Like most people, I would like to end the epidemic of heroin and drug over doses.
But there is an underlying assumption on the part of many well meaning people and politicians that if we only did more, spent more money, devoted more resources, employed more people, we could clean up this problem, as if it were like treating tuberculosis, smallpox or measles.
Clearly, drug abuse and drug deaths ought to be considered a public health problem, not a criminal problem.
Countries from the Netherlands to Portugal have in their own different ways decriminalized drug abuse and by many measures those countries have seen huge social and medical benefits.
In Portugal the rate of needle acquired HIV fell by 95% after drugs were legalized. Similar declines in rates of Hepatitis C and Hepatitis B and subacute bacterial endocarditis will likely soon be documented.
All these illnesses place a burden on any national healthcare system--more in countries with national health care than in the United States, where we hope those afflicted drug addicts will simply die outside the hospital, but when they get sick enough, they almost always find their ways to the emergencies rooms, the wards and the intensive care units so the idea we can simply let them die and not have to pay for them is another tough guy fantasy.
The problem is, there is reason to believe little of what we do in rehabilitation programs actually succeeds in getting people off drugs and keeping them off drugs. The most thorough exploration of this issue I've ever seen is in the TV series, "The Wire," where the psychology, the culture and the intractability of drug use is explored thoroughly and at length.
With the use of naloxone to save people who have stopped breathing (respiratory arrest) the phenomenon of these patients waking up in the clinic and leaving, often with the IV still in the arm, in search of their next fix, is well known.
The rate of infections with and deaths from tuberculosis in England declined long before effective antibiotics were introduced. The reasons for this are not really known, but the usual explanation was indoor heating and plumbing, better diet and overall better hygiene and nutrition may have made people simply more robust, healthier and less likely to be crowded together to transmit this communicable disease.
If we ever see a decline in IV drug use and deaths it may occur because we now have meaningful work, well paying jobs and a better life to offer those who wish to escape the lives they have in the tip of a needle.
But there is an underlying assumption on the part of many well meaning people and politicians that if we only did more, spent more money, devoted more resources, employed more people, we could clean up this problem, as if it were like treating tuberculosis, smallpox or measles.
Clearly, drug abuse and drug deaths ought to be considered a public health problem, not a criminal problem.
Countries from the Netherlands to Portugal have in their own different ways decriminalized drug abuse and by many measures those countries have seen huge social and medical benefits.
In Portugal the rate of needle acquired HIV fell by 95% after drugs were legalized. Similar declines in rates of Hepatitis C and Hepatitis B and subacute bacterial endocarditis will likely soon be documented.
All these illnesses place a burden on any national healthcare system--more in countries with national health care than in the United States, where we hope those afflicted drug addicts will simply die outside the hospital, but when they get sick enough, they almost always find their ways to the emergencies rooms, the wards and the intensive care units so the idea we can simply let them die and not have to pay for them is another tough guy fantasy.
The problem is, there is reason to believe little of what we do in rehabilitation programs actually succeeds in getting people off drugs and keeping them off drugs. The most thorough exploration of this issue I've ever seen is in the TV series, "The Wire," where the psychology, the culture and the intractability of drug use is explored thoroughly and at length.
With the use of naloxone to save people who have stopped breathing (respiratory arrest) the phenomenon of these patients waking up in the clinic and leaving, often with the IV still in the arm, in search of their next fix, is well known.
The rate of infections with and deaths from tuberculosis in England declined long before effective antibiotics were introduced. The reasons for this are not really known, but the usual explanation was indoor heating and plumbing, better diet and overall better hygiene and nutrition may have made people simply more robust, healthier and less likely to be crowded together to transmit this communicable disease.
If we ever see a decline in IV drug use and deaths it may occur because we now have meaningful work, well paying jobs and a better life to offer those who wish to escape the lives they have in the tip of a needle.
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