What’s the deal with excessive drug addiction in major North American cities?

[PhilliesPhan]

I have lived in and around Philly my entire life. As a result, I'm very familiar with Kensington. I've walked the streets of Kensington multiple times over the years. In fact, some of my favorite establishments--Sacred Vice Brewing Company (before they moved to South Kensington), Kensington Pub, and Caphe Roasters--made walking past the zombies on Kensington Avenue worth it.

Kensington used to be the "Workshop of the World". If you look beyond the zombies of Kensington Ave, you'll see tons of former factories in all directions. Deindustrialization hit Kensington (and much of North Philly) HARD, and the rowhomes full of factory workers gradually began to lose work opportunities. Many of the former factory workers lacked even a high school education, so finding other opportunities became tougher as Philadelphia transitioned from a manufacturing-based to a service-based economy. A lot of those people turned to drugs, and Kensington became a haven for them. We also can't ignore that Kensington attracts addicts from across the region: a lot of the addicts on Kensington Ave are from Delco, South Jersey, and even the Main Line.

I think that Kensington will become gentrified in the long-term. There was a point in time where Fishtown was considered part of Kensington (and was very similar to it) and Northern Liberties was a crime-ridden neighborhood full of crackheads (as my mom, who used to party in the 90s, put it). Northern Liberties and Fishtown have been so thoroughly gentrified that the gentrification bubble has spread to other formerly rough neighborhoods that used to be considered part of Kensington, such as South Kensington, Olde Kensington, Norris Square, and East Kensington. Small-scale gentrification is actually taking place in Harrowgate (northeast of Allegheny Avenue), which most people would consider part of Kensington. Gentrification is also taking place below Frankford Ave along the Port Richmond/Kensington border.

[biguc]

Originally Posted by tdawg

I was just in Amsterdam for a few days and was kind of surprised by the lack of people walking around openly high. I know that drug use is highly regulated there but "my" reality didn't match my expectations. When I think of American cities with open drug problems they typically have to do with fentanyl. I'm thinking of LA's skid row, the Tenderloin in San Francisco, and Kensington in Philadelphia. It is interesting that we don't have any such areas (that I'm aware of) in New York City close to being as depressing/upsetting.

Drug problems and homelessness have a viciously cyclical relationship, obviously. Amsterdam is one of the best cities in Europe at dealing with homelessness. I haven't read up on it in a while so I'm fuzzy on the details, but they do something like housing first and something like a UBI, but it's also illegal to sleep rough. I'd imagine the latter point lets them sweep up everyone fucked up or obstinate enough to not just take the safe place to crash.

It's also worth noting that fentanyl is not nearly the problem in Europe that it is in NA.

[biguc]

Originally Posted by llamaorama

My concern with involuntary institutionalization is it's unlikely to be humane in the long run since this is a part of the population that the general public doesn't care about.

Also you get on a slippery slope of poor farms and vagrancy laws like in the 19th and early 20th century. If you were unemployed you could get arrested in a lot of US states.

I'd rather deal with homeless drug addicts on the street than deal with the threat that in the future, AI could take my and 90% of everyone else's job and leave me destitute, and as punishment for the crime of being poor I could be sent to some prison camp to do menial labor for the rest of my life.

But whatever, it's already coming. With the Grants Pass Supreme Court decision, cities and states can now jail people for sleeping in public. Louisiana passed a law this year that puts people in prison for an involuntary amount of time as a punishment for homeless loitering type offenses, and while there's technically a way out in the form of a work program, that will probably not work out for a lot of them, and also people with previous convictions for things like drugs aren't eligible so it's effectively a life sentence.

Sure, let's take the poor and needy and lock them in un-airconditioned bunk houses and use them in chicken slaughterhouses for $1/hour loaded into an account that gets garnished for fines they'll never ever be able to pay back.



Saving people or helping them isn't ever the justification for these things. It's get rid of them because they are nuisances.

Funny how it's always Louisiana, eh? They really are the bottom of every slippery slope. I use them as a trump card in capital punishment debates.

You make a lot of great points but as far as the slippery slope goes, almost everywhere manages to not be Louisiana. And Louisiana will be no matter what the rest of us do.

[Gresto]

Originally Posted by mhays

I would much rather institutionalize drug and mental cases when they're creating chronic problems on the street (strewing trash, stealing, blocking sidewalks, shouting at passers-by). Don't use the worst treatments of the 50s and give them decent apartments.

Letting them camp on the street isn't terribly humane. And I want civic order on a normal first world level.

Agreed. They have no right to sleep in encampments in parks or on streets, but as long as the only alternative is shelters, I don't blame them. I wouldn't want to sleep in a shelter either.
I see housing as a human right in a civilized modern society, and there should be efficiency units built to house the homeless. Perhaps one can have discrete agglomerations of homeless housing. Over here you have housing for people who are otherwise able to function normally but merely situationally penniless and jobless and need a roof over their heads; while over here you have housing, with staff on hand, for those who are addicted and/or mentally ill, and need some degree of help taking care of themselves. The latter are obviously the much more challenging, intractable cases, but society should care more than to simply cast these people aside as so much trash.
From a civic perspective, as you say, we should expect to be able to walk down any city street without encountering piles of discarded paraphernalia, overdosing junkies, belligerent drunks, and dangerous psychotics.

[Wigs]

Originally Posted by ana

So depressing. So many lives that could be saved and useful to society as a whole are left to rot. And this in supposedly the most "advanced" countries in the world.

Bad things including drug addiction and homelessness have never happened in Portugal, ever I suppose

Increase the population of Portugal by 30x to be the size of USA and you might be shocked with what problems your country has to deal with. Or even 4x to be roughly the same population size as Canada.

[craigs]

Originally Posted by Wigs

Bad things including drug addiction and homelessness have never happened in Portugal, ever I suppose

Increase the population of Portugal by 30x to be the size of USA and you might be shocked with what problems your country has to deal with. Or even 4x to be roughly the same population size as Canada.

Hush, you colonial gremlin. Forumers here are most privileged to toil in the glow of the majestic presence of European right-wingers like Ana and New Brisavoine. Show proper fealty, heretic!

[mhays]

You think the US problem is about population size? We have a huge, disproportionate street-behavior problem PER CAPITA. I've been to many cities and towns in Europe and have never seen anything like the US level of problem.

[muppet]

Tbf to the US, the Sackler family knowingly pushing addictive opioids to an entire generation, unsuspecting and trusting of their medical professionals, has devastated certain levels of society, and made optics pretty bad. 900,000 have since died from overdoses, with OxyContin alone a primary catalyst.

I'm sure any country would be reeling with the same problems if the Sacklers had free rein there too. Seriously, imagine running the roulette of getting medication for pain relief in the 14 year period 1996-2010. A broken leg, car accident, sports injury, post surgery care, or chronic pain, then your entire life hijacked when you become a full blown junkie forever more. You could have been a student, a parent with a family, a successful business owner, a nurse, a doctor.

The Sacklers are now banned from the US opioid industry, but have never faced prosecution for the devastation wrought against ordinary Americans as they pushed fentanyl, codeine, OxyContin, hydromorphone, hydrocodone and oxycodone like the very best dealers, with aggressive marketing tactics. Tripling opioid prescriptions to 210 million by 2011, with 11 million self reporting as addicted or misusing at its height (and obvs much higher in reality).

To the respect of ordinary citizens, many were able to wean themselves off, but many not. Once again, it would be unfair to not take this into account if comparing any other country.

Imagine if Portugal, pop 11m had to deal with 460,000 of their randomly selected citizens becoming addicts (likely far more), through no fault of their own.

[bobdreamz]

It's kind of weird seeing my hometown of Miami on the other map for a change! Hollywood even gave us a TV show (Miami Vice) built around the whole drug scene that encompassed the area at the time. In its heyday the drug of choice was Cocaine which was expensive back in the 1980s and I presume it still is?

[mhays]

The crack cocaine epidemic was behind the huge number of murders in the 1980s and 90s. Seattle's murder rate peaked around triple the 2025 rate (twice the murders, but 2/3 the population).

[Wigs]

Originally Posted by muppet

Tbf to the US, the Sackler family knowingly pushing addictive opioids to an entire generation, unsuspecting and trusting of their medical professionals, has devastated certain levels of society, and made optics pretty bad. 900,000 have since died from overdoses, with OxyContin alone a primary catalyst.

I'm sure any country would be reeling with the same problems if the Sacklers had free rein there too. Seriously, imagine running the roulette of getting medication for pain relief in the 14 year period 1996-2010. A broken leg, car accident, sports injury, post surgery care, or chronic pain, then your entire life hijacked when you become a full blown junkie forever more. You could have been a student, a parent with a family, a successful business owner, a nurse, a doctor.

The Sacklers are now banned from the US opioid industry, but have never faced prosecution for the devastation wrought against ordinary Americans as they pushed fentanyl, codeine, OxyContin, hydromorphone, hydrocodone and oxycodone like the very best dealers, with aggressive marketing tactics. Tripling opioid prescriptions to 210 million by 2011, with 11 million self reporting as addicted or misusing at its height (and obvs much higher in reality).

To the respect of ordinary citizens, many were able to wean themselves off, but many not. Once again, it would be unfair to not take this into account if comparing any other country.

Imagine if Portugal, pop 11m had to deal with 460,000 of their randomly selected citizens becoming addicts (likely far more), through no fault of their own.

People forget one family and their pharmaceutical company essentially got tens of millions of Americans across every State (and probably territory) addicted to opiates knowing the harm it would cause!

[ana]

Originally Posted by Wigs

Bad things including drug addiction and homelessness have never happened in Portugal, ever I suppose

Increase the population of Portugal by 30x to be the size of USA and you might be shocked with what problems your country has to deal with. Or even 4x to be roughly the same population size as Canada.

Actually Portugal experienced a severe drug addiction crisis in the 1980s and 1990s, marked by a heroin epidemic, a drastic increase in HIV/AIDS infections, and high overdose rates. It was estimated that there were around 100,000 drug addicts (about 1% of the population), which led to profound social and public health changes. This critical phase affected all levels of society, generated widespread social alarm, and led the country to completely change its strategy at the end of the 1990s.
Faced with the failure of a purely criminal approach, the State focused on prevention, treatment, and harm reduction, that is, a more humanistic approach.
The law passed in 2000 shifted the focus away from punishing the user, treating addiction as a public health issue.

[mhays]

"Harm reduction" has been part of the problem in the US. It's led to permissiveness and therefore tents on streets and high death rates.

We also haven't done enough on the treatment part of the equation. And we've done basically nothing to actually enforce public behavior.

[mousquet]

Originally Posted by ana

Faced with the failure of a purely criminal approach, the State focused on prevention, treatment, and harm reduction, that is, a more humanistic approach.
The law passed in 2000 shifted the focus away from punishing the user, treating addiction as a public health issue.

Yes, the Portuguese policy in that matter would've been rather effective, or so they say here in France.
Some over here would like to try the same, but the French conservatives are reluctant; they think it would only make it worse in our country.
Repression is something irrepressible to them, lol.

I think alcohol/booze should be regarded an unhealthy drug too. The fact that it's always been legal to our European culture doesn't change anything to the harm it causes.

[mhays]

Most people can handle alcohol while also being productive and healthy. Many do so with pot too. Not so much meth, fentanyl... Or that's my impression, and it seems to be part of why we allow the first two.

[mousquet]

Originally Posted by mhays

Most people can handle alcohol while also being productive and healthy.

What productivity? It all depends on what you're supposed to do. Try to solve an optics or fluid mechanics problem in a reasonable time when you're on marijuana. I tried it when I was younger and couldn't in any serious way. You can't focus enough. It drives you dumb, makes you lose your mind.

Same to alcohol, I guess. If teens want to focus on serious things, then they need to take care of themselves and avoid anything to make them even dumber than they already are.

[mhays]

Most people drink or smoke pot in the evenings, not before work. Maybe they have a beer at lunch if they can handle it.

[hauntedheadnc]

Working in addiction medicine, I can tell you that what got the ball rolling on the opioid epidemic is that oxycodone was given out like candy, for everything, with an enormous advertising and bribery apparatus behind it to ensure it got given out like candy, for everything, to everyone. Probably half the patients here fell into addiction after having been prescribed it after a medical procedure.

Another problem is that drug dealers, like anyone, are always trying to maximize profits while minimizing costs. How does the savvy dealer do so? By substituting heroin with fentanyl to start. You can't get heroin anymore, at least not around here. It's all fentanyl... or it would be except that you know what you can use even less of than fentanyl while turning even bigger profits?

Xylazine! Yes, the wonder veterinary anesthetic! Unregulated! You can buy it by the pound off the internet. Recreational use of xylazine got started in Puerto Rico, then jumped to the mainland in Philadelphia, and has been radiating outward ever since. A couple of years ago we did a test to get an idea of xylazine prevalence in this area, by testing the urine of ten of our regular fentanyl users at this facility and ten at a sister facility. Six of the ten had it at our sister facility while three of the ten had it here, and we know the problem has gotten much worse since then.

Xylazine causes you to rot, by the way. Ordinarily if you see cellulitis or persistent wounds on a substance user it's due to infection setting up at the injection site because they used a dirty needle. With xylazine though, necrosis can set up anywhere you have poor circulation.

And other substances like medetomidine are always entering circulation too.

Then you've got kratom and its derivatives like 7-OH and MGM-15. You can buy them anywhere, legally, and because they're considered "supplements" they aren't regulated. They don't have to tell you what's in them, and they don't have to tell you where they come from. They also come in misleadingly labeled or unrealistic packaging. For example, you can buy kratom in liquid form in a tiny little bottle that is supposed to contain three doses. Nobody does that. They buy the bottle and drink the bottle in one go. Likewise, you can buy it in tablet form, but you're supposed to cut the unscored tablet into four, and just take one-fourth. Nobody does that either.

When we tested the kratom liquid in house, it came back positive for fentanyl, but when we sent it to the lab that processes our drug screens, they informed us it wasn't actually fentanyl, but fentanyl analogs that still react in your brain like fentanyl. There were also several chemicals that are not allowed for use in any form, or any setting, in the US whatsoever. Other samples were contaminated with e-coli and salmonella, some had MDMA analogs, and others. We're seeing a big uptick in patients seeking treatment specifically for kratom, and they're reporting weird symptoms as they try to get off it. They're reporting visual, auditory, and olfactory hallucinations, and olfactory hallucinations are very rare. One of the patients with visual hallucinations keeps going temporarily blind. They're telling us kratom is the hardest substance to stop using that they've ever experienced.

[sopas ej]

Interestingly, by some accounts, racism has influenced the way the US has been treating the current opioid addiction issue and substance abuse.

Back in the 1980s, when there was that "War on Drugs" campaign, crack cocaine heavily impacted the African-American community, and the whole War on Drugs thing heavily focused on punishment; policy response was mandatory jail sentences.

But when the early prescription opioid crisis mostly affected white people, media and government response started treating it like a public health issue, and things started shifting towards medical treatment and sympathy. Lawmakers even started focusing on medication-assisted treatment and distributing overdose-reversal drugs... Hmm, see how this benefits the drug companies?

INTERESTING...

[jmecklenborg]

Originally Posted by mhays

Most people drink or smoke pot in the evenings, not before work. Maybe they have a beer at lunch if they can handle it.

Drinking at work has gone way down in my lifetime but people show up high all the time. They show up high and then smoke in their cars on break. Many workplaces have huge turnover because people fail drug tests 4 days after they get hired (they had to pass a drug test to get hired, but then immediately resume and hit a pole with machinery and...away they go).