area, I would guess that prescription deaths are less inexperienced teenagers specifically and more people of any age mixing pills with booze and… other pills)
posted by atoxyl at 11:47 AM on April 26
What is the line that you are drawing between “prescribed” and “diverted” here, anyway? This is something that frustrates me about popular understanding of the whole picture of the “prescription epidemic.” Media loves the story of the guy who spiraled into addiction after his doctor prescribed him OxyContin for his back pain, because it’s the most sympathetic one, but this ends up obscuring how much of the larger story was diversion at scale.
So anyway, I certainly didn’t mean to imply those ODs were all from “legitimate prescriptions,” whatever that means, just that they were with clean drugs in known dosage units, so obviously danger isn’t reduced to zero. But at the same time those graphs suggest that the danger was considerably lower than in the heroin and fentanyl waves that followed.
(As someone with some experience in the area, I would guess that prescription deaths are less inexperienced teenagers specifically and more people of any age mixing pills with booze and… other pills)
posted by atoxyl at 11:47 AM on April 26
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