How widespread are the homeless/mental health/addiction issues in your city/province?

[Hecate]

Originally Posted by someone123

It depends. Some drugs users end up with permanent brain injury. Example: https://www.cbc.ca/news/canada/calga...dict-1.5422219

Yes of course that’s true. But it doesn’t mean these people don’t deserve a future where they are productive, safe, cared for and loved.

[someone123]

Originally Posted by Hecate

Yes of course that’s true. But it doesn’t mean these people don’t deserve a future where they are productive, safe, cared for and loved.

It's easy to agree on principles like this but it is hard to get there.

We have the criminal justice system we have. It's not humane and won't work at all to rehabilitate this group. It could remove them from society. Some portion of the voting base (more in the USA, maybe 10-20% here?) thinks this system is good and maybe you should just be tougher on drug addicts and lock them up more.

We have addictions counselling type services. They're likely strained for resources and the article discusses why they don't work for those with anoxic brain injury. A lot of people think these services are a solution but we just don't invest enough in them. I think just scaling this out on its own would help but only with some fraction of the population. I think it's nice to have counsellors but I don't believe that drug addictions would all be solved if only the drug addicts had counsellors to talk to after the fact.

We have the housing market, economy, and social structure. A lot of people who aren't brain damaged drug addicts and can advocate for themselves struggle to find housing and social support. It would be very difficult to build really good supportive housing/institutions for drug addicts in this kind of environment.

I think that for this problem to be solved, the basics of the economy and society would have to be working well and then it would be necessary to invest in new kinds of institutions that don't follow either the prison model or a counselling only model. Something like thurmas' rural healing center would probably be one example of a range of different resources.

[Acajack]

I definitely agree that support programs for addicts need to be greatly enhanced but this is separate from the crimes some of them commit. Especially when we are talking about violent crime. Alcoholism is also a disease but we don't go easy on alcoholics who commit serious crimes when they are drunk.

[Wigs]

Drunk drivers that kill people in Canada usually serve minimal and sometimes no jail time.
Ask Kevin O'Leary's wife

[Acajack]

Originally Posted by Wigs

Drunk drivers that kill people in Canada usually serve minimal and sometimes no jail time.
Ask Kevin O'Leary's wife

That's a crime of criminal negligence.

We don't let people who commit murders or violent assaults off easy if they're drunk.

[Acajack]

The Chinese embassy in Ottawa is complaining about the increasingly dangerous conditions on the street in front of it and asking for more security. They are located just east of the Byward Market.

[O-tacular]

Originally Posted by someone123

It's easy to agree on principles like this but it is hard to get there.

We have the criminal justice system we have. It's not humane and won't work at all to rehabilitate this group. It could remove them from society. Some portion of the voting base (more in the USA, maybe 10-20% here?) thinks this system is good and maybe you should just be tougher on drug addicts and lock them up more.

We have addictions counselling type services. They're likely strained for resources and the article discusses why they don't work for those with anoxic brain injury. A lot of people think these services are a solution but we just don't invest enough in them. I think just scaling this out on its own would help but only with some fraction of the population. I think it's nice to have counsellors but I don't believe that drug addictions would all be solved if only the drug addicts had counsellors to talk to after the fact.

We have the housing market, economy, and social structure. A lot of people who aren't brain damaged drug addicts and can advocate for themselves struggle to find housing and social support. It would be very difficult to build really good supportive housing/institutions for drug addicts in this kind of environment.

I think that for this problem to be solved, the basics of the economy and society would have to be working well and then it would be necessary to invest in new kinds of institutions that don't follow either the prison model or a counselling only model. Something like thurmas' rural healing center would probably be one example of a range of different resources.

Alberta is trying this with trailers north of Red Deer but there is some controversy. The guy behind it is a formerly homeless addict. There are some potentially unconstitutional parts such as taking people against their will when a family member signs off. Also the program prohibits drug use of any kind which would not work for someone like lio's gf. As usual conservatives are promoting abstinence no matter what. I think PeePee has expressed similar views. He sees safe injection sites or dispensaries as dealers who are only making the problem worse. Tell that to someone coming off of drugs. Hell I've had to go slow getting off of medications before. You can't go cold turkey or your body goes into serious withdrawal.

[Wigs]

Good point on not being able to go cold turkey.

The withdrawal from alcohol abuse is bad enough
https://en.m.wikipedia.org/wiki/Delirium_tremens

I can't even imagine trying to get off opiates/opioids or the strongest substance, fentanyl/Carfentanil and related, or combined substances.

lio's personal story should be eye opening to a lot of Canadians.

[wg_flamip]

Originally Posted by O-tacular

I think PeePee has expressed similar views. He sees safe injection sites or dispensaries as dealers who are only making the problem worse. Tell that to someone coming off of drugs. Hell I've had to go slow getting off of medications before. You can't go cold turkey or your body goes into serious withdrawal.

This view that safe injection sites are there to facilitate drug use or coddle drug users is terribly short-sighted. In addition to minimizing overdoses and the strain they put on the healthcare system, they serve three important public health goals that affect all of us.

Firstly, by providing addicts with safe equipment, the spread of blood-bourn diseases like Hepatitis and HIV are kept in check. These diseases not only cost our healthcare system vast sums through the infected individual's lifetime, they are also at risk of spreading to non-drug users.

Secondly, by concentrating drug use in a supervised environment, the amount of dangerous equipment (e.g., syringes) left lying around in streets, parks and other public spaces is significantly reduced.

Finally, overdoses in public spaces can be extremely disturbing—even traumatizing—to those everyday people who find them and the first responders called in to treat them.

[niwell]

Originally Posted by Wigs

Good point on not being able to go cold turkey.

The withdrawal from alcohol abuse is bad enough
https://en.m.wikipedia.org/wiki/Delirium_tremens

I can't even imagine trying to get off opiates/opioids or the strongest substance, fentanyl/Carfentanil and related, or combined substances.

Alcohol and benzos are basically the only substances where cold turkey withdrawal can easily kill you. Not commenting on the difficulty of getting off of other substances, but those are two where you have to be very, very careful. Benzos (such as Ativan) were also prescribed like candy by quite a number of GPs - I've know a few people who had to have very closely monitored tapering to get off safely. My grandmother for instance was heavily addicted but nobody in the family believed me when I mentioned she was taking a titanic (prescribed) amount because "her doctor must know what he's doing!". When she was hospitalized for a broken hip the staff were shocked and immediately had to wean her off.

[Acajack]

Originally Posted by wg_flamip

This view that safe injection sites are there to facilitate drug use or coddle drug users is terribly short-sighted. In addition to minimizing overdoses and the strain they put on the healthcare system, they serve three important public health goals that affect all of us.

Firstly, by providing addicts with safe equipment, the spread of blood-bourn diseases like Hepatitis and HIV are kept in check. These diseases not only cost our healthcare system vast sums through the infected individual's lifetime, they are also at risk of spreading to non-drug users.

Secondly, by concentrating drug use in a supervised environment, the amount of dangerous equipment (e.g., syringes) left lying around in streets, parks and other public spaces is significantly reduced.

Finally, overdoses in public spaces can be extremely disturbing—even traumatizing—to those everyday people who find them and the first responders called in to treat them.

I don't believe anywhere in North America has done what, say, Portugal has done and followed through with all of the critical ancillary supports needed to accompany this type of safer, wider access.

As such all that has been done is the enabling of greater access with only a patchwork of half-assed supports if anything.

You can see the disastrous results in Vancouver and a number of US cities, mostly on the west coast.

Non merci.

[Wigs]

niwell, your family expected your grandma's doctor to provide good care, meanwhile he was apparently Dr. Feelgood.
Hope your grandma was okay after being weaned off of them.

[1overcosc]

Originally Posted by wg_flamip

This view that safe injection sites are there to facilitate drug use or coddle drug users is terribly short-sighted. In addition to minimizing overdoses and the strain they put on the healthcare system, they serve three important public health goals that affect all of us.

Firstly, by providing addicts with safe equipment, the spread of blood-bourn diseases like Hepatitis and HIV are kept in check. These diseases not only cost our healthcare system vast sums through the infected individual's lifetime, they are also at risk of spreading to non-drug users.

Secondly, by concentrating drug use in a supervised environment, the amount of dangerous equipment (e.g., syringes) left lying around in streets, parks and other public spaces is significantly reduced.

Finally, overdoses in public spaces can be extremely disturbing—even traumatizing—to those everyday people who find them and the first responders called in to treat them.

Safe injection sites are one of those touchy public health policies that go against people's puritanical instincts, but make a lot of sense from a holistic public health perspective, for the reasons you just gave.

It's interesting that in Canada we're very.. selective on where we think this way, versus where we adopt the older more puritan-style "shame on you for being bad" type thinking.

The former applies to drug addiction and unprotected sex, the latter applies to alcohol (and from 2020-2022, to covid). With obesity, we largely shifted from the latter to the former over the last few years.

[1overcosc]

Originally Posted by Acajack

I don't believe anywhere in North America has done what, say, Portugal has done and followed through with all of the critical ancillary supports needed to accompany this type of safer, wider access.

As such all that has been done is the enabling of greater access with only a patchwork of half-assed supports if anything.

You can see the disastrous results in Vancouver and a number of US cities, mostly on the west coast.

Non merci.

On the other hand, this is also true. In a vacuum, where nothing else is being done, the harm reduction approach causes a whole bunch of other problems.

[esquire]

Interesting discussion. The current crop of street drugs presents a dilemma in that it takes almost nothing to become addicted to them, but in most cases it takes a ton of time and money to get someone off of them. In some cases like lio's girlfriend, that comes in the form of private resources. But for the most part, the expectation is that the state should step up and deliver the resources to help people get cleaned up.

The problem is when you start dealing with large numbers of people with addictions. If we did things the way that advocates in the sector say we should, we'd probably be dedicating several GDP percentage points to addictions treatment alone by now. This does not seem like a recipe for a happy and prosperous nation.

I'm not sure I am on board with this idea that there should be unlimited public resources for treatment, because that is but one of a large number of important demands on the public purse.

[1overcosc]

Originally Posted by esquire

Interesting discussion. The current crop of street drugs presents a dilemma in that it takes almost nothing to become addicted to them, but in most cases it takes a ton of time and money to get someone off of them. In some cases like lio's girlfriend, that comes in the form of private resources. But for the most part, the expectation is that the state should step up and deliver the resources to help people get cleaned up.

The problem is when you start dealing with large numbers of people with addictions. If we did things the way that advocates in the sector say we should, we'd probably be dedicating several GDP percentage points to addictions treatment alone by now. This does not seem like a recipe for a happy and prosperous nation.

I'm not sure I am on board with this idea that there should be unlimited public resources for treatment, because that is but one of a large number of important demands on the public purse.

This issue is kind of like dealing with asylum seekers, if you think about it.

Doing pretty much any approach with asylum seekers that is economically practical - build walls to keep them out, detain them, deport them, let them in but make them fend for themselves, etc. - is arguably inhumane, but the humane solution (letting them all in and giving them all the resources they need) is too much of a drain on resources.

There's no good answer to either problem.. other than, preventing the problem in the first place (preventing social despair that leads to addiction, and preventing geopolitical crises that lead to asylum seeking). But that's not really helpful advice without a time machine.

In Canada's case we had the benefit for many years of not really having to face these dilemmas, so we got on a bit of a moral high horse about it. We tut-tutted at the harsh drug crackdowns of Duterte in the Philippines and the giant walls to keep migrants out in Central Europe while maintaining a moral smugness that surely we'd never do the same sort of inhumane things. Well.. now it's time to put up or shut up.

[Acajack]

My confidence in us liberalizing access to even harder drugs plus getting everything else right is about as close to zero as you can get.

[O-tacular]

Originally Posted by Acajack

My confidence in us liberalizing access to even harder drugs plus getting everything else right is about as close to zero as you can get.

Is it 'liberalizing access' for lio's gf to receive medical opioids from the pharmacy so that she doesn't go into medical distress while trying to kick heavy drugs?

Also, as was already pointed out, safe infection sites reduce diseases like Hepatitis and AIDS while leaving less discarded needles on the streets and saving not only lives but our healthcare system from spending even more money. Help me to understand the moral panic that this creates?

[lio45]

By pure coincidence yesterday evening my gf pointed out there’s no real (24/7) supervised injection site in our city (unlike in Montreal), without knowing I was discussing the subject with some strangers online. We toyed with the idea of opening one ourselves.

Completely disagree with decriminalization though. Any half-decent dealer will be well organized enough that the cops can usually only hope to get them for Simple Possession; at least in the current legal framework, after a bunch of those, judges can start to be more harsh on a given individual (keep in mind everyone is always innocent until proven guilty beyond all doubt). But if you make it okay to have some on you, forget having cops bothering to fight trafficking and temporarily put at least some traffickers behind bars occasionally, it becomes basically “taps open” for those substances into society.

[someone123]

Originally Posted by lio45

But if you make it okay to have some on you, forget having cops bothering to fight trafficking and temporarily put at least some traffickers behind bars occasionally, it becomes basically “taps open” for those substances into society.

The discussion is often stuck in moralizing territory and incentive structures or goals are de-emphasized. We want a fair and humane system, sure, but we also want low drug use, not high drug use. We accept this with smoking which the government has worked hard to wipe out.

I'm not sure but you might actually get in more trouble in Vancouver for smoking tobacco than for doing hard drugs in a lot of places. Not sure what the relative affordability is like.

As far as incentive structure we have an economy where low skill wages are poor and often don't even allow people to get secure housing. For a person with no supports who may already have a lot of problems (like brain damage from a drug overdose) I wonder how much of a quality of life difference there is between trying really hard to get your life in order with all the real life setbacks that happen and just doing drugs and bouncing around whatever social services exist. On top of that there's the addiction factor slanting things.