Why aren't fentanyl test strips more widespread? (2021)
healthaffairs.org
healthaffairs.org
Instead they have to resort to playing Russian roulette every time they use.
Decriminalisation and regulation are the biggest harm reduction measures that could be taken and it would have the added bonus of freeing up space in the prisons and reducing the power of the cartels.
There wouldn't be a fent problem at all if sufferers could get reliable access to real meds. It's absurd that we're even still having these types of discussions in this day and age.
Maybe the Government doesn't like the type of people that get addicted to drugs... a friend of mine just died this week from overdose... maybe from Fentanyl but I don't know.
It probably killed a lot more people then Covid-19...
I'm pretty sure that most heavily addicted people would voluntary get such a vaccine... unless there's a major downside
It would be great for folks who are in remission and don't want to be tempted back though
Well, here in San Francisco you can access both relatively easily. But it turns out that people with substance abuse addictions tend not to exhibit strong executive functioning (at least contemporaneously) as compared to the average non-abuser. So when you remove all coercive policies whatsoever (because of abstract academic arguments that equivocate all policies short of giving out free drugs and free money and turning a blind eye to dealers), you manifestly end up nurturing a base of hard-core, long-term addicts. Also, fentanyl is cheaper and some users have even begun preferring fentanyl for its unique effect. Here in San Francisco fentanyl is becoming (or has already become) less an adulterant and more the drug you're knowingly buying. Plenty of people--users and public service workers--do carry naloxone, though. So that's something.
Except that's not at all what happened in Portugal (or in other European programs)...?
The Portugal narrative hasn't actually been as positive as initially reported by the Cato papers that were based on the first few years following the policy change. More recent data has shown an uptick of lifetime drug use and an increasing trend of drug deaths that doesn't really support the initially successful picture of their program.
One of the challenges with interpreting the Portugal data is that they had relatively low drug use to begin with. The initial declarations of victory for their decriminalization programs were based on relatively small numbers and sample sizes that wouldn't pass muster in more rigorous analysis.
I know the narrative about Portugal was set years ago by the Cato papers and a few authors, but it isn't really the success story that it's made out to be. It did, however, reduce the number of drug-related prosecutions, though that's an obvious downstream effect of removing a class of drug-related offenses.
In the US[1], for example, drug overdose deaths went from about 20k in 2001 to 40k in ~2006, then to 80k in the mid to late 2010's, and now over 100k as of last year[2].
[1] https://nida.nih.gov/drug-topics/trends-statistics/overdose-...
[2] https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/...
> recent data has shown an uptick of lifetime drug use and an increasing trend of drug deaths
Depends on the numbers, of course. But I think that is what folks realistically should have expected. Most societies tolerate the same with alcohol.
Thing is, it's actually better there, regardless of what papers are written. Everyone's healthier, using less drugs and there's less violence.
Like HIV dropped by 90% among drug users, being the original goal, this is quite a success. Drug related deaths dropped to by 85%.
https://twitter.com/shellenbergermd/status/14153458369139220...
Portugal has humane, coercive policies to get people off drugs, public use is illegal, and people get arrested.
> Thing is, it's actually better there, regardless of what papers are written. Everyone's healthier, using less drugs and there's less violence.
> Like HIV dropped by 90% among drug users, being the original goal, this is quite a success. Drug related deaths dropped to by 85%.
>> Portugal has humane, coercive policies to get people off drugs, public use is illegal, and people get arrested.
Okay? Same as mental health most places? It's still decriminalized and mostly treated as a health problem.
The lie is that there are no coercive policies in Portugal for drug addicts. It is not all treated like mental health, especially in the US. Public drug use is illegal, police enforce it, and addicts who are arrested can be jailed if they have more than 10 days personal supply, and they can be coerced in to treatment. Open drug scenes like we have in San Francisco are not all allowed.
Compare to SF.
There's your answer.
It's not the drugs that's different. It's that one jurisdiction actually gives a crap about making sure the ancillary problems (that are the reason drugs were ever criminalized to begin with) are mitigated.
No idea what you're trying to imply...
Example headlines:
Why We Must Arrest Drug Addicts
This is revealing as to where they are coming from:
> People who want to kill themselves in the privacy of their own homes by smoking fentanyl should be free to do so. But people who use drugs, camp publicly, and break other laws stemming from their addictions, such as shoplifting, should be arrested.
And a big part of it is lying about how other countries deal with drugs to try to paint liberal American cities in a bad light.
https://michaelshellenberger.substack.com/p/why-we-must-arre...
It's no surprise that San Francisco is attractive to a certain kind of lifestylist. But when you look at the country you have 2 million addicts and only 400k on methadone. I find it very hard to believe that the average methadone clinic is running at 20% capacity.
https://www.healthaffairs.org/do/10.1377/forefront.20190920....
Except that's not what happens. The group of tents closest to my home ~2 years ago is still there. And it's no longer the nearest.
"It's not worth arguing."
In cases where it's not worth arguing, it's usually not worth mounting an ad hominem attack, either.
Your claim that tents aren't being removed isn't true either.
https://www.sfexaminer.com/findings/tent-dwellings-are-down-...
It's plausible that enforcement in SF is lighter than what is efficient (prison overcrowding will do that), but the claim that it isn't happening is, again, false.
Your comment "commenters are so weird" was a reply to my comment, so presumably was directed at me. I didn't assert "some utter nonsense".
"Your claim that tents aren't being removed isn't true either."
The article you linked says that tents are being removed from the Tenderloin, so that they can be relocated to other areas of the city. So, unless you live in the Tenderloin (a small % of SF), your experience will be just like mine: tents are permanent and are not being removed by the police.
I recall reading about an economist who based on studying the failure of the prohibition, tried to warn about the futility of 'war on drugs'; from this I thought that if some economist knew it'd fail, so could the government have known....
Until we, as a society, get over our desire to punish people for getting inebriated, addicts will continue to dwell in abject poverty while funding violent drug distribution organizations. This is a choice that we have made, and we're going to live with the consequences until we reverse course.
Anecdotally, I know (or knew if they died) several people from PhD programs adjacent to my own who were habitual users of heroin (or stuff branded as such). I have significant experience with it (originating with friends in academia!!!), and it is very nice, but it just so happens that I like pooping more than I like opioids, which apparently is a stroke of luck
I also saw about 12 different heroin addicts in the streets next to my home, but tbh they were a lot less loud, aggressive and/or obnoxious than the alcoholics.
Despair is not even in the picture. Too bad you paint it as a viable excuse for making yourself even more stupid than usual.
https://www.businessinsider.com/scientists-and-geniuses-who-...
Making it free will only make that area a hub for people seeking to get high. Portland, Seattle, and SF are already hot spots where people actively come because they know they can get high easily. Making it completely free is just an even bigger invitation.
I think one of America’s greatest successes has been with tobacco. For the most part, Americans don’t want to smoke and find the idea disgusting—that’s a massive turnaround from a couple decades ago and even completely different from many countries in Europe or Asia. It’s also getting harder and harder to purchase tobacco in many places, but what kept me and much of my generation from ever touching a cigarette was media campaigns in the 90s that depicted cigarette smokers as vile, disgusting people. Other anti-drug programs try fear mongering with saying one dose of weed will kill you or whatever and people saw through that. But telling kids that they’re gross losers who everyone hates if they use a substance? That has a bit more effect.
But for people who are active addicts, treatment is hard. There are countless interviews with addicts on YouTube, and the conclusion every single one of them presents is “I could’ve gotten help, but I didn’t want it.” You need to make people want to overcome their addiction. Feeding it won’t do anything.
It also prevents, you know, fentanyl from getting into the supply, having people get more addicted to a stronger drug.
Drugs are partly an issue of convenience. An 18-21 year old who isn’t thinking much about the future and figures “why not” is more likely to try something if it’s free and “safe” due to being distributed by someone reputable than they are to try a grimy baggy that could have anything inside.
When people know they can get a good, pure LSD hookup, they’re more likely to try it. People are more concerned about trying random research chemicals because the effects are unknown—that keeps quite a few people from ever trying LSD or psychedelics as a whole. If people could drop by a volunteer-operated free distribution center, I’m pretty sure we’d have loads more people trying LSD. (Not that I’m saying LSD is deadly like heroin, but the fear of danger is keeping people away from it)
Nonsense. It's not that cheap to manufacture (under regulated conditions) and distribute opioids like that. 1/1000th of the price? Even the cheapest, most easily manufactured commercial opioid medications aren't coming anywhere near that after decades of optimization the manufacturing processes.
GP said “legalization or free supply”, and for alcohol we have legalization. So, yes, we do what the GP actually suggested, though not your strawman, for alcoholics.
We don't provide this for other drugs.
There's a handful of safe injection sites for drugs in some cities around the world (such as Vancouver) but the drugs are still toxic. It's good that people are on hand to handle the inevitable overdoses and other issues. This saves lives.
The further necessary solution however is a safe supply of drugs, so that people can actually know what they're using. This is the core problem that is driving so many deaths.
Imagine if there was no such thing as legal liquor or bars and alcoholics just drank some stuff that some guy made. There'd be a lot more deaths and poisonings from this.
Probably a lot more than two issues here, but two significant ones are that:
1) the real problem is that the drugs are toxic and no one knows what they're taking. Maybe the dose is wrong or maybe it's not even fentanyl, and just a bunch of crazy shit (eg. benzos). The drugs aren't what people expect and people die. The fastest way to end deaths would be to create a safe supply of drugs so people know what they're taking.
2) "Decriminalization" doesn't necessarily mean and end to police harassment, drug confiscation, and related issues that all make life hard for drug users and create barriers to them getting the real help they need.
While under decriminalization you may not end up in jail for having drugs, you are still able to have them confiscated and get a ticket (or summons to some thing), and then you're back at square one, needing to find more money to get drugs again. No wonder petty theft is such an issue in some places.
High policing and confiscation of drugs from drug users just helps the dealers sell more illegal product.
Circling back to point one again, a real safe supply of prescribed drugs handles this issue well in dealing with the money issue. But beyond this if we're going to allow people to have a safe supply of drugs, we also need to let people hold drugs too and not be harassed by police.
Ideally there's not just a safe supply of drugs but also a safe use site as well where medical staff can monitor and help people. These sorts of sites can be touch points where people can build relationships and help people when they're ready to move to some further stage of recovery.
It's not actually a solution to the Fentanyl problem.
Fentanyl ends up in drugs because it's extremely cheap (among other reasons). The price difference between fentanyl-laced illicit narcotics and the actual substance these people are seeking is actually massive, and end-user cost becomes a huge motivator for people dependent on constant daily intake of opioids. Even in a hypothetical world where regulated opioids were available over the counter, you'd still have significant inflows of illicit and potentially contaminated drugs.
Decriminalization and regulation have been floated as magic bullets, yet even when it comes to drugs like Marijuana in states like California and Colorado we have multiple estimates suggesting that the majority of marijuana sales are still illicit rather than via regulated channels ( http://www.cahcc.com/Portals/0/ADE%20Cannabis%20Report%20_8-... ).
> The real question we should be asking is why can't these poor people get access to proper medicine and treatment?
There is no one, singular "real question" we should be asking. This needs to be addressed on every level. Even in a theoretically idealized world there would still be a need for fentanyl test strips. Experimenting with "research chemicals" (aka obscure drugs synthesized in clandestine labs) is an increasingly common hobby even among people with access to common drugs. There isn't really a scenario where we just flip the decriminalization switch and all of these problems go away.
It literally does not matter if decriminalization is "only 5% effective" (in whatever metric you're using to measure success, which here is just marijuana sales?). Sane polities implement laws that don't have 100% effectiveness.
Speaking of the US, one of the issues is that drug treatment and mental health care are for-profit businesses, so someone reaching out for help is likely to get grifted even if they have insurance or can pay for the treatment on their own.
Why would they care about the "illegals" (immigrants, addicts etc) or "immorals" (women or transgender who want control over their body) ?
As far as I can tell, this program is not widely known. It shouldn't be too hard to scale up the pharmacy collection side, and make it available in pretty much every community. I don't know how to convince people to actually use it, though.
I assume they'd have a word with their dealer? Or at least adjust the dose?
If you don't mix the correct ratio of drugs to water its very easy to get false positive (for amphetamines and mdma) or a false negative with others.
Also, frankly, it makes the whole experience less sexy and fun. I know its a dumb reason but its true.
Training people how to use drugs in order to be allowed to purchase them and offering mental health services would be far less expensive to society.
New acronym just dropped. :-/
It seemed extremely awkwardly worded but now I know why! Thanks for sharing that link.
I actually agree, at least partially: I think both people-first language and acronyms have the potential to depersonalize, even if they prevent more general dehumanization. But I also think there are plenty of contexts in which their use makes sense, like an article written for a medical audience (like this one).
A drug user is not the same as a disabled person. If you're a drug abuser, I think the words people use to describe you are the least of your problems.
All this politically-correct clamoring accomplishes nothing in the end. If these new words like "PWUD" became widely adopted, they would just inherit the same stigma as their predecessors. It's happened time and time again.
It has nothing to do with improving people's lives and everything to do with providing lip service to a voting demographic. If you're not a politician, why waste your (and everyone else's) time with this doublespeak?
Drug addiction is a biological phenomenon, but it can't happen without drug use, which is a social problem. For example, drug overdose death rates are six to eight times higher among white Americans than among Asian Americans: https://www.kff.org/coronavirus-covid-19/press-release/drug-.... I'm pretty sure the biology of drug addiction doesn't meaningfully differ between those groups.
And even if they were, it is pointless to use language like that in drug harm reduction material - it will make the users of drugs feel judged or alienated.
So the user does a test that shows no fentanyl and makes poor decisions based on a false negative.
As a casual outside observer I thought no. In which case test strips are less useful
Addiction is a powerful compulsion, but so is safety: an addict (or someone who isn't yet an addict) might choose not to use a particular batch if they have access to test strips. Even if they do choose to use: access to test strips allows them to plan for other harm reduction activities.
My drug awareness extends little beyond watching The Wire, but I'd guess users might test before purchasing or be more likely to work with dealers who would accommodate testing. In theory, at least.
It's all a multi-faceted problem and providing tools seems smart to me. It's remotely akin to being distressed about abortion but not keen on sex education or providing birth control. Attack the issues from all angles.
In other countries, yes. Australia's heroin supply is still basically just heroin, and extremely high purity, even on the street, interestingly.
While fentanyl does exist here, it's not that common. I cannot give a good reason as to why. It's interesting.
This was because importation was difficult, making any imported product vastly more expensive than what you could make yourself.
These days the bulk of the heroin in the country is brought in from Asia, controlled by Chinese and Vietnamese crime syndicates.
So I would be shocked if it was anywhere near as easy to get drugs in to Australia as it is the US, let alone easier.
Yes, even more so than the US frankly. Our border is difficult to get black market goods through.
It's also why heroin is nearly 10x the cost here in Australia, of course.
I am aware, in passing, of the purity of club drugs. I mean, theoretically. Totally in the abstract, in case you’re a DEA plant.
It heavily depends on what, and where. In my…research…
Street-level opiates? I honestly have no idea, besides what I hear in the media. Not my bag.
Cocaine? It’s rare, but it happens, and it seems to be ramping up in scale, unfortunately. And more realistically, it’s contaminated with significant amounts of filler, including lidocaine to give you that mouth tingle.
Ketamine? Nah. Either pretty darn pure, or just cut with filler. (Well…mostly nah, I am pretty sure a friend got some cut with PCP one time.)
Ecstasy/molly (which is such a semantic jumble): rare, but it happens. But more likely, instead of the MDMA you want, it’s MDA, or some other substituted phenethylamine…or just sucrose as filler, and it does nothing at all.
Other more obscure club drugs, such as the stuff people claim is 2C-B? Rare, but plausible, and there was a rash of that in California recently.
Dealers don't commonly go around lacing drugs on purpose - killing your customers is bad for business.