“Humphreys thinks the root of “San Francisco’s drug crisis” is “a libertarian, individualistic culture” that since the 19th century has attracted people who yearn “to be free of traditional constraints back East, to reinvent themselves, to escape the small-mindedness of small towns and to find themselves.” While that culture “underlies the city’s entrepreneurialism, artistic energy and tolerance for diversity in all forms,” he says, it “has a downside when it comes to addiction, which thrives in such a cultural milieu.” San Francisco “has long been one of the booziest cities in the country,” he writes, and “heavy use of substances has always been part of how San Francisco defines freedom and the good life.”
Conflating “heavy use of substances” with libertarianism is more than a little strange. Libertarianism focuses on the proper role of government; it does not tell people how they should conduct their private lives, except insofar as their actions impinge on the rights of others.”
“The actual cause of ever-escalating drug deaths, he avers, is “the libertarian assumption that given freedom and tolerance, everyone will rationally and productively pursue their self-interest,” which “cannot explain why a starving person would, for example, forgo food in exchange for fentanyl or cocaine.”
The assumption that Humphreys describes as “libertarian” is plainly at odds with reality. But libertarianism does not assume that people never make mistakes, never develop bad habits, or never engage in behavior they ultimately regret. It simply argues, for moral and pragmatic reasons, that the possibility of error is not enough to justify using force, which should be reserved for conduct that violates other people’s rights.
Humphreys suggests that decisions regarding psychoactive drugs are a special case because those substances negate the ability to choose. As I explain in Saying Yes, this belief is a tenet of voodoo pharmacology, which posits that drugs take control of people and compel them to act against their own interests.
Survey data, which show that people can and generally do use both legal and illegal drugs without developing life-disrupting habits, contradict that theory. Observational and laboratory research confirms that the way people react to drugs is not pharmacologically determined but highly contingent on the circumstances and incentives they face, as psychologists such as Stanton Peele, Bruce Alexander, and Carl Hart have been pointing out for many years.”
“”Portugal is in no way a libertarian country,” Humphreys writes. “Rather, it’s a cohesive, communal society in which drug use is culturally frowned upon rather than celebrated as a sign of freedom. When drug-addicted people commit crimes in Portugal, they are sent to a ‘dissuasion committee’ that can apply penalties to those who refuse to seek and stay in addiction treatment. Informally, this is backed up by pressure from family and community for addicted individuals to enter recovery.”
Humphreys is right that Portugal’s approach is not libertarian. While “dissuading” drug users is preferable to arresting, prosecuting, and incarcerating them, it shows little respect for individual autonomy. Humphreys is comfortable with that because he thinks individual autonomy is meaningless in the context of drug use. Hence he thinks San Francisco should “use court authority to mandate addiction treatment more broadly than it currently does.””
“Life expectancy in the United States dropped last year to its lowest since 1996, extending a downward trend that began in 2020, according to new data from the Centers for Disease Control and Prevention.
The latest figures from the CDC, which leave expected U.S. lifespans well below those in other large, wealthy nations, reflect the federal and local governments’ ongoing struggle to meet the demands of concurrent public health crises.
The Covid-19 pandemic has had “a domino effect,” said Nora Volkow, director of the National Institute on Drug Abuse, by “exacerbating the already very severe problem that we have in overdose deaths.”
The two crises, the Covid-19 pandemic and rising drug addiction and overdoses, are “a wake-up call” for government, added Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “It clearly is what’s cutting into the health of our communities, unlike almost anything we’ve seen before.””
“The ongoing politicization of the U.S. Covid response has negatively impacted many Americans’ decisions about vaccination and other mitigation measures. Roughly 14 percent of Americans and 36 percent of people 65 and over have received the latest booster, according to the CDC.
At the same time, Volkow believes the pandemic drove social changes that made people more vulnerable to taking drugs as a way of escaping. The pandemic also made it harder to get help. “Resources that were able to support people in the past were no longer available,” she said.”
“The initiative that legalized magic mushroom businesses allows cities and counties to ban them via ballot initiative. Local governments also retain the power to craft “time, place, and manner” regulations over psilocybin businesses.
This past election, 25 of Oregon’s 36 counties voted to ban psilocybin businesses, including four that voted to legalize psilocybin in 2020. Only two counties that put the questions to voters, Deschutes and Jackson counties, kept these businesses legal.
And this week, those two counties will consider new land use regulations that could severely restrict where newly legal “psilocybin service centers” can set up shop.”
“When marijuana was legalized in Oregon, it went through a similar journey. Voters approved a relatively liberal legalization ballot initiative. The legislature followed this up with more constricting regulations. Then a long list of local governments opted not to allow marijuana businesses. Those that did often imposed zoning regulations that made a lot of prime real estate off-limits to the new industry.
Given that history, it’s perhaps unsurprising that local governments would want to tightly regulate legalized psychedelics facilities—given how novel and new they are.
Subjecting new industries to heavy regulation is nevertheless a great way to strangle them in the crib. A business as weird as legalized shrooms requires a lot of experimentation. And we shouldn’t trust county commissions to design the perfect trip.”
“According to a 2022 report from the National Academies of Sciences, Engineering, and Medicine, “on average, the number of ongoing drug shortages has been increasing and are lasting longer.” The root cause of that problem, per a report from the Food and Drug Administration, is the economics of the pharmaceutical market itself.
The reasons for shortages are generally consistent no matter the drug: either a shortage of raw materials or a problem at the plant where the drug is manufactured. Shortages for medicines that a patient can pick up at the pharmacy often draw the most headlines, but most of the medications that end up in short supply are generic, injectable drugs that are used in hospitals: usually, these drugs have only one or two suppliers. So if there is a problem at the factory of one company, there is not an easy way to scale up production to make up for a shortfall. And they are usually cheap, which means the companies that manufacture them do not have a strong economic incentive to produce any excess supply.”
““It makes a lot of sense when you think about it from their perspective. But when you think about it from the hospital perspective, it’s very frustrating.”
Some of these shortages have led directly to patient deaths. An Associated Press report in 2011 linked at least 15 deaths over the prior 15 months to drug shortages. A more recent study, following the year-long shortage of a drug used to treat septic shock, found higher mortality rates for patients who relied on a substitute. Even short of death, drug shortages can meaningfully change the care patients get — if, for example, a pregnant person undergoes a cesarean delivery, with its higher risk of complications and longer recovery time, because the drug that could have induced labor earlier is out of stock.
Experts do have ideas about how to make the pharmaceutical supply chain more resilient. But they require action by the federal government. Until that happens, there is little reason to think the pace and duration of America’s drug shortages will slow down.”
“These companies rely on razor-thin margins and massive scale to make their business work. They have a “just in time” production schedule, which means almost as soon as the product rolls out of the factory, it is delivered to health care providers. There aren’t warehouses with emergency stockpiles, because it wouldn’t really make financial sense for manufacturers to produce and store the excess supply.”
“Danny had chronic, searing pain from an electrocution accident years earlier. For treatment, he and Gretchen, his caretaker, traveled regularly from their home in Georgia to a pain management physician in Beverly Hills, California, to receive pharmaceutical fentanyl. But on November 1, DEA agents suspended the Beverly Hills physician’s narcotics prescribing license, having decided that he was inappropriately prescribing painkillers. A week later, Danny and Gretchen killed themselves.”
“It was the most recent of the many dreadful outcomes that follow when cops practice medicine.”
“The DEA has not formally charged the physician, David Bockoff, who has been practicing medicine with a spotless record in California for 53 years. He was treating many “pain refugees” like Danny: patients with chronic pain, well-managed with opioids, whose previous physicians had either closed after a DEA visit or abruptly cut off their pain medication fearing the wrath of law enforcement.”
“Today, 38 states have laws on the books that limit the dosage and amount of pain relievers doctors can prescribe to their patients. Many of these laws have cast in stone the Centers for Disease Control and Prevention’s now-discredited 2016 Guideline for Prescribing Opioids for Chronic Pain. The guideline came under so much criticism from pharmacologists, clinicians, and academic physicians that the agency revised it this past November. No matter. The flawed 2016 guideline remains the basis of the prescribing laws in most states. Doctors face losing their licenses or, worse, jail time if they violate these laws.”
“All 50 states maintain Prescription Drug Monitoring Programs to surveil all prescriptions issued and filled within the state. These primarily serve as law enforcement tools. In most states, police drug task forces use them to go on warrantless fishing expeditions, hoping to find a doctor to bust for “inappropriate prescribing” or a patient they can arrest for “doctor shopping.” These programs have not reduced the overdose rate. If anything, they have driven non-medical users who cannot obtain diverted prescription pain pills to more dangerous drugs in the black market, causing the overdose rate to increase.”
“opioid-related overdose deaths reached a record high in 2021, exceeding 71,000, 89 percent of which involved illicit fentanyl. Despite a dramatic drop in opioid prescribing, deaths have soared.
According to government data, addiction to prescription pain relievers has been relatively stable at under one percent in this century. Chronic pain patients rarely become addicted to opioids. The overdose crisis is a prohibition-induced crisis. Neither the practice of medicine nor the act of self-medication belongs in the realm of the criminal legal system.”
“President Joe Biden, who recently issued a mass pardon for low-level marijuana offenders, says cannabis consumption should not be treated as a crime. His administration nevertheless defends the federal ban on gun possession by marijuana users, arguing that Second Amendment rights are limited to “law-abiding citizens.”
Last week, a federal judge agreed, dismissing a challenge to that rule by medical marijuana patients in Florida. The reasoning underlying that decision shows that the constitutional right to armed self-defense, which the Supreme Court has repeatedly upheld, is still subject to legislators’ arbitrary whims and irrational prejudices.”
“Winsor noted a long history of banning gun ownership by people convicted of certain crimes. But as Supreme Court Justice Amy Coney Barrett pointed out in a 2019 dissent as a judge on the U.S. Court of Appeals for the 7th Circuit, that history does not suggest that any crime, or even any felony, will do.
“Legislatures have the power to prohibit dangerous people from possessing guns,” Barrett wrote. “But that power extends only to people who are dangerous.”
Are cannabis consumers dangerous? Winsor suggested that they are, accepting the Biden administration’s analogy between the gun ban for marijuana users and laws enacted in the 17th, 18th, and 19th centuries that prohibited people from either carrying or firing guns “while intoxicated.”
That analogy fails, however, because those laws did not impose general bans on gun possession by drinkers. They applied only when gun owners were under the influence.”
“it’s inaccurate to say that undocumented immigrants crossing an open border are chiefly responsible for fentanyl arriving at the country’s doors. In reality, U.S. citizens carrying the drug through legal ports of entry are primarily to blame.”
“Voters on Tuesday approved the legalization of recreational marijuana in Maryland and Missouri while rejecting similar measures in Arkansas, North Dakota, and South Dakota. Meanwhile, voters in five Texas cities passed ballot measures that bar local police from issuing citations or making arrests for low-level marijuana possession. But the most striking election result for drug policy reformers looking beyond the ongoing collapse of marijuana prohibition happened in Colorado, where a broad psychedelic decriminalization measure is winning by two points with 80 percent of votes counted.
Prior to yesterday’s elections, 37 states had approved marijuana for medical purposes, and 19 of them also had legalized recreational use. The Maryland and Missouri results raise the latter number to 21.”
“Colorado voters this week passed the broadest reform of psychedelic drug policy ever approved in the United States. With 88 percent of ballots counted as of Wednesday night, 51 percent of voters had said yes to Proposition 122, which decriminalizes noncommercial activities related to the use of “natural medicine” by adults 21 or older. That term covers five psychedelics found in plants or fungi, some or all of which will eventually be available at state-licensed “healing centers.””
“The initiative defines “natural medicine” to include psilocybin, psilocyn (another psychoactive component of “magic mushrooms”), dimethyltryptamine (DMT, the active ingredient in ayahuasca), ibogaine (a psychedelic derived from the root bark of the iboga tree), and mescaline (the active ingredient in peyote). The covered activities include “growing, cultivating, or processing plants or fungi capable of producing natural medicine for personal use.” The initiative also eliminates civil and criminal penalties for possessing, storing, using, transporting, or obtaining the listed psychedelics or distributing them to adults 21 or older “without remuneration.””
“The initiative notes that “natural medicines have been used safely for millennia by cultures for healing.” It adds that “an extensive and growing body of research” supports “the efficacy of natural medicines combined with psychotherapy as treatment for depression, anxiety, substance use disorders, end-of-life distress, and other conditions.” But like Oregon’s initiative, Proposition 122 does not require that clients of psychedelic centers have any particular medical or psychiatric diagnosis.”
“When California legalized recreational marijuana in 2016, the state had more than 3,000 weed shops. They ostensibly served the medical market, but the rules were so loose that pretty much anyone who wanted pot could buy it legally. Six years later, California had less than half as many licensed marijuana merchants, accounting for between a quarter and a third of total sales.
Something clearly has gone wrong “when you try to legalize weed and accidentally end up illegalizing it instead,” note University of California, Davis, economists Robin Goldstein and Daniel Sumner. In their book Can Legal Weed Win?, they explain how burdensome licensing requirements, regulations, and taxes have frustrated plans to displace the black market.”