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Comment by atdrummond | Hacker News Reader

Harm reduction in the Vancouver/SF model is a failure.

Estonia (with fentanyl) and Switzerland (with heroin) only worked because over time the state became the only source of these drugs. They rooted out most dealers and sources of the drugs.

As long as it is available on the streets cheaply, people will defect and return to illicit purchasing. Estonia and Switzerland have basically eliminated new illicit opioid users from the population. In much of the US, suggesting this is a positive aim is tantamount to “hating” addicts.

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I agree that opiates require a more comprehensive approach than just legalizing, but I wonder if the astronomical cost of housing in those cities contributes to making it hard to really get people off the streets and out of the system.

There is a serious opioid problem in the rural Midwest and Appalachia but most users there are housed because housing is affordable. Many also have roots like family in the area. Makes treatment way easier if people are safe and off the street already.

How do you get off the street when, at least in SF, the poverty line is upwards of $100k/year? You could leave but that’s a big leap for someone battling addiction with no resources and a very small world.

Don’t know.. it just seems like other places in the world have decriminalized to better effect and something else is wrong in West Coast cities. The cost of housing seems like one possibility.

Edit: could also be cultural. I know Vancouver has a deeply rooted opiate culture. Just go listen to some 90s industrial from that place. Every song is about smack or trying to kick smack or being back on smack. Good music though. There’s a whole thing about heroin and good music. Too bad it’s so addictive and toxic.

Most unhoused opioid users in SF are happy to remain homeless. Their base income is north of $12k tax free a year (SNAP and their SF homeless grant); one woman I’ve been trying to help for over two years makes north of $30k annually, tax free, with zero expenses other than fentanyl and food. Very few are willing to trade the amenable weather and lack of any behavioral restrictions for the (frankly quite minimal) requirements that come with temporary shelter, let alone those associated with a SRO or permanent long term housing.

Sounds like I am missing the most obvious thing: they literally pay people to be homeless.

It sounds like once you are in that lifestyle the incentive is very much to stay there. So no wonder.

Of course the high cost of real housing doesn’t help. Makes it that much harder to get truly out of poverty. It also makes a life off the street look unattainable. It’s telling a mentally ill addict there is no hope for them to truly get off the street unless they can somehow produce an engineering degree or gain equivalent experience.

Yes - and I think worse than that, they don’t pay people to get better. So they create a very real financial cliff for anyone who is determined to make a lifestyle change.

What is the probability of being able to get better once addicted to strong opioids, regardless of incentive? Is it possible the brain’s chemistry gets irreversibly broken at some point?

It is difficult but possible.

I have used opioids since the mid-2000s. I am on a low enough dose today that it treats my cancer/Crohns pain but I feel no noticeable psychological effects. I can and do easily taper off multiple times a year for tolerance resets.

Further, every year a number of people in my programme finally taper off methadone for good; the relapse rate is in the low single digits. This is similarly the case for patients in Switzerland’s heroin assisted treatment programme. (I live in Estonia and am on their methadone equivalent.)

Are drugs legalized, taxed, and regulated in Vancouver/SF?

If no, it’s a straw man argument.

For the first and third, yes. I can walk into a pharmacy as a non-resident and within 24 hours be approved for emergency safe supply hydromorphone (dilaudid).

You also have the DULF distributing medicinal grade heroin with the tacit support of local government.

Your examples are of a national nature (and much smaller/heterogeneous populations). When you have hot spots like Portland and SF they become drug tourist locations.

Let the people have their drugs. Try to minimize consumption and abuse (and profit motive), and treat such abuse as a health issue, not a criminal one. That is the only sensible and humane way. Easier said than done, of course.

At the risk of redundancy, I want to include that proper discussion of the subject requires an understanding of the origins and intentions of these laws. The current system fails in every way except in satisfying those original intentions (hint: not benign).

And here come the bullshitter prohibitionists, to argue for the same essential policy that has been a CONSISTENT failure for going on 60 years now in a war without end that has been the root cause of this entire cartel industry, trillions in spending and untold numbers of murders.

Yes, the cartels diversify, yes, they can make money from other things, but no, the profits of these other revenue sources will simply not match the backbone of support and systematic, prolonged institutional corrupting power that the illegal drug market provides in the long run.

Half-baked and half applied legalization7decriminalization models are not the answer, and when they very sparsely get applied, full of regulatory hurdles (never mind the outright global prohibition that still exists for the sale of most hard drugs and even marijuana) you simply can't make a fair argument for how any existing policy has failed at legalization and that thus the only answer is some variation of continuing the immensely destructive prohibitionist model that has spent decades bringing things to their present state.

How stupid, intellectually dishonest or bloody-minded does one have to be to continue advocating for anything except complete legalization and regulation in a practical, broadly-applied, responsible way?

What is intellectually dishonest is mischaracterizing my beliefs, which you have done to an impressive degree.

I’m an opioid addict and formerly homeless person who has spent thousands of hours advocating for, and working with, the unhoused. I am the furthest thing from a 1980s drug warrior.

In fact, I have always argued that American drug policies are an unequivocal failure. All I have stated, and continue to believe, is that one cannot emulate successes such as those in Estonia, Switzerland, Portugal and other jurisdictions by picking only the policies that are most politically feasible or attractive. These are holistic approaches that require changing the incentives of all agents interacting in the illicit drug economy.

If one only focuses on a single element of the trade (say, the users, as has been done in many American metropoles) then the policy is bound to fail.

If this is the case than I do seriously apologize. I assumed you were arguing for prohibition and a return to tendencies in this direction that are only just now, finally being reevaluated in favor of at least debating legalization. To me that essential prohibitionist stance is disgusting, and especially so after so many years of abject failure.

I agree, a holistic approach is a good idea, but at least in my assessment, it absolutely needs to include a serious move towards practical legalization while investing in support for addiction problems among users. The latter is important, but the formar is the very major missing piece. Multinational drug trafficking organizations will diversify, but without that huge central source of revenue, they'll be walking on a much weaker path in their attempts to dominate entire regions and national governments.

We seem to be in agreement here. I apologise that these discussions have to become so heated; I understand this only comes from a place of compassion and frustration on your part. I appreciate your enthusiasm for change and obvious love for people who are - and have been in - my former position; there’s absolutely no anger on my side for the accidental friendly fire.

Thank you so much for speaking up. The necessary changes in this space are only going to happen with continued pressure to abdicate the status quo.

It's an emotionally charged topic, but one of the reasons it's bad to call others names is that they can turn around and do the same thing to do. "You're too dumb and stupid to see the right answer". It adds nothing and worsens the convo.

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