I have worked in harm reduction for nearly 20 years. I work internationally - not in the US. There are so many excellent programs that work so well, yet Americans seem almost totally unaware of them, and in the US, programs that are not best practice are set up again and again, spending a lot of $$, taking a lot of money from the most vulnerable people - ie users and their families are getting ripped off, and then the program does not work long-term for most people. The most likely time for someone to die from overdose is after they get out of one of those detox programs, because, when they relapse, they don't know how much is safe to take and they take the same dose that they were taking before detox. Switzerland is a good-practice example, and so is Portugal. UNODC has clear guidelines, and programs that follow those guidelines save lives. Key services are "medically assisted treatment" MAT (this is an American term, the rest of the world calls this opioid substitution therapy - OST) with methadone or buprenorphine (this is not a detox program - adequate dosing, longterm, NOT drawing down the dose, works best) and MAT should be outpatient, in community settings (not hospitals) with take-home doses. MAT should be easily available in jails and prisons too. Clean needles should be provided for HIV and Hep C prevention - I'll bet HIV infection rates are really high in injecting communities. Naloxone should be readily available for anyone to carry, especially users, because they are the ones most likely to be around people who are overdosing. Giving naloxone to police is very suboptimal, because most users avoid the police. There are also great international guidelines on rights-based programming for stimulant users - no mystery there, the evidence is already there and other countries are implementing those life-saving programs. An excellent program for women is Sheway, in Vancouver. There should be safe injection rooms - as there are in Canada and Switzerland. Nick Kristof - I am just telling you what works and the programs that have saved lives all over the world, and that the UN supports. There is no need for you to run around the United States trying to figure this out. There is a vibrant, informed community of people globally who know what needs to be done and know about all the excellent effective programs that exist. You could tap into that. The United States is abysmally behind and stubbornly unwilling or unable to learn from other countries. That is why there are so many dead Americans from overdose, and so few Swiss who die from overdose. Anyway - maybe this will help you - I won't put it on your Facebook page because the discussion is too vitriolic on Facebook and I am tired of being verbally assaulted by angry Americans. Good luck.
I am a retired treatment program developer and manager. Mr. Kristof is exactly right. We need more treatment programs pretty much everywhere and for people of every age. We need to stop using jails and prisons as treatment facilities. They are not equipped to do the job. We need treatment that addresses not just addiction itself but underlying mental illness that frequently accompanies it. We need to address systemic and family issues that exacerbate addiction. And we need follow-up for every patient, long term, not just a few weeks. It's easy to quit drugs (though not pleasant). It's much harder to stay off them. If we believe that addiction is an illness--and it is--then we need to treat it like one. We must give teachers and others who come into contact with young addicts the wherewithal to recognize drug use. I know from experience that many school teachers and counselors don't know the signs of addiction. Yet it is not uncommon for children as young as 8 or 9 years old to already be using drugs. I've known some who were even younger. Every state must put money into prevention and treatment. In the long run, it not only saves lives and families when we spend money up front, it also costs less, due to lower incarceration and fewer hospitalizations and deaths.
My personal perspective is that we are a society rudderless, lacking collective values. The pursuit of money and power seems to be the identifying characteristics of Americans, and slowing to help those in need erodes this endless pursuit. People are well aware of homelessness, poverty, food insecurity, addiction, but they want someone else to fix using someone else's money. We are not a country that cares for the vulnerable, if anything, we are contemptuous of the unfortunate as though good and bad fortune occur through merit vs chance. The multiple crises that plague Americans are not insolva le, but there is little political will. The vulnerable rarely vote, the vulnerable don't have the means to fill campaign coffers. The vulnerable are rarely covered by media. There are pockets of decency scattered throughout the country, handfuls of local politicians trying to forge a different path, but the largely clueless and indifferent political machinery of DC and SCOTUS have made me a cynic about national politics. But, changes are possible on a local level, and your campaign will succeed if enough people begin to care about their local and state communities.
Mr. Kristof, as an American living abroad in Switzerland, I beg of you to do something about gun violence in the US. I recently read an article about ghost guns in the NYT and I am utterly horrified. I would not return to the US if I have any choice in the matter because I fear for my life there. If one doesn't die one day from medical negligence (bad health insurance and/or an overloaded system), the other cause of death might be gun violence (or drug addiction, as you also rightly point out). I am ashamed to know what happens in my country of birth, especially now that I've had years to compare the US to Switzerland. Of course, you can't compare apples and oranges, but nonetheless, I am sure we as a country, both residents and not, can do better!
Oh my, Mr Kristof, if you win, have you ever got your work cut out for you! May the voters of Oregon have the good judgment to vote for you and may you make a difference to your constituents.
I've spent most of the past 31 years sitting in meetings listening to stories like these - and sharing a few of my own. (I say "most" because I've slacked off on meetings lately, partly due to this wretched pandemic.) I can tell you one thing: you're spot on when you say we need to get these discussions up front & center. There's a reason AA & NA still keep their last names - it's because after 80 years of success stories in overcoming these addictions, society continues for the most part to view addiction as a moral failure - in much the same way poverty is viewed as the result of laziness.
I once had a conversation with an American citizen about Portugal's approach - involving the removal of criminal penalties for individual drug use and replacing the policing mechanism with diagnostic & treatment. Her response: "So, we're encouraging something bad in order to reach a good goal." To her, any help given to addicts was "bad," and this belief was so deeply embedded that I'm not sure if it's possible to change it. And this woman, I fear, represents far too large a percentage of the US population.
I love the part about providing funding for treatment programs - my own recovery began as the result of such funding and I'll always be grateful. But we have to be vigilant - once "gummint money" becomes part of the equation, graft & corruption often follow. There must be strict, consistent oversight because there are plenty of charlatans hiding among those who are genuinely concerned with helping people.
Bottom line is - YES! - let's have these discussions! In Oregon, like many areas of the US, it will often be an uphill climb, but every life that is saved makes it worthwhile. I wish you the greatest success in the pursuit of these goals.
This is a long time coming.... And the fix, getting all those who need behavioral health care the care they need, and that's gonna cost lots of money. What spending should be curtailed and what tax increase will you support to piece together the necessary dollars?
Thank you for defining what many of us see as the highest priority problems in OR (save one, but I cannot see how you could mention guns at this time). Good luck to you and us!
I have worked in harm reduction for nearly 20 years. I work internationally - not in the US. There are so many excellent programs that work so well, yet Americans seem almost totally unaware of them, and in the US, programs that are not best practice are set up again and again, spending a lot of $$, taking a lot of money from the most vulnerable people - ie users and their families are getting ripped off, and then the program does not work long-term for most people. The most likely time for someone to die from overdose is after they get out of one of those detox programs, because, when they relapse, they don't know how much is safe to take and they take the same dose that they were taking before detox. Switzerland is a good-practice example, and so is Portugal. UNODC has clear guidelines, and programs that follow those guidelines save lives. Key services are "medically assisted treatment" MAT (this is an American term, the rest of the world calls this opioid substitution therapy - OST) with methadone or buprenorphine (this is not a detox program - adequate dosing, longterm, NOT drawing down the dose, works best) and MAT should be outpatient, in community settings (not hospitals) with take-home doses. MAT should be easily available in jails and prisons too. Clean needles should be provided for HIV and Hep C prevention - I'll bet HIV infection rates are really high in injecting communities. Naloxone should be readily available for anyone to carry, especially users, because they are the ones most likely to be around people who are overdosing. Giving naloxone to police is very suboptimal, because most users avoid the police. There are also great international guidelines on rights-based programming for stimulant users - no mystery there, the evidence is already there and other countries are implementing those life-saving programs. An excellent program for women is Sheway, in Vancouver. There should be safe injection rooms - as there are in Canada and Switzerland. Nick Kristof - I am just telling you what works and the programs that have saved lives all over the world, and that the UN supports. There is no need for you to run around the United States trying to figure this out. There is a vibrant, informed community of people globally who know what needs to be done and know about all the excellent effective programs that exist. You could tap into that. The United States is abysmally behind and stubbornly unwilling or unable to learn from other countries. That is why there are so many dead Americans from overdose, and so few Swiss who die from overdose. Anyway - maybe this will help you - I won't put it on your Facebook page because the discussion is too vitriolic on Facebook and I am tired of being verbally assaulted by angry Americans. Good luck.
I am a retired treatment program developer and manager. Mr. Kristof is exactly right. We need more treatment programs pretty much everywhere and for people of every age. We need to stop using jails and prisons as treatment facilities. They are not equipped to do the job. We need treatment that addresses not just addiction itself but underlying mental illness that frequently accompanies it. We need to address systemic and family issues that exacerbate addiction. And we need follow-up for every patient, long term, not just a few weeks. It's easy to quit drugs (though not pleasant). It's much harder to stay off them. If we believe that addiction is an illness--and it is--then we need to treat it like one. We must give teachers and others who come into contact with young addicts the wherewithal to recognize drug use. I know from experience that many school teachers and counselors don't know the signs of addiction. Yet it is not uncommon for children as young as 8 or 9 years old to already be using drugs. I've known some who were even younger. Every state must put money into prevention and treatment. In the long run, it not only saves lives and families when we spend money up front, it also costs less, due to lower incarceration and fewer hospitalizations and deaths.
My personal perspective is that we are a society rudderless, lacking collective values. The pursuit of money and power seems to be the identifying characteristics of Americans, and slowing to help those in need erodes this endless pursuit. People are well aware of homelessness, poverty, food insecurity, addiction, but they want someone else to fix using someone else's money. We are not a country that cares for the vulnerable, if anything, we are contemptuous of the unfortunate as though good and bad fortune occur through merit vs chance. The multiple crises that plague Americans are not insolva le, but there is little political will. The vulnerable rarely vote, the vulnerable don't have the means to fill campaign coffers. The vulnerable are rarely covered by media. There are pockets of decency scattered throughout the country, handfuls of local politicians trying to forge a different path, but the largely clueless and indifferent political machinery of DC and SCOTUS have made me a cynic about national politics. But, changes are possible on a local level, and your campaign will succeed if enough people begin to care about their local and state communities.
Mr. Kristof, as an American living abroad in Switzerland, I beg of you to do something about gun violence in the US. I recently read an article about ghost guns in the NYT and I am utterly horrified. I would not return to the US if I have any choice in the matter because I fear for my life there. If one doesn't die one day from medical negligence (bad health insurance and/or an overloaded system), the other cause of death might be gun violence (or drug addiction, as you also rightly point out). I am ashamed to know what happens in my country of birth, especially now that I've had years to compare the US to Switzerland. Of course, you can't compare apples and oranges, but nonetheless, I am sure we as a country, both residents and not, can do better!
Oh my, Mr Kristof, if you win, have you ever got your work cut out for you! May the voters of Oregon have the good judgment to vote for you and may you make a difference to your constituents.
I've spent most of the past 31 years sitting in meetings listening to stories like these - and sharing a few of my own. (I say "most" because I've slacked off on meetings lately, partly due to this wretched pandemic.) I can tell you one thing: you're spot on when you say we need to get these discussions up front & center. There's a reason AA & NA still keep their last names - it's because after 80 years of success stories in overcoming these addictions, society continues for the most part to view addiction as a moral failure - in much the same way poverty is viewed as the result of laziness.
I once had a conversation with an American citizen about Portugal's approach - involving the removal of criminal penalties for individual drug use and replacing the policing mechanism with diagnostic & treatment. Her response: "So, we're encouraging something bad in order to reach a good goal." To her, any help given to addicts was "bad," and this belief was so deeply embedded that I'm not sure if it's possible to change it. And this woman, I fear, represents far too large a percentage of the US population.
I love the part about providing funding for treatment programs - my own recovery began as the result of such funding and I'll always be grateful. But we have to be vigilant - once "gummint money" becomes part of the equation, graft & corruption often follow. There must be strict, consistent oversight because there are plenty of charlatans hiding among those who are genuinely concerned with helping people.
Bottom line is - YES! - let's have these discussions! In Oregon, like many areas of the US, it will often be an uphill climb, but every life that is saved makes it worthwhile. I wish you the greatest success in the pursuit of these goals.
Bravo to you…for facing the hard, hard stuff. Wishing you the verybest so that people can really get help!
https://twitter.com/michmccarthy/status/1459606781890420738?s=20. I believe this is why it's so hard to change anything - read Nick Carmody's thread here. Godspeed to you, Nick. 🙏
This is a long time coming.... And the fix, getting all those who need behavioral health care the care they need, and that's gonna cost lots of money. What spending should be curtailed and what tax increase will you support to piece together the necessary dollars?
Thank you for defining what many of us see as the highest priority problems in OR (save one, but I cannot see how you could mention guns at this time). Good luck to you and us!