"But even though the concentration in Appalachia does suggest some vaguely Case-Deaton-y conclusions, the rest of the regional pattern does not.... Maryland is the richest state in the union."
Gotta stop you there. You may be right that the opioid crisis is not primarily driven by poverty. But pointing to the wealth of Maryland is a total red herring. Maryland has extremes of wealth, and extremes of poverty. Maryland has Chevy Chase, and Maryland has Prince Georges County. And, famously, Maryland has Baltimore. They made a good tv show about it, once.
If you want to make your case about poverty not being a driver, then drill down to the county-level or finer. States like MD and CT have huge disparities of wealth within them. Talking about the wealth of the state as a whole is a disservice to your argument and to your readers.
If the parties were smart, they'd order there primaries by margin of victory in the previous election year. The first primaries of 2020 would have been Michigan, New Hampshire, Pennsylvania. The first 3 of 2024 would be Georgia, Arizona, Wisconsin.
That's a good suggestion. The other good way to do it would be to start from the states that are closest to various medians (in income, racial composition, education etc) and then work out toward the outliers.
The interesting thing is both of our proposals would arrive at very similar results, and I don't think that's a coincidence. The "swing" states also happen to be "median" states. States that are at extremes in various ways tend to be highly partisan already. WV and Connecticut and California and Mass and NY and Maryland and ND and SD are would go last under either of our systems.
It isn't possible to redraw state lines, as I know you know, but it would be possible without a new Constitution to organize the federal government into regional federal administrative districts, headed by federal governors confirmed by Congress and responsible for federal administration in the district. The Cabinet could basically be a council of federal governors.
And to tie this into today's topic, FDA recently proposed regulations that would preempt licensure laws for drug wholesalers and 3PLs, as directed by the Drug Supply Chain Security Act and replace them with a federal licensing system -- which just goes to show how much of what State govts do is subject to federal preemption under the Commerce Clause.
Btw, Congress should broadly preempt state licensure laws, especially in healthcare, not just in the drug supply chain.
I am not aware of a legal prohibition preventing two or more states to renegotiate their borders. I always thought they were free to do so, should they want to.
I once drew up a plan for Nevada and California to swap Clark County for a handful of eastern California counties that would leave both states with roughly the same population as before and therefore the same Congressional representation. I didn't know there was a statutory impediment.
The Oregon Territory should never have been split up, it baffles me as to why it wasn't admitted as a free state in its entirety the same time California was as part of the Compromise of 1850 in order to fully shut off slavery from spreading to the Pacific. If that had happened, you'd have a state with 20 electoral votes that would still go 11.7 votes for Biden in 2020:
However, if you're going to split up the Oregon Territory, the next link below is the way that it should have been done. Two states west of the Cascades divided by the Columbia River, a third state consisting of southwestern Idaho and eastern Oregon (the latter agitating to become a part of "Greater Idaho") with the Snake and Columbia Rivers as its northern border, a fourth state consisting of eastern Washington, northern Idaho, and Montana west of the Continental Divide (this has been called the state of Lincoln in several proposals), while Eastern Idaho gets merged into Utah, given it too was heavily settled by Mormon pioneers to an extent that the rest of the state was not.
Yes, the states east of the Cascades are still awfully small, to say nothing about the lowly populated rump of Eastern Montana that's left, but that's what would make the most sense culturally in the Northwest.
County level data might not help much. The biggest counties (eg Maricopa, Los Angeles, Kings) also have extremes of wealth and poverty. You’d need to get data by census tract for it to tease out wealth effects.
Slowboring could use an aspiring data journalist like me or 1,000 smart, young people. I would like to see Matt’s analysis laid on top of more serious numbers
I was curious and looked. The counties in and around baltimore/DC are by far the worst. Western Maryland has a small increase but not awful. There's some thought that the existing trafficking infrastructure in baltimore/DC/New England is why things got worse there than you'd expect.
While those states certainly do have poor areas, they are still much wealthier than other states by nearly every metric. They have a much higher median wealth than other states and their poverty rates are much much lower.
There is still suffering in those states, but objectively they are wealthier.
I had something of the same thought which led me to wonder what the national map would look like shaded according to the legend. I’ll bet that purple over W. Virginia would bleed across the borders into its neighbors significantly.
I agree but we have to be careful with how we use the words "rich", "poor" and "affluent" because people who are somewhat poor in the US are actually affluent by the standards of the poorest countries.
Drug overdoses do seem concentrated in globally affluent communities. But within the USA, they are a bit more concentrated towards the lower end of the SES ladder.
It's also easy to confuse cause and effect. A lot of the people I went to high school with were on track to be fairly middle class but addiction dragged them down and they ended up living in very low income neighborhoods. So they'd be marked as "low income" when they died or die, but they had been more middle income 10 years earlier.
The same happened to the people who lived in my current house, which is in a higher income - around 2005 they sold the house for a bargain price to a house-flipper because of financial problems triggered by their addiction.
i think the country point is key. And more to the point before you say the issue is the direction of the economy, Portugal's GDP is below 2009 levels. From 2008-2015 their economy experienced a prolonged contraction of over 20%, and yet no real public health crisis to speak of. Life expectancy actually grew faster during that contraction than during the modest recovery since.
Some years ago on the Weeds the crew talked about a study that indicated in a developed economy people die more in expansions than recessions because basically people drive more, smoke more cigarettes, and do more drugs. Unfortunately this doesn't suggest a very clear policy solution.
My little brother died 2 weeks ago of a heroine overdose. Got started on oxy when he was 16 after an intense chest surgery. It was a decade of pain, struggle, lies, theft, rehab, false hope, and finally an end that none of us wanted but all knew was likely coming.
We come from an upper-middle class family in Houston, though my folks are now broke from all the rehab and we all had to chip in to pay for the cremation. I had my own struggles with addiction. Was an alcoholic for about a decade, though I was able to recover with the support of my immediate family and am 3 years sober. The dividing line between me and my little brother is very thin and blurry. We are separated only by a few simple decisions and a lot of luck. Common between us is that we were both ASD and both suffered from depression and anxiety before the introduction of any substances. I, eventually, learned how to manage and get my head over those, for the most part. He did not.
Thank you for sharing this, my heart goes out to you and your family. I am lucky to have an extremely non-addictive brain/personality, and stories like this make it easier to understand the struggle that so many people experience.
I am so sorry for your loss. Reading your comment thread about using drugs to dull the pain of life reminds me of what my recovering addict mom taught me growing up: “we have to learn to deal with life on its own terms.” And she would continue by saying she didn’t do it to feel high or drunk, but just to feel normal and okay. Words of hard fought wisdom I’ve tried to incorporate and pass on to my teens.
Ahhh, it’s so hard. Again, so sorry for what you and your family are going through.
I’m so sorry for your loss. As a parent I really appreciate you sharing this. What would you recommend parents look out for or be careful about when it comes to keeping their kids away from drugs, or dealing with suspected drug use?
It is a really important and tough question, for which I do not have a real answer to. We have two boys (6 & 10). L (6 year old) was just diagnosed with ASD as well, whereas J (10 yr old) has ADHD and definitely anxiety, possibly some aspects of depression. I share bc all of these led to me and my brother searching for something outside of ourselves that will make "it all go away" or make the differences between us and others less evident (to ourselves and others). We share your same concern.
I can state, pretty confidently, that there is nothing my parents could have done to keep me and my brother from getting a hold of and trying drugs. Any kind of drug. That was the case 20 years ago when I was in Highschool and I bet it has only gotten easier. There is no making sure they only associate with the “right kind of person”, school, neighborhood, or anything I can think of that could have stopped us from being exposed and using if we wanted to. Additionally, and this is conjecture, it at least feels like the desire to do so was a bit already baked into our chemistry.
So what do we do? Well were still figuring it out. I know one of my problems growing up was that I did not know myself. I did not know my limits, but beyond that I didn’t know what my state of happiness was, or contentment or satisfaction or just enough. And always sought those things outside of myself. I think my brother had it even harder and knew himself even less. So we are trying to create the space where our kids can really understand themselves and their own needs. I was lucky that I was into philosophy and psychology at a young age and could find a lot of support in books, which helped me then turn around and reflect on myself. I was very lucky I had that and eventually the love of the family I now have. Not sure if it will help, but we want to equip our kids with tools to have that level of reflections and the love and support available when it isn’t enough.
So sorry about your brother. Wanted to echo this parenting advice as someone whose only family has dealt with a lot of addiction and work with a lot of addicts. I think that the deaths of despair model misses that despair isn't just about the hardships life throws at you but also how you understand and deal with those.
The things that I have tried to be very about with my daughter are: Life is often connected, wonderful, and joyful but that it can also be incredibly painful and unfair. Every human experiences pain (physical and emotional); envy, lonliness, shame, anger, and sadness at levels that feel beyond our ability to handle at some point in our lives. Some people more because of circumstances or because their brain chemistry makes these emotion feel stronger. People eventually use drugs because they are addicted and not using them is in itself painful. But people start abusing drugs because they offer a brief escape from feeling this feelings or artificially create good emotions for a short period that the person feels that they need. But they do so by hijacking your brain chemicals making them less able to naturally feel those good emotions and more impacted by the negative ones. They also distract you from addressing the causes of your negative feelings by either changing your circumstances or your understanding them. So you need to learn how to experience and dwell in those feelings and not run away from them.
When she was little we experimented with things like somatic practices, mindfulness, and meditation techniques as well as some cognitive behavior therapy lite. Now that she is a teen we are having to reintroduce those and deal with it more deeply. Its been a good reminder that you never grow out of needing to learn those lessons more fully.
Former oxycontin/heroin addict here. The right way to think about addiction treatment is as a lottery. Each time you send an addict to treatment they have an x% probability of recovering. That x% is mostly correlated with *length* of stay in a treatment facility. And when I say "stay" I mean inpatient, because all outpatient addiction treatment is bullshit, at least for the acute phase. Effectively zero people have ever quit using opioids from outpatient treatment alone.
The most important thing you can do is physically separate the person from the drugs - by force. This means we need to retain the threat of prison on the books for these crimes, but we shouldn't be using it. We should be giving people a stark choice "go to prison or go to treatment" and in that treatment center, they will be held, by force if necessary. Each time you do this to someone, you get an x% probability of them not going back to using. 'x' is probably not super high, but it is correlated primarily with *length* of stay, and almost nothing else. Different treatment modalities probably help at the margin, but we don't really know what's best and that barely matters anyway.
What works is physical separation by force. Force someone to stop using, and you get some chance that they won't go back. The best we can really do is keep cycling addicts through this system each time they're caught. But the key piece here that I really want to emphasize is "force". The state just paying for their treatment is not enough. They need to be put there and held there at the point of a gun if necessary. Actually exercising the state's power to compel people who've broken the law is what's necessary here.
Ironically the solution here is a middle path between conservatism and liberalism. You need force and coercion, but it needs to be used in a compassionate, not punitive way. I suspect this is why we've made less progress than we otherwise might. Conservatives just want to punish. Liberals just want to tolerate. Those willing to use coercion aren't using it in a useful way.
This was what I learned in policy school. RAND had done a huge study and found that each time you put someone in rehab you get them to stop using for that period, and likely for some amount of time after they get out and even if they relapse, you are reducing their overall consumption and thereby lowering the harm that they cause to themselves and the community. And that there is no difference in the likelihood of rehab succeeding connected to it being voluntary or involuntary. People who go to rehab to avoid incarceration have as much remission as those who check themselves in.
I’ve been thinking lately that maybe the solution is drug jails. Segregate users from gen pop, make it very akin to a rehab facility with comfortable accommodations, but make it mandatory and enforce participation in treatment. People will say it is draconian, but you are completely right that physical separation and time are the two ways people quit.
I tried to stay away from "should" statements. Whether or not the government *should* do this is a moral and ethical question. However, I think it's undeniable that it is the only way to address the problem that's likely to have success.
Whether or not that means we *should* do it is still an open question.
Unpopular opinion- we could to a certain extent give up? We could decriminalize possession of small amounts of hard drugs (as I believe Oregon is doing), and continue to prosecute dealing. Along with decriminalization, we could mandate that an officer confiscate any drugs they see in public view- enough to motivate addicts to not shoot up right on the street (no one wants to lose their drugs).
Most importantly, we could offer treatment options *to those who want it*, but we could move away from judges mandating rehab (which would be a non-issue with possession decriminalized anyways). Rehab is expensive, lots of pro-rehab legislation is just a front for shady treatment centers, addicts have to go through 7-10+ times in their life for it to 'work', and most importantly- forcing someone to go to rehab who isn't self-motivated is a complete waste of everyone's time, including the taxpayer who's paying for it. One thing that's difficult to get the left-leaning 50% of the population to understand is that lots of addicts are perfectly happy with their lifestyle- or, not unhappy enough to change. You can't force large-scale behavioral changes on the unwilling. Some people, unfortunately, just can't be saved.
If your response is 'well drug addicts stealing/panhandling/camping on the streets is bad', I have no objection to enforcing laws against that- and now police officers will have more time and more resources to go after those petty crimes, when they're not wasting time arresting folks just for possession.
We don't have to have a magic solution for drug addiction- we could simply stop wasting law enforcement time & resources on arresting people for simple possession. Arrest dealers, make supply more difficult as Matt mentions, and offer treatment to those who are self-motivated. If you disagree, tell me what society is doing to force the enormous number of alcoholics in the US to change their behavior. The answer is, if they don't break any other laws, nothing- we can't make them save themselves
“ One thing that's difficult to get the left-leaning 50% of the population to understand is that lots of addicts are perfectly happy with their lifestyle- or, not unhappy enough to change. ”
How do you figure that they are able to make a valid choice?
For example, some people have their first drink (or several) and say this is awful - and they rarely if ever drink again. Some people (the majority) have a few drinks, enjoy it and drink reasonably for the rest of their lives. And then you have the small percentage of people who have their first drink and every neuron in their brain blazes in unison MORE!!!
That’s true for all drugs.
Do you think they are making a rational decision given their intense susceptibility to whatever drug they are addicted to?
Let's throw a discussion of free will out the window and just focus on practical implementation. How do you propose to make addicts stop using drugs? I'm saying that a judge-ordered, mandatory rehab doesn't do anything. What are the methods you plan to use, that have not been effective in any country to date, that you've come up with?
It's an unsolvable problem. There's nothing state or federal governments can do for people who voluntarily choose to abuse hard drugs
No offense but you are giving up ridiculously, laughably easy. There's plenty of countries around the world with far lower usage of illegal drugs. Even among western countries, Portugal's approach seems far better and worth looking into.
My mom was a recovering addict with 26 years sobriety and said addicts have to hit rock bottom to find the motivation to change. Places like SF make it harder to hit rock bottom with the open markets and law enforcement that tolerates it. The addiction just gets more profound and ingrained—addicts are surrounded by other homeless addicts using in broad daylight and the hopeless lifestyle is reinforced because it’s tolerated. It’s incredibly cruel. As the previous commenter posted, there needs to be a choice between forced rehab or jail. You can’t force people to recover, but at least they have a chance (it took my mom 8 stints and she came out the other side to live a very fulfilling, beautiful, sober life surrounded by people who adored and admired her.)
Except that judge ordered mandatory rehab does work some of the time, permanently. Far more often it works temporarily. Additionally, in many cases it makes the individual aware of resources which they may utilize later in life as their problems become more incapacitating(which is often the case).
Maybe. I don't know, it's not so simple to me because even though the theory is the same there are some massive qualitative differences. Probably 200-250 million americans have tried alcohol but only 3-5 million (kind of a wild guess, admittedly) americans have tried heroin over the last 10 year and maybe 10% (again a guess, but somewhere in the ballpark) of them are dead.
I’d say vagrancy and a lack of gainful employment would be a good start.
If you want to get drunk in your own home, great. If you end up in a pool of your own feces in someone’s doorway because you don’t have a place to live - off you go.
And, now that you mention our prison population, a lot of those folks would have been in a state hospital 70 years ago. I’m not sure our prison population would increase. I would also add that these folks wouldn’t be convicted of a crime*. If they could get clean no felony conviction.
Completely agree with this. There are a lot of challenges for patients in getting access to buprenorphine - docs are still limited in the number of patients they can treat at once, and have to take on extra training (a requirement that doesn't apply to docs dispensing pain meds) - https://www.samhsa.gov/medication-assisted-treatment/become-buprenorphine-waivered-practitioner. There are also long-acting injectable medications to treat OUD, but they're limited-distribution specialty drugs that are really expensive, so it continues to be challenging for patients to access them. Consequently a lot of OUD patients are receiving abstinence-based treatment that's been shown to have a much lower efficacy rate than medication assisted treatment (https://pubmed.ncbi.nlm.nih.gov/32280122/)
Agreed. My understanding is that different drugs have very different addiction patterns.
From my understanding, marijuana is not that addictive, cocaine is not necessarily that addictive, but heroin famously is EXTREMELY addictive.
That doesn't necessarily mean we need the full War on Drugs on it, but as much as I'm pro-legalization for some drugs I'm much less sure about my stance for heroin/fentanyl etc.
Even if you legalize the drug, you still need to regulate it in such a way that many usages will be criminal.
Let's say we legalize tomorrow...can my kid's daycare teacher give their class fentanyl to calm them down? Can I open a heroin pub across the street from an elementary school? Is it OK if the police and firemen and ambulance drivers relax after work with a spoon and a needle? Is it OK if my neighbors with 3 kids start spending more and more of their time and money on heroin and less on raising their children? Is it OK if your kids 3rd grade teacher disappears one day because. they fatally overdosed?
Probably none of those things are OK, which means simple legalization doesn't even solve half the most serious problems.
My point is "legal" still means regulated, ie, many usages are actually criminal. It's not legal to drink and then drive, for example, and I can be fired for showing up drunk.
But it's oversimplified to say it's the same thing. Alcohol is not as addictive as heroin, and does not have the same potential to kill suddenly (as opposed to after years of chronic use). Something like just under 1% of Americans use heroin and it's killing something like 3-5% (my best guess) of those users a year.
What prevents all those folks from getting sh*tfaced drunk in those situations? A combination of reasonable regulation and the fact that not everyone is constantly looking for a way to get high covers most of it. If it was legal, would you do it? I wouldn’t.
It depends an awful lot on what we mean by legal. Is it sold in specific state-owned shops? Or is it supplied in the same way, but police just look the other way?
There's still other differenced between opioids and alcohol that need to be considered. One is the addictive force is quite a lot higher. The other is that acute danger is probably also much higher.
I wouldn't go out and try an opioid tomorrow if it was legal, but I would be concerned that my teenage relatives might try it out if they were even more readily available. I was prescribed Vicodin once myself and I probably would have kept using it for as long as a doctor prescribed, I certainly kept using it past the point of pain in my gums (wisdom teeth pulled)
"One thing that's difficult to get the left-leaning 50% of the population to understand is that lots of addicts are perfectly happy with their lifestyle- or, not unhappy enough to change."
I'm not sure that it's 50%, but I do think that many advocates for progressive social policies fail to grasp what I think of as the "Acceptable Levels of Survival" problem. (From the Architect's monologue in "The Matrix: Reloaded": "There are levels of survival we are prepared to accept.") I.e., there is a non-trivial part of the population that is willing to accept an extremely low level of "survival" if it means they don't actually have to work or can work intermittently/very little. Which, from a libertarian perspective is fine in isolation (or at least presents a private problem for family and friends), but becomes a societal problem as soon as you develop broad social programs, public services, etc. that don't recognize this reality.
Why not do something more like Portugal where drug use isn't treated very much like a criminal matter, but they do require the addicts to attempt to fix themselves if they wish to fully participate in society?
If you're going to shoot up heroin, I guess that's your right. But I don't think society owes you a job in that case.
It's worth mentioning that a lot of drug addicts have children. How is letting people shoot up heroin fair to their kids?
If fentanyl is driving the presence of the visibly homeless in major cities, giving up means accepting a massive shift to the right in city politics generally.
I don't think it is though. Fentanyl is no worse financially than heroin or meth. It just kills faster. My understanding is fentanyl didn't even really arrive substantially on the west coast until fairly recently, like 2019-2020.
But I agree Left failures on homelessness and especially the visible homeless will eventually shift portions of the urban voters to the right.
How would you say that arresting people for simple possession addresses that issue? I mean, seeing as arresting people for possession is what's the norm now- how would you say that's working out? Remember, they just get released from jail with a court date 1-2 days later, as even America doesn't have enough jail capacity for every addict found with a bag of crack or fentanyl.
Remember, you can still arrest people for *other crimes that they commit*- just not possession
I would be curious to read more on how the police in Portugal actually investigate and prosecute drug dealers without having the ability to force users to help them in exchange for having charges reduced or dropped. There's a lot of undiscussed differences in European law that usually lets their police do a lot more stopping/detaining/searching without cause compared to the US (see the debate over pretext stops here vs most European countries just having a law that says cops can stop any car without a reason).
I think I’d be on board with a program if “do to thyself as thou wilt” coupled with “the second it impacts others you spend long periods of time in jail away from your precious drugs”.
1) Have you read, like, anything that Popehat has written about the prison system?
2) Define, legally "impacts others"
3) Makes assumption that users are making clear, rational decisions.
#3, source - friend was in horrific car accident that, honestly, it would have been a kindness if he hadn't survived. Is now absolutely lit to the gills on opiod pain medication that have been legally given to him. His decision making due to this is muddled at best. And the totality of his situation is one where a box truck t-boned him into a jersey barrier, and then had modern medicine do the only thing they can do. But if he slips once, fuck 'em, he goes to prison? Nah.
I thought, in context, that I was clear enough in meaning “robs someone for drug money” or “drives under the influence”, not “uses drugs”.
There are basically four possible policy approaches to this problem:
1. Zero tolerance, i.e. East Asia. I am philosophically most aligned with this, to be frank, but getting there from where we are today would require *punitive* levels of incarceration for simple drug use until it filters into the wider culture that you *will* end up in prison for it. We’re talking a prison population of tens of millions of people for decades until drug use tapers off to near-nothing like in Singapore or Japan. Obviously unacceptable, harms are far greater than benefits.
2. Public health/public order maintenance, i.e. Portugal or perhaps the Netherlands. This is my preferred outcome, in which we focus efforts on removing as many people from the pool of users as possible while also effectively punishing those who will not or cannot give up the habit when they harm others. But I’m not confident we can do it.
3. Status quo, i.e. US. In which we have all the “benefits” of a war on producers and suppliers but are quite lax to users even when they inflict harms on others, mostly because our police lack the bandwidth to deal with the latter after pursuing the former.
4. Liberalization and public order. This is what I outlined above, in which people are permitted to harm *themselves* all they like but get quashed quite brutally if they harm others at all. Not my preference but I think it’s the only thing we can realistically *do*.
We should try, no doubt. Worst that happens is we end up with something like #4.
But it does require a coherent effort to enforce public order too. This stupid lefty strain of “chaos=liberty” needs to be shot and buried once and for all. It’s done nothing but harm the vulnerable among us since the hippy movement concocted it in the 60’s.
If slip means "uses drugs again" that indeed sounds very harsh and counterproductive. But if slip means "gets doped up and drives erratically" then it's not so clear, as he may cause another crash. That's the way I interpreted Dave R
Let’s be precise: “Slips once” sounds terribly sympathetic, but in reality is a euphemism for “robs a convenience store to get drug money” or “runs down a child driving high”.
Ah, no doubt. When do you forecast we'll win the War On Drugs then, General? It's only been going on for (checks notes) a century now. We'll just round up all the addicts, make them go to Drug Court, and then the war will be over?
A quick look at that meta-study leaves me desiring a whole lot more info. For one thing its cost-benefit ratio is based 'criminal justice system costs', which is given one line and not explained further. Would any of these costs include.... locking up folks for possession? Couldn't we uh just eliminate that cost by choosing not to do so?
"Michael Shellenberger and other Bay Area critics of Chesa Boudin argue that bad progressive policy is responsible for drug addiction, and drug addiction is responsible for San Francisco’s homelessness problem. I think this is pretty clearly mistaken."
This strawman's Shellenberger and others quite a bit. He doesn't argue that the policy of SF is responsible for drug addiction, but that it exacerbates it, concentrates it, & on the margins makes it easier to remain an addict (ignoring the crime aspects).
"But even though the concentration in Appalachia does suggest some vaguely Case-Deaton-y conclusions, the rest of the regional pattern does not.... Maryland is the richest state in the union."
Gotta stop you there. You may be right that the opioid crisis is not primarily driven by poverty. But pointing to the wealth of Maryland is a total red herring. Maryland has extremes of wealth, and extremes of poverty. Maryland has Chevy Chase, and Maryland has Prince Georges County. And, famously, Maryland has Baltimore. They made a good tv show about it, once.
If you want to make your case about poverty not being a driver, then drill down to the county-level or finer. States like MD and CT have huge disparities of wealth within them. Talking about the wealth of the state as a whole is a disservice to your argument and to your readers.
Everything west of Hagerstown (or arguably Frederick) is Appalachia, too.
And the Eastern Shore might as well be a different country.
Yup. Maryland is a land of many contrasts.
Which is why I (very lightly) think Maryland should be the first state in the presidential primary calendar
If the parties were smart, they'd order there primaries by margin of victory in the previous election year. The first primaries of 2020 would have been Michigan, New Hampshire, Pennsylvania. The first 3 of 2024 would be Georgia, Arizona, Wisconsin.
That's a good suggestion. The other good way to do it would be to start from the states that are closest to various medians (in income, racial composition, education etc) and then work out toward the outliers.
The interesting thing is both of our proposals would arrive at very similar results, and I don't think that's a coincidence. The "swing" states also happen to be "median" states. States that are at extremes in various ways tend to be highly partisan already. WV and Connecticut and California and Mass and NY and Maryland and ND and SD are would go last under either of our systems.
So Hawaii gets to go to the back of the line because they have too many Asians and Pacific Islanders?
Oddly drawn states being lands of contrast is something I know well, as I could go on regarding how Idaho might as well be three different states.
Roryslife at gmail.com
Hey. It’s hard to find your reply on My phone. Let me know if u want to get coffee sometime and BS. I should be in town a few days.
Sure, let me think of a good way to connect--or do you have a method of contact where I could reach out to you?
It isn't possible to redraw state lines, as I know you know, but it would be possible without a new Constitution to organize the federal government into regional federal administrative districts, headed by federal governors confirmed by Congress and responsible for federal administration in the district. The Cabinet could basically be a council of federal governors.
And to tie this into today's topic, FDA recently proposed regulations that would preempt licensure laws for drug wholesalers and 3PLs, as directed by the Drug Supply Chain Security Act and replace them with a federal licensing system -- which just goes to show how much of what State govts do is subject to federal preemption under the Commerce Clause.
Btw, Congress should broadly preempt state licensure laws, especially in healthcare, not just in the drug supply chain.
https://www.fda.gov/about-fda/economic-impact-analyses-fda-regulations/national-standards-licensure-wholesale-drug-distributors-and-third-party-logistics-providers
I am not aware of a legal prohibition preventing two or more states to renegotiate their borders. I always thought they were free to do so, should they want to.
I once drew up a plan for Nevada and California to swap Clark County for a handful of eastern California counties that would leave both states with roughly the same population as before and therefore the same Congressional representation. I didn't know there was a statutory impediment.
The Oregon Territory should never have been split up, it baffles me as to why it wasn't admitted as a free state in its entirety the same time California was as part of the Compromise of 1850 in order to fully shut off slavery from spreading to the Pacific. If that had happened, you'd have a state with 20 electoral votes that would still go 11.7 votes for Biden in 2020:
https://kevinhayeswilson.com/redraw/?share=67ab15c75d58e64f8g3hi67j159k4l44L102n92o99p105q120r64s16t24u14v83w87x82y115z11AL2AL4AL3AL2AL3A2L6ALAL3ALAL9A93B17C10D21E33F62G100H53I88J77K36L67M5N46O66P95Q14Rm27RV2Rm10RV3RV43Rm114RV6Rm18Rm8R29S14T133U14LV12LV11L55W72X11YL5YLYL3Y
However, if you're going to split up the Oregon Territory, the next link below is the way that it should have been done. Two states west of the Cascades divided by the Columbia River, a third state consisting of southwestern Idaho and eastern Oregon (the latter agitating to become a part of "Greater Idaho") with the Snake and Columbia Rivers as its northern border, a fourth state consisting of eastern Washington, northern Idaho, and Montana west of the Continental Divide (this has been called the state of Lincoln in several proposals), while Eastern Idaho gets merged into Utah, given it too was heavily settled by Mormon pioneers to an extent that the rest of the state was not.
https://kevinhayeswilson.com/redraw/?share=67ab15c75d58e64f8g3ui67j159k4l2m2ShS2mhSh3m3Sh2m2S2mhSm2hmhmSmhS2mShS3m102n92o99p105q120r64s16t24u14v83w87x82y115z11Ah2Ah4Ah3Ah2Ah3A2h6AhAh3AhAh9A93B17C10D21E33F62G100H53I88J77Km5LmLmL3m2LmL2m3LmLm2LmL4mLmL67M5N46O66P95Q254R29S14Tu61Uu70Uhm2h2VmV3hmh5V2hVhVhVh5V2h2VmV2h55W72X23Y
Yes, the states east of the Cascades are still awfully small, to say nothing about the lowly populated rump of Eastern Montana that's left, but that's what would make the most sense culturally in the Northwest.
"Everything west of Hagerstown (or arguably Frederick) is Appalachia, too."
The more I think about this, the more I think it's unfair to Portland and Seattle.
Chicago and LA, I'll concede.
Ha, right. The bounds of this comment end where the land starts getting flat again.
County level data might not help much. The biggest counties (eg Maricopa, Los Angeles, Kings) also have extremes of wealth and poverty. You’d need to get data by census tract for it to tease out wealth effects.
"County level data might not help much."
Oh, it would be a big improvement over state-level.
"The biggest counties ... also have extremes of wealth and poverty."
Fair point, but there aren't that many of them.
"You’d need to get data by census tract for it to tease out wealth effects."
Yup. About time for Milan to hire an intern.
Slowboring could use an aspiring data journalist like me or 1,000 smart, young people. I would like to see Matt’s analysis laid on top of more serious numbers
"Slowboring could use an aspiring data journalist like me or 1,000 smart, young people."
You really think it would take 1,000 smart young people to do as much data journalism as you can? I would like to see your analysis of that claim.
I'm so old that one smart young person could do as much as 1,000 of me.
I was curious and looked. The counties in and around baltimore/DC are by far the worst. Western Maryland has a small increase but not awful. There's some thought that the existing trafficking infrastructure in baltimore/DC/New England is why things got worse there than you'd expect.
i knew you’d say that
It was an easy prediction to make, for a top-notch data journalist like you.
While those states certainly do have poor areas, they are still much wealthier than other states by nearly every metric. They have a much higher median wealth than other states and their poverty rates are much much lower.
There is still suffering in those states, but objectively they are wealthier.
I had something of the same thought which led me to wonder what the national map would look like shaded according to the legend. I’ll bet that purple over W. Virginia would bleed across the borders into its neighbors significantly.
I agree but we have to be careful with how we use the words "rich", "poor" and "affluent" because people who are somewhat poor in the US are actually affluent by the standards of the poorest countries.
Drug overdoses do seem concentrated in globally affluent communities. But within the USA, they are a bit more concentrated towards the lower end of the SES ladder.
It's also easy to confuse cause and effect. A lot of the people I went to high school with were on track to be fairly middle class but addiction dragged them down and they ended up living in very low income neighborhoods. So they'd be marked as "low income" when they died or die, but they had been more middle income 10 years earlier.
The same happened to the people who lived in my current house, which is in a higher income - around 2005 they sold the house for a bargain price to a house-flipper because of financial problems triggered by their addiction.
i think the country point is key. And more to the point before you say the issue is the direction of the economy, Portugal's GDP is below 2009 levels. From 2008-2015 their economy experienced a prolonged contraction of over 20%, and yet no real public health crisis to speak of. Life expectancy actually grew faster during that contraction than during the modest recovery since.
Some years ago on the Weeds the crew talked about a study that indicated in a developed economy people die more in expansions than recessions because basically people drive more, smoke more cigarettes, and do more drugs. Unfortunately this doesn't suggest a very clear policy solution.
My little brother died 2 weeks ago of a heroine overdose. Got started on oxy when he was 16 after an intense chest surgery. It was a decade of pain, struggle, lies, theft, rehab, false hope, and finally an end that none of us wanted but all knew was likely coming.
We come from an upper-middle class family in Houston, though my folks are now broke from all the rehab and we all had to chip in to pay for the cremation. I had my own struggles with addiction. Was an alcoholic for about a decade, though I was able to recover with the support of my immediate family and am 3 years sober. The dividing line between me and my little brother is very thin and blurry. We are separated only by a few simple decisions and a lot of luck. Common between us is that we were both ASD and both suffered from depression and anxiety before the introduction of any substances. I, eventually, learned how to manage and get my head over those, for the most part. He did not.
"My little brother died 2 weeks ago of a heroine overdose."
Holy crap. I am so sorry to hear about your loss.
Really do appreciate it
I’m so sorry
Appreciate it, Milan
Thank you for sharing this, my heart goes out to you and your family. I am lucky to have an extremely non-addictive brain/personality, and stories like this make it easier to understand the struggle that so many people experience.
I am so sorry for your loss. Reading your comment thread about using drugs to dull the pain of life reminds me of what my recovering addict mom taught me growing up: “we have to learn to deal with life on its own terms.” And she would continue by saying she didn’t do it to feel high or drunk, but just to feel normal and okay. Words of hard fought wisdom I’ve tried to incorporate and pass on to my teens.
Ahhh, it’s so hard. Again, so sorry for what you and your family are going through.
Thank you and thank you for sharing that wisdom. That really is it.
I’m so sorry for your loss. As a parent I really appreciate you sharing this. What would you recommend parents look out for or be careful about when it comes to keeping their kids away from drugs, or dealing with suspected drug use?
My quick response and will think more:
It is a really important and tough question, for which I do not have a real answer to. We have two boys (6 & 10). L (6 year old) was just diagnosed with ASD as well, whereas J (10 yr old) has ADHD and definitely anxiety, possibly some aspects of depression. I share bc all of these led to me and my brother searching for something outside of ourselves that will make "it all go away" or make the differences between us and others less evident (to ourselves and others). We share your same concern.
I can state, pretty confidently, that there is nothing my parents could have done to keep me and my brother from getting a hold of and trying drugs. Any kind of drug. That was the case 20 years ago when I was in Highschool and I bet it has only gotten easier. There is no making sure they only associate with the “right kind of person”, school, neighborhood, or anything I can think of that could have stopped us from being exposed and using if we wanted to. Additionally, and this is conjecture, it at least feels like the desire to do so was a bit already baked into our chemistry.
So what do we do? Well were still figuring it out. I know one of my problems growing up was that I did not know myself. I did not know my limits, but beyond that I didn’t know what my state of happiness was, or contentment or satisfaction or just enough. And always sought those things outside of myself. I think my brother had it even harder and knew himself even less. So we are trying to create the space where our kids can really understand themselves and their own needs. I was lucky that I was into philosophy and psychology at a young age and could find a lot of support in books, which helped me then turn around and reflect on myself. I was very lucky I had that and eventually the love of the family I now have. Not sure if it will help, but we want to equip our kids with tools to have that level of reflections and the love and support available when it isn’t enough.
So sorry about your brother. Wanted to echo this parenting advice as someone whose only family has dealt with a lot of addiction and work with a lot of addicts. I think that the deaths of despair model misses that despair isn't just about the hardships life throws at you but also how you understand and deal with those.
The things that I have tried to be very about with my daughter are: Life is often connected, wonderful, and joyful but that it can also be incredibly painful and unfair. Every human experiences pain (physical and emotional); envy, lonliness, shame, anger, and sadness at levels that feel beyond our ability to handle at some point in our lives. Some people more because of circumstances or because their brain chemistry makes these emotion feel stronger. People eventually use drugs because they are addicted and not using them is in itself painful. But people start abusing drugs because they offer a brief escape from feeling this feelings or artificially create good emotions for a short period that the person feels that they need. But they do so by hijacking your brain chemicals making them less able to naturally feel those good emotions and more impacted by the negative ones. They also distract you from addressing the causes of your negative feelings by either changing your circumstances or your understanding them. So you need to learn how to experience and dwell in those feelings and not run away from them.
When she was little we experimented with things like somatic practices, mindfulness, and meditation techniques as well as some cognitive behavior therapy lite. Now that she is a teen we are having to reintroduce those and deal with it more deeply. Its been a good reminder that you never grow out of needing to learn those lessons more fully.
Thanks for sharing. That quote has definitely been in my head the past few days as I drive the kids to school
I'm very sorry to hear of your troubles.
I am so sorry for your loss.
Thank you
Former oxycontin/heroin addict here. The right way to think about addiction treatment is as a lottery. Each time you send an addict to treatment they have an x% probability of recovering. That x% is mostly correlated with *length* of stay in a treatment facility. And when I say "stay" I mean inpatient, because all outpatient addiction treatment is bullshit, at least for the acute phase. Effectively zero people have ever quit using opioids from outpatient treatment alone.
The most important thing you can do is physically separate the person from the drugs - by force. This means we need to retain the threat of prison on the books for these crimes, but we shouldn't be using it. We should be giving people a stark choice "go to prison or go to treatment" and in that treatment center, they will be held, by force if necessary. Each time you do this to someone, you get an x% probability of them not going back to using. 'x' is probably not super high, but it is correlated primarily with *length* of stay, and almost nothing else. Different treatment modalities probably help at the margin, but we don't really know what's best and that barely matters anyway.
What works is physical separation by force. Force someone to stop using, and you get some chance that they won't go back. The best we can really do is keep cycling addicts through this system each time they're caught. But the key piece here that I really want to emphasize is "force". The state just paying for their treatment is not enough. They need to be put there and held there at the point of a gun if necessary. Actually exercising the state's power to compel people who've broken the law is what's necessary here.
Ironically the solution here is a middle path between conservatism and liberalism. You need force and coercion, but it needs to be used in a compassionate, not punitive way. I suspect this is why we've made less progress than we otherwise might. Conservatives just want to punish. Liberals just want to tolerate. Those willing to use coercion aren't using it in a useful way.
This was what I learned in policy school. RAND had done a huge study and found that each time you put someone in rehab you get them to stop using for that period, and likely for some amount of time after they get out and even if they relapse, you are reducing their overall consumption and thereby lowering the harm that they cause to themselves and the community. And that there is no difference in the likelihood of rehab succeeding connected to it being voluntary or involuntary. People who go to rehab to avoid incarceration have as much remission as those who check themselves in.
This is the best thing I've read on the subject all day.
I’ve been thinking lately that maybe the solution is drug jails. Segregate users from gen pop, make it very akin to a rehab facility with comfortable accommodations, but make it mandatory and enforce participation in treatment. People will say it is draconian, but you are completely right that physical separation and time are the two ways people quit.
Ya, agree. Something like this is necessary if we actually want to solve the problem.
Disagree. I don't think it's any of governments business what I put in my body
And people have to want to get clean.
I did everything under the sun. I even did 10 months in jail.
I stopped partying as I grew up got married etc
I tried to stay away from "should" statements. Whether or not the government *should* do this is a moral and ethical question. However, I think it's undeniable that it is the only way to address the problem that's likely to have success.
Whether or not that means we *should* do it is still an open question.
Unpopular opinion- we could to a certain extent give up? We could decriminalize possession of small amounts of hard drugs (as I believe Oregon is doing), and continue to prosecute dealing. Along with decriminalization, we could mandate that an officer confiscate any drugs they see in public view- enough to motivate addicts to not shoot up right on the street (no one wants to lose their drugs).
Most importantly, we could offer treatment options *to those who want it*, but we could move away from judges mandating rehab (which would be a non-issue with possession decriminalized anyways). Rehab is expensive, lots of pro-rehab legislation is just a front for shady treatment centers, addicts have to go through 7-10+ times in their life for it to 'work', and most importantly- forcing someone to go to rehab who isn't self-motivated is a complete waste of everyone's time, including the taxpayer who's paying for it. One thing that's difficult to get the left-leaning 50% of the population to understand is that lots of addicts are perfectly happy with their lifestyle- or, not unhappy enough to change. You can't force large-scale behavioral changes on the unwilling. Some people, unfortunately, just can't be saved.
If your response is 'well drug addicts stealing/panhandling/camping on the streets is bad', I have no objection to enforcing laws against that- and now police officers will have more time and more resources to go after those petty crimes, when they're not wasting time arresting folks just for possession.
We don't have to have a magic solution for drug addiction- we could simply stop wasting law enforcement time & resources on arresting people for simple possession. Arrest dealers, make supply more difficult as Matt mentions, and offer treatment to those who are self-motivated. If you disagree, tell me what society is doing to force the enormous number of alcoholics in the US to change their behavior. The answer is, if they don't break any other laws, nothing- we can't make them save themselves
“ One thing that's difficult to get the left-leaning 50% of the population to understand is that lots of addicts are perfectly happy with their lifestyle- or, not unhappy enough to change. ”
How do you figure that they are able to make a valid choice?
For example, some people have their first drink (or several) and say this is awful - and they rarely if ever drink again. Some people (the majority) have a few drinks, enjoy it and drink reasonably for the rest of their lives. And then you have the small percentage of people who have their first drink and every neuron in their brain blazes in unison MORE!!!
That’s true for all drugs.
Do you think they are making a rational decision given their intense susceptibility to whatever drug they are addicted to?
Let's throw a discussion of free will out the window and just focus on practical implementation. How do you propose to make addicts stop using drugs? I'm saying that a judge-ordered, mandatory rehab doesn't do anything. What are the methods you plan to use, that have not been effective in any country to date, that you've come up with?
It's an unsolvable problem. There's nothing state or federal governments can do for people who voluntarily choose to abuse hard drugs
No offense but you are giving up ridiculously, laughably easy. There's plenty of countries around the world with far lower usage of illegal drugs. Even among western countries, Portugal's approach seems far better and worth looking into.
My mom was a recovering addict with 26 years sobriety and said addicts have to hit rock bottom to find the motivation to change. Places like SF make it harder to hit rock bottom with the open markets and law enforcement that tolerates it. The addiction just gets more profound and ingrained—addicts are surrounded by other homeless addicts using in broad daylight and the hopeless lifestyle is reinforced because it’s tolerated. It’s incredibly cruel. As the previous commenter posted, there needs to be a choice between forced rehab or jail. You can’t force people to recover, but at least they have a chance (it took my mom 8 stints and she came out the other side to live a very fulfilling, beautiful, sober life surrounded by people who adored and admired her.)
Except that judge ordered mandatory rehab does work some of the time, permanently. Far more often it works temporarily. Additionally, in many cases it makes the individual aware of resources which they may utilize later in life as their problems become more incapacitating(which is often the case).
I think you should be able to do as much drugs as you want. The second you become a public burden/nuisance you get sent to a secure facility.
The alternative to a secure facility would be (in the case of narcotics) implantable buprenorphine.
https://archives.drugabuse.gov/news-events/news-releases/2016/05/fda-approves-six-month-implant-treatment-opioid-dependence
How are you defining public burden?
One place I think it's unclear is parenting. If you have a kid should you be "allowed" to shoot up heroin?
Apply the same standards as you do to the wine mom who is passed out in her own vomit ever day when the kids get home.
Maybe. I don't know, it's not so simple to me because even though the theory is the same there are some massive qualitative differences. Probably 200-250 million americans have tried alcohol but only 3-5 million (kind of a wild guess, admittedly) americans have tried heroin over the last 10 year and maybe 10% (again a guess, but somewhere in the ballpark) of them are dead.
" The second you become a public burden/nuisance you get sent to a secure facility."
This idea makes me very nervous - because who decides when someone is a public nuisance and for how long they should be put away.
The US already has a prison population of over 2 million. Are we looking to add a couple more million for being a public nuisance with drugs?
I’d say vagrancy and a lack of gainful employment would be a good start.
If you want to get drunk in your own home, great. If you end up in a pool of your own feces in someone’s doorway because you don’t have a place to live - off you go.
And, now that you mention our prison population, a lot of those folks would have been in a state hospital 70 years ago. I’m not sure our prison population would increase. I would also add that these folks wouldn’t be convicted of a crime*. If they could get clean no felony conviction.
* of course due process would apply.
Completely agree with this. There are a lot of challenges for patients in getting access to buprenorphine - docs are still limited in the number of patients they can treat at once, and have to take on extra training (a requirement that doesn't apply to docs dispensing pain meds) - https://www.samhsa.gov/medication-assisted-treatment/become-buprenorphine-waivered-practitioner. There are also long-acting injectable medications to treat OUD, but they're limited-distribution specialty drugs that are really expensive, so it continues to be challenging for patients to access them. Consequently a lot of OUD patients are receiving abstinence-based treatment that's been shown to have a much lower efficacy rate than medication assisted treatment (https://pubmed.ncbi.nlm.nih.gov/32280122/)
Agreed. My understanding is that different drugs have very different addiction patterns.
From my understanding, marijuana is not that addictive, cocaine is not necessarily that addictive, but heroin famously is EXTREMELY addictive.
That doesn't necessarily mean we need the full War on Drugs on it, but as much as I'm pro-legalization for some drugs I'm much less sure about my stance for heroin/fentanyl etc.
Even if you legalize the drug, you still need to regulate it in such a way that many usages will be criminal.
Let's say we legalize tomorrow...can my kid's daycare teacher give their class fentanyl to calm them down? Can I open a heroin pub across the street from an elementary school? Is it OK if the police and firemen and ambulance drivers relax after work with a spoon and a needle? Is it OK if my neighbors with 3 kids start spending more and more of their time and money on heroin and less on raising their children? Is it OK if your kids 3rd grade teacher disappears one day because. they fatally overdosed?
Probably none of those things are OK, which means simple legalization doesn't even solve half the most serious problems.
Everything you mentioned applies to alcohol. Alcohol is a super dangerous and powerful drug.
Not everything, but a lot of it does.
My point is "legal" still means regulated, ie, many usages are actually criminal. It's not legal to drink and then drive, for example, and I can be fired for showing up drunk.
But it's oversimplified to say it's the same thing. Alcohol is not as addictive as heroin, and does not have the same potential to kill suddenly (as opposed to after years of chronic use). Something like just under 1% of Americans use heroin and it's killing something like 3-5% (my best guess) of those users a year.
I’m curious about that. I had a colonoscopy recently and one of the things given as part of conscious sedation was fentanyl. All I can say is, meh.
I mean you’re probably right. I’m just curious how those things are ranked.
What prevents all those folks from getting sh*tfaced drunk in those situations? A combination of reasonable regulation and the fact that not everyone is constantly looking for a way to get high covers most of it. If it was legal, would you do it? I wouldn’t.
It depends an awful lot on what we mean by legal. Is it sold in specific state-owned shops? Or is it supplied in the same way, but police just look the other way?
There's still other differenced between opioids and alcohol that need to be considered. One is the addictive force is quite a lot higher. The other is that acute danger is probably also much higher.
I wouldn't go out and try an opioid tomorrow if it was legal, but I would be concerned that my teenage relatives might try it out if they were even more readily available. I was prescribed Vicodin once myself and I probably would have kept using it for as long as a doctor prescribed, I certainly kept using it past the point of pain in my gums (wisdom teeth pulled)
"One thing that's difficult to get the left-leaning 50% of the population to understand is that lots of addicts are perfectly happy with their lifestyle- or, not unhappy enough to change."
I'm not sure that it's 50%, but I do think that many advocates for progressive social policies fail to grasp what I think of as the "Acceptable Levels of Survival" problem. (From the Architect's monologue in "The Matrix: Reloaded": "There are levels of survival we are prepared to accept.") I.e., there is a non-trivial part of the population that is willing to accept an extremely low level of "survival" if it means they don't actually have to work or can work intermittently/very little. Which, from a libertarian perspective is fine in isolation (or at least presents a private problem for family and friends), but becomes a societal problem as soon as you develop broad social programs, public services, etc. that don't recognize this reality.
Why not do something more like Portugal where drug use isn't treated very much like a criminal matter, but they do require the addicts to attempt to fix themselves if they wish to fully participate in society?
If you're going to shoot up heroin, I guess that's your right. But I don't think society owes you a job in that case.
It's worth mentioning that a lot of drug addicts have children. How is letting people shoot up heroin fair to their kids?
do you want anyone with their kids while going through withdrawal? really?
If fentanyl is driving the presence of the visibly homeless in major cities, giving up means accepting a massive shift to the right in city politics generally.
I don't think it is though. Fentanyl is no worse financially than heroin or meth. It just kills faster. My understanding is fentanyl didn't even really arrive substantially on the west coast until fairly recently, like 2019-2020.
But I agree Left failures on homelessness and especially the visible homeless will eventually shift portions of the urban voters to the right.
How would you say that arresting people for simple possession addresses that issue? I mean, seeing as arresting people for possession is what's the norm now- how would you say that's working out? Remember, they just get released from jail with a court date 1-2 days later, as even America doesn't have enough jail capacity for every addict found with a bag of crack or fentanyl.
Remember, you can still arrest people for *other crimes that they commit*- just not possession
Anything less than full legalization means we still get all the violence and OD deaths from prohbition
Interesting, do you know whether any other place somewhere else in the world has taken that approach?
I would be curious to read more on how the police in Portugal actually investigate and prosecute drug dealers without having the ability to force users to help them in exchange for having charges reduced or dropped. There's a lot of undiscussed differences in European law that usually lets their police do a lot more stopping/detaining/searching without cause compared to the US (see the debate over pretext stops here vs most European countries just having a law that says cops can stop any car without a reason).
I think I’d be on board with a program if “do to thyself as thou wilt” coupled with “the second it impacts others you spend long periods of time in jail away from your precious drugs”.
1) Have you read, like, anything that Popehat has written about the prison system?
2) Define, legally "impacts others"
3) Makes assumption that users are making clear, rational decisions.
#3, source - friend was in horrific car accident that, honestly, it would have been a kindness if he hadn't survived. Is now absolutely lit to the gills on opiod pain medication that have been legally given to him. His decision making due to this is muddled at best. And the totality of his situation is one where a box truck t-boned him into a jersey barrier, and then had modern medicine do the only thing they can do. But if he slips once, fuck 'em, he goes to prison? Nah.
“Slips once”
I thought, in context, that I was clear enough in meaning “robs someone for drug money” or “drives under the influence”, not “uses drugs”.
There are basically four possible policy approaches to this problem:
1. Zero tolerance, i.e. East Asia. I am philosophically most aligned with this, to be frank, but getting there from where we are today would require *punitive* levels of incarceration for simple drug use until it filters into the wider culture that you *will* end up in prison for it. We’re talking a prison population of tens of millions of people for decades until drug use tapers off to near-nothing like in Singapore or Japan. Obviously unacceptable, harms are far greater than benefits.
2. Public health/public order maintenance, i.e. Portugal or perhaps the Netherlands. This is my preferred outcome, in which we focus efforts on removing as many people from the pool of users as possible while also effectively punishing those who will not or cannot give up the habit when they harm others. But I’m not confident we can do it.
3. Status quo, i.e. US. In which we have all the “benefits” of a war on producers and suppliers but are quite lax to users even when they inflict harms on others, mostly because our police lack the bandwidth to deal with the latter after pursuing the former.
4. Liberalization and public order. This is what I outlined above, in which people are permitted to harm *themselves* all they like but get quashed quite brutally if they harm others at all. Not my preference but I think it’s the only thing we can realistically *do*.
I like #2 also, and I wish more people would seriously engage with it instead of saying some version of "there's nothing that can be done"
We should try, no doubt. Worst that happens is we end up with something like #4.
But it does require a coherent effort to enforce public order too. This stupid lefty strain of “chaos=liberty” needs to be shot and buried once and for all. It’s done nothing but harm the vulnerable among us since the hippy movement concocted it in the 60’s.
If slip means "uses drugs again" that indeed sounds very harsh and counterproductive. But if slip means "gets doped up and drives erratically" then it's not so clear, as he may cause another crash. That's the way I interpreted Dave R
The latter.
Let’s be precise: “Slips once” sounds terribly sympathetic, but in reality is a euphemism for “robs a convenience store to get drug money” or “runs down a child driving high”.
“runs down a child driving high”.
I reserve my right to run down any child who is driving high.
Man, it is very easy to get drugs in prison. Nothing to do on the inside but get strong and get high.
I’ve had the same thought for a bit now. Also as it would potentially help with the drug trade/border issues.
Ah, no doubt. When do you forecast we'll win the War On Drugs then, General? It's only been going on for (checks notes) a century now. We'll just round up all the addicts, make them go to Drug Court, and then the war will be over?
A quick look at that meta-study leaves me desiring a whole lot more info. For one thing its cost-benefit ratio is based 'criminal justice system costs', which is given one line and not explained further. Would any of these costs include.... locking up folks for possession? Couldn't we uh just eliminate that cost by choosing not to do so?
"Michael Shellenberger and other Bay Area critics of Chesa Boudin argue that bad progressive policy is responsible for drug addiction, and drug addiction is responsible for San Francisco’s homelessness problem. I think this is pretty clearly mistaken."
This strawman's Shellenberger and others quite a bit. He doesn't argue that the policy of SF is responsible for drug addiction, but that it exacerbates it, concentrates it, & on the margins makes it easier to remain an addict (ignoring the crime aspects).