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I had originally posted this in the Friday fun thread but it turns out that it was killing the vibe in there. Not sure what I was thinking. Anyway...
Note: I will completely qualify Portugal Europe and Portland Oregon in this article because they're easy to mix up.
Is liberalism peaking in Oregon?
In 2020, the state of Oregon passed a referendum, ballot Measure 110, which decriminalized all drugs(!) with a vote of 58% in favor.
Voters in Oregon (such as myself) believed this was the path to enlightened drug policy, being informed by the revered Portugal Europe model. Tacked onto the referendum was a bit of social justice theory as well: the police would be required to document in detail the race of anyone they stopped from now on for any reason. To ensure the police weren't disproportionately harassing the 2.3% of the population that's black.
As an occasional drug enjoyer, I do find it a relief to wander the streets of Portland Oregon squirting ketamine up my nostrils like I'm a visionary tech CEO without fear of police. But in broad strokes it appears to be a disaster.
Indeed, the ensuing data was an almost perfect A/B test, the kind you'd run with no shame over which kind of font improved e-commerce site checkout conversions.
By 2023, Oregon's drug overdose rate was well outpacing the rest of the country, so much so that the police officers regularly Narcan with them and revive people splayed out in public parks. Sometimes the same person from week to week. It's true this coincides with the fentanyl epidemic, which could confound the data and have bumped up overdoses everywhere but that wouldn't explain alone why deaths have especially increased in Oregon. The timing fits M110.
https://www.axios.com/local/portland/2024/02/21/fentanyl-overdose-rate-oregon-spikes
At some point someone decided to compare notes with Portugal Europe's system. Some stark differences!
https://gooddrugpolicy.org/wp-content/uploads/2024/02/PortugalvOregon1.pdf
Briefly, Portugal Europe uses a carrot and stick model with a lot of negative incentive, whereas Oregon just kinda writes a $100 ticket and suggests calling a hotline for your raging drug problem maybe.
In the first 15 months after Measure 110 took effect, state auditors found, only 119 people called the state’s 24-hour hotline. That meant the cost of operating the hotline amounted to roughly $7,000 per call. The total number of callers as of early December of last year had only amounted to 943.
The absence of stick appears to not be very effective in encouraging users to seek treatment.
Are the kids having fun at least? https://www.nytimes.com/2023/07/31/health/portland-oregon-drugs.html (paywall bypass: https://archive.ph/fHxWk)
That's the brightest part of the article. The rest is pretty depressing and sad and sickening and worrisome.
After a few years of this, the Oregon legislature yesterday finished voting to re-criminalize drugs.
The NYT again https://www.nytimes.com/2024/03/01/us/oregon-drug-decriminalization-rollback-measure-110.html (paywall bypass: https://archive.ph/3zksH)
The governor has indicated that she would sign.
Critics are out in force, arguing that the legislature overrode the will of voters (remember it was passed by referendum) and that the state sabotaged the program by not efficiently distributing treatment resources to addicts. This poster believes the low uptake and missing negative incentives prove that drug harm reduction is not primarily about access to treatment, but about incentive not to use. I do sympathize that better public services and addiction resources that people actually trusted would help, but fentanyl complicates the situation substantially. People need to hit bottom before they seek help (or so goes the popular saying) but fentanyl is so potent and unpredictable that they're dying of an unexpected OD before they find themselves at bottom, ready to seek change.
Frankly, I'm surprised Oregon repealed this so quickly. Has liberalism peaked in Oregon?
As someone who voted for the referendum back in 2020, I'm a little sad that some of the overdose deaths are on my hands. Kind of. Like 1 millionth of the overdose deaths perhaps. It's good to run experiments though, right? This was a pretty good experiment. We at least have an upper bound on how liberal a drug policy we should pursue.
I believe this shows Oregon is not quite as ideologically liberal as previously led to believe. Or, at least, not anymore.
Portland is not quite progressive enough. Why not go all the way like Canada and have MAID for drug addicts? Now that's a compassionate way to handle social issues.
Don't worry, there is still time for even more deaths for your buck.
This feels mostly boo-outgroup. Setting aside both the moral arguments and factual issues of how Canada uses MAID, it's obvious that most of the drug addicts already have access to effective lethal injections if they wanted to use them, so the ones who are alive are probably ones who don't want help dying.
Yet fentanyl is a notoriously lethal drug. It appears hard to argue that somebody voluntarily taking fentanyl or products routinely laced with fentanyl is not somewhere, seeking death.
Perhaps I just have a tendency to find slopes slippery, but a community that chooses to turn a blind eye to this type of practice seems to be practicing some form of soft MAID. If supporters of 'soft-MAID' are uncomfortable with calling it MAID, why is that? Is there something wrong with helping people end their suffering?
I don't really know about this fuzzier sense of "seeking death". Maybe that is what some of them are doing. Speaking as guy who fully expects to take his eventual death into his own hands but doesn't expect to ever abuse opioids, it's not what I would do if I were seeking death, but I can see how it could be that way for some. Certainly it's not a thing to do if you're unwilling to risk death. Regardless, I don't think most of the ones who are alive are seeking death in the immediate sense -- the sense in which they would actually choose to make use of a MAID kit if it were offered to them.
I grant there's not a bright line between
(1) "refrain from taking away the means for people to kill themselves"
(2) "actively give people the means to kill themselves",
(3) "kill people at their request",
(4) "kill people people at your discretion"
It's appealing to try to erect a fence between (1) and (2), which separates decriminalization of potentially lethal drugs from MAID. A fence between (1) and (2) looks like making it generally permissible to possess but not to distribute. But of course this runs into problems with the presumption of "intent to distribute", and with the substantial overlap between users and distributors.
Personally, I don't care so much if people who want to die actually do so, and don't believe it's possible or desirable to spend a lot of effort to prevent this in general. It is worth spending effort to make people less inclined to self-destruction in the first place, and maybe keeping them from initially getting their hands on substances that set them off down the spiral is an important part of that. Ultimately I just don't know enough about why these people are abusing these drugs in the first place -- hard to believe it's that they don't know what road they're stepping into when they start.
I suspect the root of the problem is that we don't know how to build the "rat park" mentioned elsewhere in this thread, neither can we actually stop the movement of the fentanyl, so none of this going to get "solved" in any way that doesn't look like brutally grinding a bunch of unfortunates under society's heel. It's not surprising that this is unpalatable enough for people to try just looking the other way.
Where do you think "not providing free Narcan" would fall on that scale?
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I consider the whole thing itself as just another aspect of a sick society. It is valuable to go and attempt to rescue some of these poor souls, like a one-man Rittenhouse crusading against urban Covid super-spreaders, but ultimately, it's like bailing out with a spoon.
It's hard to say exactly where charity should be placed, but there does appear to be some more effective approaches to drug containment, namely in El Salvador or the Philippines, we don't necessarily have to throw our hands in the air. 'Aaaah these people are just desperate, no can do, drugs will just keep flowing' Which I suppose would still largely be included in
Whether your child OD's, cuts their genitals, becomes a girlboss dogmom, a journalist, join the reddit volunteers for Ukraine or immolates themselves for or against Israel... It's all some failure of parenting that's unfortunately incredibly common because overcoming the odds requires some serious skills in this century.
It's cute we can still laugh at the "A|B testing" ravaging our cities like this is all a Sim City game and we can load after the aliens destroyed the map.
It is cute but I think it's actually good to run experiments? Don't we bemoan vetocracies and general unwillingness by politicians to take risks? Initiative petitions (referendums) appear to be a good outlet for some direct democracy.
We do get some good outcomes from time to time and the fact that we rolled back so quickly is a credit.
If you asked this question two years ago I'm sure the sentiment would have been that the West Oregon leftists that dominate state political power would never roll back such a pro-drug law that was wrapped in racial justice.
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Sick society, sure, hard to argue with that, but I can't believe a Philippines-style approach makes it any healthier -- what's the evidence that executing however many thousand people there even improved the problem at all? Last I heard, the outgoing Duterte government didn't make much of an attempt to quantify the positive effects the several-year "reign of terror" had on stopping drug crime. Certainly haven't heard the compelling evidence that it worked well enough to justify normalizing the "shoot a guy and sprinkle some meth on him" tactics that police were empowered to use against civilians (and maybe civilians against each other).
I don't know who's laughing about how the need to test our policies to see if they work entails the risk of making people's lives worse, and I'm certainly not seeing how some Judge Dredd approach is so self-evidently superior that it wouldn't need to be empirically evaluated.
Many of us are living proof.
https://journals.sagepub.com/doi/pdf/10.1177/147470491501300114
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Based on murder rates in the Philippines it looks like it worked. The murder rate dropped from 10 per 100k in 2016 to 4 per 100k in 2021. The Judge Dredd approach also worked in El Salvador which is now safer (with respect to murder) than the USA.
It looks like it took the police killing at least 6k people, possibly up 12k or even higher, to reduce the number of murders over that period by ~15k cumulatively. Probably a fair bit of "substitution" there, assuming drug gangsters were murdering each other at high rates before -- some of this must be criminal-on-criminal killings being replaced by cop-on-criminal killings. Still, it does look like it was plausibly a net win on that measure -- have to be believe at least that police killings were better targeted at criminal elements than the background murders were. And it sounds like Filipinos broadly supported the effort. Still not sure how much it cut down on the actual drug use, but cutting down on the associated crimes is probably more important.
El Salvador, yeah there it does sound like they made big gains with locking up all the gangsters, don't know if they had to kill a lot of people to do that, or if US accusations that Bukele cut deals gang leaders are true. Easier to know who to go after in a place where the criminals are basically tattooing their criminal affiliations on their faces.
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Fentanyl is only lethal because illegal manufacturers and distributors can't control the dose well enough. In terms of therapeutic index, it's safer than other opiates -- that is, the ratio of a lethal dose to an effective dose is high. The problem is that the absolute amounts of both are low.
Sure, but, what do with this information? Have the state manufacture pure fentanyl and dose junkies up in safe use sites?
I stick with the libertarian answer: legalize drugs, enforce only purity restrictions. But as @iprayiam3 notes above, this requires not socializing the costs of addiction either. At most socialist they would be paid for with taxes on the drugs. Otherwise the addict's addiction is his problem and any problems he causes he's liable (civilly and or criminally).
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I imagine it stems more from a lack of trying than an absolute technical problem, a certain carelessness perhaps, or an outright malevolence.
Drug dealers don't generally want to kill their customers as a general class. Some, specific customers, like ones that are extorting drugs from the dealer at knifepoint, sure, but as a general class no. Dead people don't buy more drugs, and drug dealers want to sell drugs.
The problem with fentanyl is that the lethal dose is so small (LD50 is like 1-3 mg) that "a grain was passed through whole rather than dissolved" or "a grain stuck to the apparatus instead of being cleaned off" can be all it takes (note that LSD does not have this problem, as while active doses are tiny it has a fuckhuge dose ratio and as such lethal is still ~1 gram).
It's not impossible to counteract this, but you need big batches, high-quality equipment with fine tolerances, and nobody messing with the product between the fine-tolerance dilution and the end-user - which works fine in the hospital system, but which is very difficult for illegal supply chains to do, as the people further up the distribution chain can't dilute it without increasing the volume and ruining fentanyl's notorious ease of smuggling, and the people at street level don't have the scale to do big batches or afford high-quality equipment (not to mention that the people at street level don't always follow "manufacturer recommendations").
And sure, they could maybe do it anyway and jack up their prices to account for the much-greater risk and expense, but the safety of illegal drugs is quite illegible to the end-user, so there's a collective-action problem there.
No offense but have you met many drug dealers? Like everyone has their cool guy that hooks them up with the best LSD imaginable like it's some sacrament but that is not the norm at all. My Ayn Rand view of them was shattered when I bought drugs on the street a few times. They often don't know what they're selling, in the concentrations that they're selling. They don't particularly care about repeat business. They don't care if they kill you. They're also generally too dumb to even think about testing their stuff or weigh things. If they are smart enough to weight things they're probably not going to buy the $300 milligram scale when the whippet shop sells some that advertises milligram precision for $20. They may be addicts themselves. They are not rational economic actors.
Drug dealing doesn't primarily attract smart entrepreneurial people who to make a fortune. It attracts rather unsmart, not well people who have very few other options for making money.
Sure, I’ll believe they cut corners and accept that drug users have a high mortality rate. But even quite dumb people with undiagnosed mental illnesses generally understand that repeat business is good for them, personally, and want to maximize their cash flow that way.
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As an alternative theory, fentanyl may be both an extremely pleasurable and extremely addictive substance that (desperate and not especially well-informed or conscientious) people try without grasping the full consequences of what they're doing.
That said, the people who are most hands-off on fentanyl proliferation do not appear to give one crap about the people suffering from addiction to it. It's decentralized MAID. Naively a misanthrope might consider it an effective way to get rid of undesirables, but even that makes no sense: its an addiction that reproduces itself for each new doomed-to-die cohort.
So we need some kind of public awareness campaign? That would improve the issue? I do believe that some of the issues with the Drug War was that the government was doing fear-mongering and not really providing accurate information, but still. I think a lot of people take it because it's the best they can get. Perhaps if the most desperate of sinners were provided safer high quality drugs then they would not resort to fentanyl? Or perhaps we need to refashion society in such a way that constantly seeking a new high is not a marginally acceptable alternative to being a semi-productive member of society.
Does it really? A lot of these addicts seem to have quite a decent life expectancy, what with all these good samaritans going around with Narcan. The addiction itself is accessory. Desperate people would become addicted to something else if fentanyl and the other street stuff was completely eradicated. They are just a symptom of a sick society and they rightfully pile up in these progressive cities, in front of the very eyeballs that need to connect some dots, but that has not worked so far.
Last year, over 800 people died in San Francisco to overdose. Compare that to 56 homicides and 27 traffic deaths. Or, heck, the ~700 COVID deaths from 2020 to the end of 2021.
Addicts have a shockingly low lifespan. And fentanyl is the key component of their mortality: approximately nobody dies from crack or meth, the usual drugs of choice. Which isn't to say they're not damaging or that I don't want to see them off the streets, but fentanyl stands out as particularly evil.
Nitpick, but "approximately nobody dies from crack or meth overdose". I'm guessing methamphetamine addiction would have been involved in a decent chunk of those murders, even if the numbers are still obviously lower than those from fentanyl.
I think some of that might be substitution effect, too- meth users who would eventually OD on the stuff die from fentanyl first.
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