Destigmatize? The point was to decriminalize. Those are not the same thing. If we were destigmatizing drug use then we'd be encouraging its use, which we are not. Even with legalized marijuana we're not encouraging people to consume it. We just don't see how it's humane to increase the profits of our private corrections system by criminalizing a health issue.
But the whole point of the article is many advocates and policy makers are going beyond decriminalization to destigmatization. "Do it with friends" sure sounds like destigmatization to me.
It is a safety issue. The billboard's whole point is you warning that if you do this stuff solo you are more likely to die. Which is unquestionably true - you are not going to be in a position to use narcan to stop the overdose if you're by yourself.
If you have 5 people who are going to use opioids, you want them to be together when they do it and you want narcan or similar available to them, if you do truly care about saving lives.
"The image on the billboard that appeared in downtown San Francisco in early 2020 would have been familiar to anyone who'd ever seen a beer commercial: Attractive young people laughing and smiling as they shared a carefree high. But the intoxicant being celebrated was fentanyl, not beer. "Do it with friends," the billboard advised, so as to reduce the risks of overdose.
The advertising campaign was part of an ongoing national effort by activists and health officials to [encourage "safe"] hard-drug use on the theory that doing so would lessen its harms. Particularly in blue cities and states, that idea is having a moment. The general message carried by the San Francisco billboard appeared as well in the New York City health department's "Let's Talk Fentanyl" campaign, which last year told subway riders, "Don't be ashamed you are using, be empowered that you are using safely," and further counseled them to "start with a small dose and go slowly.""
> Destigmatize? The point was to decriminalize. Those are not the same thing.
They aren't, but in today's world, there appears to be an actual slippery slope going from decriminalization to destigmatization and maybe even to celebration.
> Even with legalized marijuana we're not encouraging people to consume it.
"We're not"? Marijuana is a legitimate business in many states now, so it will get promoted.
This strikes me as a distinction without a difference. Stigmatism is the antibody of the criminal law immune system. And in order to decriminalize something you have to first destigmatize it. That’s precisely why medical marijuana was the first step.
That billboard and "harm reductionists" is destigmatizing, not decriminalizing. I also think the possession of some subset of drugs should remain a criminal offense. Decriminalizing heroin and fentanyl doesn't sound like a good idea at all.
This is just an op-ed complaining about your average culture wars stuff. "Taboos exist for a reason" is such a thought-terminating cliche, and it seems like it should be anathema to free thinking startup folks.
The Atlantic has really fallen off and dove straight into the conservative culture wars in the last 2-3 years. It's really too bad as I used to really enjoy their publication for its thoughtful and culturally rich posts. I recently unfollowed them on instagram after the 127th clearly culture war fanning article lowered my brain cell count just from reading the headline.
If you are going to use opioids it is unquestionably safer to do it with other people while at least some of them are sober-ish. You can't narcan yourself in a solo overdose situation.
And I agree with that. What I don't agree with is that this knowledge should be disseminated in the way it is done on that billboard, with a bunch of people shown having great fun. That is promoting drug use. That sends the wrong message to the kids. You'll have the whole generation growing up thinking any drugs are OK and just part of having fun together. This is horrible.
At the same time the text makes it fairly clear that it is dangerous to use. There's a reason it talks about having narcan and people checking on you, or doing it as a group - my takeaway from the billboard on the whole is that opioids are a scary thing to do with very real risk. It doesn't make me more likely to do fentanyl, but less.
I wouldn't have used that picture myself, but I also am not convinced it by itself is going to lead people to believe that doing fentanyl is a fun activity.
Except the article gives plenty of reasons why these taboos exist, and details some of the real harms associated with the lack of these taboos. On the contrary, your comment seems to be the one to want to hand wave away the concerns expressed in the article.
But they do exist for a reason. We evolved many extremely useful taboos, and this is one of them.
The value of culture is 1) the material prosperity it creates, 2) the emotional fulfilment it generates, and 3) how well it self-propagates.
Hard drugs destroy the first two, and by killing the user and innocent bystanders early, it interferes with the third. Much of America’s falling life expectancy can be blamed on drugs.
And yet it seems that there aren't many places where decriminalization, destigmatization and lack of efforts to limit supply have brought paradise on earth. Weed and tobacco takes years to fuck you properly, people seem to be able to drop and get clean from coke, alcohol, laughing gas and heroin. But fentanyl seems to be way more of a one way street.
If I'm reading this correctly, the author is at least partially aiming at public health campaigns designed to prevent deaths, on the margin, stemming from the US opioid crisis. Only in the second to last paragraph does the author make passing reference to synthetic opioids being pushed excessively by drug companies. Purdue Pharma and the Sackler family are not mentioned.
The Sacklers are currently before the Supreme Court, negotiating a deal that will shield them from further civil action by paying a $6 billion dollar fine (leaving them a few billion ahead)[1]. While I don't think we can extract justice from punishing one responsible entity, articles like these give cover to people, companies, and systems that created this crisis.
I think drug use is a spectrum from caffeine and alcohol and pot on one side, and meth and cocaine and heroin on the other side, and in the middle there are a whole lot of drugs that are potentially dangerous or problematic if misused, but could offer benefits if used responsibly. I don't think we necessarily need a strong social stigma against pot or drinking (within reason), but we probably need one against using meth and opiates recreationally -- and I think there _is_ one that has never gone away. People even today keep that kind of drug use on the down low if they aren't deep into drug culture or an out of control addict.
A random coworker might talk to you about some new strain of pot they found, but they definitely aren't going to talk to you about heroin they shot up last weekend that they bought on a street corner.
I thought this was a good article, and together with the article about Portland last week, highlights a change a lot of those "on the left" (myself included) are coming to: there are significant negative side effects to decriminalization that are worse than many expected.
Personally, as someone who was strongly in favor of decriminalization, my mind changed a bit a couple years ago when I went through the pedestrian mall in downtown Denver. I have nothing against weed use, but walking down there was like "zombieland": tons of people walking around completely stoned out of their minds.
This doesn't mean I'm for "recriminalization", but public use was never legalized (at least in CO), but those rules are now all but completely ignored.
Vancouver resident here, so I found it interesting that the article called out BC as an example of failed/ineffective policy. And I can't exactly disagree with that sentiment -- politicians have spent decades promising then failing to solve the problem.
It just seems like the policy incentives in Vancouver are designed to erode the middle class. Allowing open air drug use and homelessness which creates a permanent underclass. More than half of VPD files in shoplifting crackdown did not result in charges, so petty theft and vandalism reduce the profitability of middle class business owners. And neither the poor nor middle class can afford to buy property in the city, making it a city that appeals to the very rich and desperately poor and squeezes the life out of anyone in between
The article outright acknowledges that outcomes are not better in areas where criminal enforcement is the primary factor vs. harm reduction. So, at most, it's not been any more of a mistake than a primarily enforcement focused efforts, and the proposed solution seems to be... everyone should just make drug users feel ashamed? I think shame is a useful and necessary human emotion, but the opioid addicts I've met over my life are already plenty ashamed of the fact they're using.
Article seems a bit hollow, it first assigns all sorts of values that do not appear to be consistent with the (sparse) references, and then it points out how the problem isn't with the drug policy concepts but with the drugs themselves.
Well duh.
Stigma on its own has never brought anything positive, any progression or any 'fixes' for problems. All it does is introduce friction in discourse, and that is never the solution. It's just so people can not only ignore problems or pretend they don't exist, but try to make it society-wide means everyone else isn't allowed to talk about it either.
Perhaps if the author didn't try the cover-up route but instead went the "talk about it, but don't use or encourage it" way, there would have been a point to it all. But just trying to deaden public awareness, that's the worst of all options.
Not involving yourself is a choice, but trying to make everyone else also not get involved, that's just human failure.
It turns out that when you threaten people with prison for drugs, sometimes they shoot at cops. And sometimes, when shooting at cops, they accidentally hit bystanders. And when you tell heroin users they can't scrub toilets for minimum wage, despite your inability to detect that they use heroin without a piss test, they steal copper wiring out of empty houses and otherwise generally make a nuisance of themselves. And the people who make these drugs, make the absolute worst possible version of them, like, does anyone believe that if the typical drugs (heroin, cocaine, meth, pot, lsd) were legal that you'd have jackasses huffing gasoline and paint and whatnot?
In a lot of ways "decriminalizing" drug use is worse than fully legalizing it or arguably worse than keeping drug use illegal, because the people _selling_ it are still technically criminals, and decriminalizing basically just increases demand and sends more money flowing into criminal organizations. They'd be better off just fully legalizing it and regulating it.
I don't disagree that drug use isn't a problem. But when the junkie buys his heroin at the liquor store, he's not sending billions of dollars out of the country for cartels so they can buy weapons to murder people with.
Drug use isn't *the* problem, it's just *a* problem, and a tiny one compared to prohibition. When there's a crackhouse in your neighborhood, that's because no one can buy this at the liquor store.
But whether there's a crackhouse, or a liquor store in my neighbourhood that sells crack, there will be crackheads around.
And that's the main problem.
If you don't agree, just take some walks through neighbourhoods with a large number of drug addicts.
On my street everything from petty crime to casual assault to literal stabbings have skyrocketed. It doesn't matter where the drugs come from; it matters where it ends up, and where it ends up is inside the brains of our brand-new underclass.
Shame does not make you do less drugs. This is a terrible take on the drug crisis. People turn to drugs because it is the only thing that gives them a tiny bit of relief in their hellish state. The less shameful tactics have already been tried or rendered ineffective by the severity of the users pain. But sure try the less shameful drugs of alcohol, weed, prescribed drugs, unhealthy food, thrill seeking behavior, and let us know if it solves the core suffering. It usually does not and the presence or absence of shame has nothing to do with it
There is no mention in Wikipedia how exactly shame reduces (or not reduces) drug use. Additionally, China and Japan have capital punishment for drug traders. So I wouldn't be so definitive about what is the cause and what is the effect.
Stigmatization has been proven to work with tobacco. I don't see any reason why branding those that use meth, heroin or ethanol as absolute losers and stupid uncool people wouldn't work either.
People that are addicted to fentanyl are already in a situation where they are past caring (or able to act on that caring) about society as thinking of them as losers.
Every opioid addict I have met is ashamed of their habits already.
>> Stigmatization has been proven to work with tobacco. I don't see any reason why branding those that use meth, heroin or ethanol as absolute losers and stupid uncool people wouldn't work either.
> People that are addicted to fentanyl are already in a situation where they are past caring (or able to act on that caring) about society as thinking of them as losers.
Maybe stigmatization is not a tactic to help existing addicts, but rather to discourage other people from getting to that state?
I have never met anyone who has become an opioid addict because they thought it was a cool and fun thing to do. Every single one of them has been because they had gotten addicted when on prescribed medication or because their lot in life had gotten so terrible that they needed an escape far greater than alcohol to cope with it.
Well ethanol in the right doses actually makes you cool - introverts do need couple of beers to get in touch with their social daredevil. Also alcohol is tasty.
And that is exactly the sort of picture that we should as society to aim to destroy. It might take a generation or two. But I believe with hard work we could get there.
Because I hate hypocrisy. Either ban nothing or ban it all. Not this stupid in between.
Either prohibition works perfectly and we can also ban ethanol, or it does not work at all and we should just go ahead and legalize everything and treat everything equally.
I am of the opinion that legalization is one of the steps needed to really solve the drug problem. I think it's not the only one because it only truly solves certain parts of the issue, on the harm reduction front.
Just having public health facilities available for users doesn't do anything either if they're not going to them. Extended, proactive, pervasive engagement with those users in a way that helps them climb out of the hole they've ended up in is also key.
The billboard with an image that they complain about, which features a group of young people and perhaps could be considered glamorous if presented without context, is next to giant words spelling out the fact that if you do the drug alone you will probably die.
And that this risk is so great that they give out free training so that people who do the drug can be potentially saved from death.
That all seems fairly fact based and scary to me, as someone who has no experience with fentanyl, and whose desire to try it is in no way enhanced by this giant warning of death.
I used to be a libertarian on drug use. Fentanyl changed my mind. It isn't a letting people have autonomy over their bodies problem anymore. The issue now is that the drugs are so deadly, getting involved in any illegal drug is like playing Russian roulette. I don't have any answers but a hard line on dealers involved with fentanyl seems like the minimum we as a society need to do.
There are people who function normally in life while using opioids. Both prescription pills, and street drugs. Obviously, long term impact from opioid use is bad, but we allow people to do all sorts of things to themselves that kill them over the long run. One of the biggest we market to kids from a young age - sugar.
The biggest acute risks from drug use are largely overdose related. Having ready access to narcan solves some of it. But issues with actual potency being incredibly unreliable are another huge risk factor that kills a lot of people, and regulated and tested drugs solves that.
Legalization makes huge headway on the acute overdose related risks. It doesn't solve all of the issues, but neither has criminalization and prosecution. I am skeptical of societal taboos doing it either, because I have seen people in my life fall into opioid addiction, and all of them were ashamed about it. I have spoken to people on the street about it, and they're ashamed to be living in tents with any money they come into going straight into more drugs. It's anecdotal, obviously, but it has been so universal that I find it incredibly unlikely that piling more shame on top of people who are already deeply ashamed of their current state in life is going to force any significant number to suddenly clean up their act.
Portugal's use of hard drugs increased at a lower rate compared to the rest of Europe post decriminalization. Obviously decriminilization is not the same as legalization, and there are other demographic factors in play, but I don't know that we have any evidence that suggests the usage of fentanyl, etc. is going to rise based on being decriminalized or legalized. This very article says that the destigmatization has no resulted in higher drug usage than in places where it is still stigmatized and laws are highly enforced.
Opioids aren't like pot or hallucinogenics or even cocaine - there's no glamour associated with them, at least not since the opulent opium dens have long since been shuttered. People can and do use them while functioning, but people mostly fall into addiction through not being able to get off of opioid based painkillers after having been prescribed them, or by their life falling apart to the point where they are medicated to an extreme extent. Will there been individuals who use if it is legalized that wouldn't otherwise? Of course. Will it be in significant quantities? I don't believe so, and don't believe there is any evidence to suggest that this would happen. The question is if the benefits can outweigh the downsides and result in overall harm reduction.
My current perspective is "I'm not interested in fighting anymore about what people should or shouldn't do. I just want to find somewhere nice, far away where I can live a clean decent peaceful life alongside anybody else who is capable of doing the same."
I think fentanyl proves the opposite. The issue is that they are illegal. If they were legal and properly manufactured like other pharmaceuticals fentanyl would not be a problem. If you could get your heroin while getting milk from the shop there would be zero issues.
I went in to this article hoping for some evidence on why harm reduction isn't always the right choice. Instead it is tone-deaf (as if fentanyl users and heroin users are in the same category as those who choose to use alcohol or pot!) and filled with correlation-implies-causation assertions.
If anyone has some credible evidence for where harm reduction doesn't work, please reply!
I used to think all drugs should be 100% legalized. This was back in 2018.
I first heard about it from late night comedy hosts who, at the time, took ten seconds out of their day to stop going on about Trump to talk about this.
