Overcriminalization of Addiction

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Recently got an ASAM email that had blurp about efforts towards avoiding overcriminalization of addiction.

I used be in this camp. A sort of can't beat it, can't stop it, prohibition failed in the US decades ago. Perhaps focus on recovery, recovery, recovery is a better approach. It jives with the fundamentals of America as a Freedom first, libertarian in spirit country.

Observing things in Oregon, a state that has gone the distance in reducing the criminalization of substance use and possession, I believe it has failed.

In summary, as less ideal as it may be, booking, charging, convicting as we had in the past is more apt to get people into recovery. Oregon has failed. I've changed my views, the legal system is still very much needed in this fight.

Thoughts?

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Recently got an ASAM email that had blurp about efforts towards avoiding overcriminalization of addiction.

I used be in this camp. A sort of can't beat it, can't stop it, prohibition failed in the US decades ago. Perhaps focus on recovery, recovery, recovery is a better approach. It jives with the fundamentals of America as a Freedom first, libertarian in spirit country.

Observing things in Oregon, a state that has gone the distance in reducing the criminalization of substance use and possession, I believe it has failed.

In summary, as less ideal as it may be, booking, charging, convicting as we had in the past is more apt to get people into recovery. Oregon has failed. I've changed my views, the legal system is still very much needed in this fight.

Thoughts?
It's a two way street, on one direction legal efforts should be focused on distributors/manufacturers and not the end user and in the other direction treatment should be more open and available for those in need.

"Can't see the forest for the trees"

I usually don't opine on your posts because you are very political, but I thought I would engage with you and see what happens.
 
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It's a two way street, on one direction legal efforts should be focused on distributors/manufacturers and not the end user and in the other direction treatment should be more open and available for those in need.

"Can't see the forest for the trees"

I usually don't opine on your posts because you are very political, but I thought I would engage with you and see what happens.
I agree. I feel like, with everything else in life, there needs to be a balance. Too far one way or the other only creates more problems. Should we be imprisoning people for less than an ounce of cannabis? No. But distribution of substances like fentanyl or methamphetamine causes major societal issues and costs if allowed unchecked. Moderation seems unpopular these days, sadly. Maybe I pay attention to TV and social media too much, though.
 
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The drug is a measurable proxy for other criminal acts. That is why cannabis is used in unrelated probation cases.
 
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Hate saying this but this is going on in my area. Are the addicts African-Americans? Throw the book at them. Are they rich Caucasian people? We need to help those poor people!

What's going on is only wealthy people can get good services. Most social services are under-funded. Then add to that the local communities and law enforcement have a bad relationship. Poor areas of this city are more like warzones.
 
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It's a two way street, on one direction legal efforts should be focused on distributors/manufacturers and not the end user and in the other direction treatment should be more open and available for those in need.

"Can't see the forest for the trees"

I usually don't opine on your posts because you are very political, but I thought I would engage with you and see what happens.
I'm just looking for discourse on this post. Truly. We are seeing these reductions of the legal system in context of substance use. Is it working? Is it making a difference? Should we press forward more? Or have we just seen enough early data in this drug trial to pull the study?

But to your other comment... I am not very political, I just stand out because I am in the minority, and my views are likely different than yours. Partly because academia, schools, and now medicine have silenced and belittled conservative minded people for too long. This oppressive culture permeates SDN, too. Saw a great meme recently using the characters from LOR, 'can't avoid upsetting the left/woke because they are already upset with everything' was the gist. Historically conservates would opt for social decorum, and quietly smile nod, to not engage in political discourse because it wouldn't go anywhere. This trend is changing. It's a tragedy when you have to mentor pre-med and med and residents 'keep your mouth shut, go through the motions and pretend you are a woke sheep like the rest.' Then there was the med student who harmed a patient for their political beliefs. I'm confident if a conservative student did the equivalent for a liberal patient they would have been dismissed the following day.

I just tried, couldn't find it again, but there was some doctor on the East Coast who had a blog (or article?), that openly declared and lambasted that conservatives/republicans can't and shouldn't be doctors. That is atrocious. To even advocate that an entire political group, half of the country shouldn't fulfill a job role. Imagine the flipped script? Just messed up. I'm more willing to speak up and show, here on SDN to any med students and residents, that there are indeed conservative leaning Psychiatrists. Saw a recent poll in past few weeks - reflecting 25% of Psychiatrists lean right. One of the lowest of all the specialties. So we'll use a buzzword... I purport advocacy for a political minority here on SDN at times.

Even the fact that you would draw attention to the nature of my posts and as a reason to avoid commentary because of that, rather than commenting on the merits of the post it self, adds further evidence to my claims/observations if only in this microsphere of SDN. *waving hands, look at me, I am triggered, I am a victim of discrimination, that isn't Inclusive. sniffle*

I conjured up a multiyear thread on the ups/downs of the start of my private practice to also be a helping tool for residents/attendings to consider starting there own. Because the left dominated academia sphere turns up its nose at the idea of talking business and private practice for residents. Rather than recognizing that it is a large element of the real practice of medicine post residency, and perhaps, having a 1 month rotation in medical business for all residents, it's continually neglected and hushed when trainees speak up. I was fortunate my program had more opened minded people. I've already been getting DMs from students, residents, attendings, and even non-psych attendings looking for extra information about private practice start ups. So we'll call that political thread outreach.

So for those pre-meds, students, residents who happen be some where libertarian to meeting attending republican, you aren't alone, they do exist even in Psychiatry. Bless your hearts as you suffer the endless political rants along the way during your studies, and muzzle your voice, and increasingly force you into displays of virtue signaling. Good luck keeping your head down. Your struggle is real, and far worse than what I endured running the gauntlet of training, have hope.

*This multi-paragraph rant shouldn't even be needed, nor should there even be a pinch of truth to what I typed. [shaking head]
 
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Hate saying this but this is going on in my area. Are the addicts African-Americans? Throw the book at them. Are they rich Caucasian people? We need to help those poor people!

What's going on is only wealthy people can get good services. Most social services are under-funded. Then add to that the local communities and law enforcement have a bad relationship. Poor areas of this city are more like warzones.
I've seen the same in caucasian-ville. It's definitely a SES component and not just restricted to AA populations on racial lines.
 
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Just for the record I'm political moderate and hate it when minorities falsely claim discrimination. Now all that said that doesn't mean if I see it with my own eyes I'm going to ignore it. Bad things happen in all ways possible depending on the situation. Are there minorities who claim victim when it wasn't the case? Of course. Are there minorities discriminated against? Of course. Oddly I am of a minority that can't get any societal benefits off of it, Asian-American, and no college was going to take me in, give me a scholarship, etc, but does my demographic get discriminated against? Yes.

The best way to handle these is to not jump the gun and get on the victim's or accuser's bandwagon immediately without looking at the evidence of the specific case in question. Anyone trying to paint an "us vs them" where all are guilty or innocent are likely playing the politics and hate card.

A parallel situation. Some supporters of police will claim they are innocent during a brutality accusation without looking at the evidence. Others will immediately cast the police as evil villains again without looking at the evidence of the specific case.
 
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The drug is a measurable proxy for other criminal acts. That is why cannabis is used in unrelated probation cases.
I'll take it at face value that this is true. If you weren't forcing people to enter a black market, crime world to obtain and use marijuana, would it not be likely they would not be engaging in other criminal acts at a higher level? If you make the culture a criminal culture, then it seems like what you're saying would result. But are the actual physiological effects of marijuana (which I would argue largely do not seem to be positive in terms of risk of development of schizophrenia, psychosis, panic, pulmonary health) the proximate reasons for other criminal acts? I don't know, but it doesn't seem terribly plausible on face value, especially compared to alcohol. It seems more plausible that a person drawn toward marijuana could be more drawn to other acts, but again I think because of the culture that criminalization created for the drug. Much like the mob took to alcohol production in prohibition (IIRC they wanted prohibition). If there were a culture of enjoying marijuana like a fine glass of wine, would you see the same thing? There must be other, better proxies.

I do think they should regulate marijuana, though. I always heard of it as a peace and love drug, and from what I've read, they've bred the plants so that the THC compared to the other chemicals in the plant over time is much higher—much like each subsequent benzo and opioid got more and more potent. It sounds like it's not entirely the same drug it once was. Is there not a way to both decriminalize but also regulate it? I'm very unfamiliar with alcohol as I've never taken it, but I think there are restrictions where you can buy up to a certain percentage in grocery stores and to buy the hard stuff you have to go a government licensed liquor store. I think legalization should be coupled with some efforts like that. That may be a very naive take, as I've never taken either alcohol or marijuana, so my impression of marijuana and THC may be off. I'm just going by things I've read anecdotally of people getting sicker from it in recent years (vomiting) and more psychosis.
 
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Just for the record I'm political moderate and hate it when minorities falsely claim discrimination. Now all that said that doesn't mean if I see it with my own eyes I'm going to ignore it. Bad things happen in all ways possible depending on the situation. Are there minorities who claim victim when it wasn't the case? Of course. Are there minorities discriminated against? Of course. Oddly I am of a minority that can't get any societal benefits off of it, Asian-American, and no college was going to take me in, give me a scholarship, etc, but does my demographic get discriminated against? Yes.

The best way to handle these is to not jump the gun and get on the victim's or accuser's bandwagon immediately without looking at the evidence of the specific case in question. Anyone trying to paint an "us vs them" where all are guilty or innocent are likely playing the politics and hate card.

A parallel situation. Some supporters of police will claim they are innocent during a brutality accusation without looking at the evidence. Others will immediately cast the police as evil villains again without looking at the evidence of the specific case.
Kudos on aspiring for moderation/objectivity.

Your local area is rife with SES and possibly even racial divisions. But do you have an opinion on say a state like Oregon? Do they need to go further? Went to far?
 
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I'm in Missouri. Mentioned this in another thread-up until about 1-2 years ago there was a forced-labor jail. One could argue it wasn't forced, "if the inmate chooses not to work that's there choice" but the inmate is put in a heat box if they don't comply. Now if that's voluntarily working I don't know what "voluntary" is.

I don't have an opinion on Oregon not having worked there or seen the numbers. Even seeing the numbers I don't know if I could trust them. Just like several other people have no idea what's going on in Missouri and the numbers presented don't really tell the story of what's going on.

The above example is only one example. I can bring up several other issues I found in blatant violation of minimum basic guidelines but no one in authority in the state seemed to care enough to make a change. Like some of the older forensic psychiatrists who were able to make change I tried but my own academic institution pretty much told me to shut up, one person above me even saying "why do you care about these people? They're inmates," while the great forensic psychiatrists mentioned above who made positive change were backed and supported by their academic institution.

My attempt wasn't a perfunctory 1 hour or 100 hours. More like a few hundred hours. Also colleagues of mine from the same university, in a different department, who were also trying to make positive change were fired for doing so, and their termination was pushed by a local politician later found to be intensely corrupt and went to federal prison, and in the case of my colleagues the university too wouldn't support them in their efforts.

That was yet another sign I needed to get out of academia at least in my area. Had I been in an academic institution willing to back me up I might've found it worth the time and effort to continue to make positive change.
 
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Recently got an ASAM email that had blurp about efforts towards avoiding overcriminalization of addiction.

I used be in this camp. A sort of can't beat it, can't stop it, prohibition failed in the US decades ago. Perhaps focus on recovery, recovery, recovery is a better approach. It jives with the fundamentals of America as a Freedom first, libertarian in spirit country.

Observing things in Oregon, a state that has gone the distance in reducing the criminalization of substance use and possession, I believe it has failed.

In summary, as less ideal as it may be, booking, charging, convicting as we had in the past is more apt to get people into recovery. Oregon has failed. I've changed my views, the legal system is still very much needed in this fight.

Thoughts?
I don't know the details of Oregon but I'm imagining they went with the whole "just don't charge anyone for anything / fully deregulate things" option. A lot of other countries that have decriminalized drug use have a flip side of basically mandated substance use treatment if you're caught using. So it's basically criminalization but where the punishment is more productive (treatment) rather than incarceration.
IMHO THC should be a schedule IV medication and regulated. Allowed for treatment but under REM guidelines.
I'm curious, are you referring to its use for spasticity-pain or treatment of severe Chemo/AIDS appetite suppression or for some broader set of less proven purposes?
 
I find it interesting you read that tweet as a student intentionally harming a patient and not a student pointing out perceived karma from having to stick a vein twice because they missed the first time.
 
I find it interesting you read that tweet as a student intentionally harming a patient and not a student pointing out perceived karma from having to stick a vein twice because they missed the first time.
Not to stir things up or derail the thread, but I don't really see a reason to write it the way she did unless she was implying intentionally missing the vein. The way the tweet was written came across as "this patient was an a**, so I made them get stuck twice." She probably didn't even perceive a missed needle stick as actual harm, but the general sentiment of publicly shaming the "other" and that it was initially perceived by the student as acceptable (as evidenced by publicly posting about it) is the problem. It was just a dumb tweet in general though. If she wanted to point out bigotry and be an advocate as the article suggested, then why even talk about the needle sticks? It continues to boggle my mind that even those in/near my generation who are considered very bright can be so stupidly oblivious.

Recently got an ASAM email that had blurp about efforts towards avoiding overcriminalization of addiction.

I used be in this camp. A sort of can't beat it, can't stop it, prohibition failed in the US decades ago. Perhaps focus on recovery, recovery, recovery is a better approach. It jives with the fundamentals of America as a Freedom first, libertarian in spirit country.

Observing things in Oregon, a state that has gone the distance in reducing the criminalization of substance use and possession, I believe it has failed.

In summary, as less ideal as it may be, booking, charging, convicting as we had in the past is more apt to get people into recovery. Oregon has failed. I've changed my views, the legal system is still very much needed in this fight.

Thoughts?
I think there's too much diagnostic overlap between substance use and certain personality traits to use such broad approaches successfully. I do think that historically the US has over criminalized substance use, but swinging to the other extreme results in a lot of people not being charged or being excused who have traits/diagnoses which are at the core of the criminal acts. Unless we want to be more specific in regards to teasing out co-morbidities and which aspect was the cause of the criminal behavior (did they do it d/t being intoxicated or would they have done it anyway d/t being antisocial?), we'll continue seeing arguments that only look at a forest and not the trees. Idk what the best answer would be, but the extent of overlap in these co-morbidities makes it a difficult problem to address.


The drug is a measurable proxy for other criminal acts. That is why cannabis is used in unrelated probation cases.
I'd be interested to see that data, especially if it looked into or tried to account for other co-morbidities and substances as confounding factors.
 
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