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Comment by luka-birsa | Hacker News Reader

Look no further than Portugal and their solution to heroin problem - decriminalization of drugs. This enables NGOs to work with people more easily, removes the stigma, provides access to save consumption sites and safer drugs, allows for funding of new drug-abuse programs (such as better access to anti-opioids for medical staff), etc...

it's not hard to figure out that whatever you're doing in the US is not working. I've been to SF and just walking past Tenderloin is not a preety sight.

- https://www.independent.co.uk/news/world/europe/portugal-dec... - https://news.vice.com/en_us/article/59eqqk/ungass-portugal-w...

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Decriminalization of drugs in Portugal didn't result in reduced drug use. It resulted in significant reduced heroin use among youth (which was also reduced in the same time period in other countries that didn't decriminalize it), but that reduction was more than made up by increased rate of use of other drugs by the youth, especially ecstasy.

In the general Portugal population, since the decriminalization, cannabis use is increased, heroin use decreased (thought much less than it decreased among the youth, which means that it likely increased in older groups), cocaine use is increased, amphetamine use is basically the same, LSD use is increased, ecstasy use is increased, and hallucinogenic mushroom use is increased.

If drug decriminalization in Portugal led to increased total drug use, and increased heroin use among people over 35, why exactly you believe that doing the same in the US would solve any problems here?

Use increased, but did the problems associated with it increase or decrease? Taking drugs is not terrible in itself (except for your health and your wallet I guess), but the associated organized crime does a lot of harm.

>Taking drugs is not terrible in itself (except for your health and your wallet)

Gee, I wonder if this is the reason why people say drugs are terrible?

Smoking tobacco is also terrible for your health, but we don't jail people for doing it.

One should compare against other countries that didn’t change their laws.

Increased use could be explained by increased availability that is independent of legality (eg: better smuggling routes or larger synthetic batches).

Anyways, reduced opiate use and increased use of the other drugs mentioned generally sounds like a win to me.

I’d also consider more widespread recreational use by previous non-users. I’m not sure if that’s a problem for the lower-dependence risk drugs mentioned.

In Germany, which didn't change its laws, prevalence of drug use fell during the same period.

Also note that it's significantly reduced opiate use among youth (15-34 y.o.): total opiate use only went down a little, which means that it likely has increased among people over 35.

Point is, even if overall drug problems decreased in Portugal (which is not clear to me at all, since total drug use increased), evidence that it's the decriminalization that helped, is flimsy at best.

Vancouver[1] does all of this, short of making drugs flat-out-legal, and it is currently in the middle of an overdose crisis (In addition to the homelessness crisis that you would expect when rents and home prices skyrocket.)

I don't think any solution short of the government/pharmacies selling/giving clean drugs to people with addictions (As long as they are actively attending counselling programs, that aren't one-size-fits-all 12-step nonsense) is going to work.

[1] Also, a hospital bed to detox in is free, but good luck getting your shit together after you go through withdrawal.

Vancouver has special problems to deal with, it is the only year-long livable city in Canada so a lot of people end up congregating here, additionally the housing market is absolutely bonkers.

There is no significant provided housing in the city and it's causing the problem to get much worse - decriminalizing drugs has helped quite a bit with street safety though.

Street safety from gangs and drug traffickers may be better, but property crime is up, and my friends bitch non-stop about used needles, and having to share public space with aggressive homeless people.

Also, 'All the homeless people moving to Vancouver' is a problem, but only a part of it. Most of the non-locals are from small dying towns in the BC interior. They aren't really suited, financially, to dealing with the social problems[1] that result - yet Vancouver would rather close its eyes, and pretend that they don't exist.

Even so, if we sent everyone who isn't originally from Vancouver back to the towns they came from, there would still be a catastrophe of homelessness, overdose deaths, etc.

[1] Yes, it would be much cheaper to provide housing for homeless persons, within their communities, instead of in the most expensive city in Canada. Sadly, nobody in Victoria seems to be keen on fixing this, on a province-wide level. The Liberals didn't care, and the NDP care, but aren't doing anything.

In practice, given a person who wants to get clean, what works better than a 12-step program? I was under the impression that those were effective. Is the "higher power" thing what you are thinking of when you say "nonsense?" In many programs that is not specifically religious as much as it is admitting that your problem is bigger than yourself. And I think having a sponsor to help you through is a huge part of why these programs work.

I have never been through a 12-step process but I know a few people who have done it for alcohol and it works for them (I know, survivorship bias etc.)

> In practice, given a person who wants to get clean, what works better than a 12-step program?

For some people, it's fixing whatever drove them to a situation where shooting heroin into their arm is a better decision then not shooting heroin their your arm.

For other people, it's switching a dependency on a street drug to a dependency on a prescription drug.

Telling people that they have zero agency in their lives, and that only Jesus can magically cure them - definitely works for some people, but not for everyone.

AA has a success rate of, depending on which study you cite, between 5% and 25%, over doing nothing.

We know that people with an opioid addiction need a medically assisted treatment programme for any real chance of sucess.

The evidence base for 12 step programmes isn't great.

Unfortunately the US has a load of wilderness-retreat style camps using some half-assed version of a 12 step program. They're very good at getting people's money and attention, but pretty poor at sucessful treatment.

Beth Macey has a good book about the Opioid Crisis and some of it is alarming.

https://www.amazon.com/Dopesick-Dealers-Doctors-Company-Addi...

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