Monday, April 08, 2024

An experiment leads to recriminalisation of hard drugs...

It seems that the Washington Post has taken a very active line in publicising research indicating that marijuana use can be harmful to health:  such that I wondered whether Bezos himself doesn't like its widespread use.  Yet now that I Google the topic, it seems that Amazon has been actively for decriminalisation, and no one seems to know whether Bezos indulges personally. 

Anyhoo, that's by way of background to this WAPO editorial that praises Oregon for changing its policies on use of hard drugs.  I mean, it does genuinely sound like it was a real disaster, and takes a line that sounds pretty sensible to me:

Oregon’s experience shows that compassion is important for addicts, but so are consequences. Responding to the social ills of drug abuse requires a mix of carrots and sticks. Just as many people with drinking problems won’t put down the bottle until they get prosecuted for driving under the influence, drug courts connect many users with help they need but might not otherwise seek.

The Centers for Disease Control and Prevention reports that the number of annual overdoses in Oregon rose 61 percent in the two years after decriminalization took effect, compared with 13 percent nationwide. Unintentional opioid overdose deaths in Oregon spiked from 280 in 2019 to 956 in 2022, according to the state health authority. A study published in the Journal of Health Economics concluded that the ballot measure caused 182 additional overdose deaths in 2021 alone. In Portland’s Multnomah County, more people died from overdoses than covid-19 during the pandemic.

Police could give people using drugs in public a $100 ticket, less than the fine for failing to signal a turn. The citation would be waived if the user called a hotline to get a referral for treatment. But more than 95 percent of people disregarded their tickets altogether, because there were no penalties for failing to pay. A state audit revealed last year that just 119 people called the 24-7 treatment referral hotline during its first 15 months. Given the price of running the hotline, that meant each phone call cost the state $7,000.

Oregon’s leaders deserve credit for reversing course — even if it required a taxpayer backlash and tragic stories of children dying from ingesting fentanyl. The new law, effective Sept. 1, will make possession of hard narcotics a misdemeanor punishable by up to six months in jail.

And this:

Many people didn’t seek treatment even when it was available and offered to them, because the architects of the law neglected how addiction alters brain chemistry. Drug addiction is that rare disease that the sufferer often does not wish to be cured from. Fentanyl and meth feel good to use in the short term; withdrawal hurts. The criminal justice system plays a vital role in applying external pressure to push addicts into detox.

 One might ask - why was decriminalisation widely considered a success in Portugal but not Oregon?  There will be multiple factors to point to (Oregon not providing the treatment beds, Portugal being able to force users into rehab, and even a degree of myth making about how successful Portugal really is), but as I have taken to noting lately - there just seems something about American society that leads to a complicated and problematic relationship with drug use and drug use policy*, such that approaches that do work in some countries can't easily be replicated in America.

Some of the comments following the editorial are interesting, too, for showing what a bitterly divided country culturally it has become: plenty of Right wingers saying "yay for the end of liberal madness", and liberals saying "the lack of compassion and support for drug users is appalling".  

Meanwhile, we wait for the unifying centrist leadership to reappear.  (Not that I am dissing Biden - he is pretty centrist on most things - but we need younger figures in cultural leadership.)

 

* And not just now:  did any other country even try alcohol prohibition in the way America did?

2 comments:

John said...

there just seems something about American society that leads to a complicated and problematic relationship with drug use and drug use policy*, such that approaches that do work in some countries can't easily be replicated in America.

Basically, Rat Park, better described as Rat Heaven. It is no coincidence that the opioid epidemic began in the Appalachians, one of the poorest areas of the USA. Early life stress, and childhood poverty drives that, paves the way for increased susceptibility to addiction, anxiety, depression, and psychosis. In the OECD The USA has the least social support and greatest wealth division.

The right will rant on about free will forever and will steadfastly refuse to recognize that drug and mental health problems often have their genesis in childhood deprivation and are sustained by cultural themes that result in increasing numbers of people living miserable lives from which there is no escape.

The left refuses to recognize that sometimes the best therapy is a kick in the backside and that because a person has a mental illness does not preclude their drug use being treated as a behavioral disorder that can be addressed by forcing the individual to make life changes. Sympathy and understanding does not change behavior, those are just feel good ideas.

A Psych professor told me of an old experiment where drug users were given several hundred dollars but on the condition they left the city. It worked, it took them out of the social environment that allowed access to drugs and promoted drug use. The heroin problem of soldiers in Vietnam mostly disappeared when they returned. The environment, the horror, the easy access to heroin, paved the way for so many to become drug addicted in Vietnam. That was the opposite of Rat Park.

John said...

Just to annoy you Steve:

https://neurosciencenews.com/cannabis-dementia-neurology-25884/

The study has problems but is supported by hundreds of studies showing a neuroprotective effect of cannabinoids. I'm not sure about the result, the contradictions trouble me but the pharmacology makes sense.