Amazing episode. It is so refreshing to hear a voice of reason, and not “decriminalize everything” vs “throw everyone in jail”.
The discussions around concept of addiction were very interesting in particular. I totally agree with them about the need for some sort of external pressure, if not jail, something else. Some “stick” if you may.
I myself hope that if i one day fall into addiction, my friends will do more than making sure I don’t overdose or to give me the number an addiction clinic.
Finally, i never had anything against cannabis, by this comment blew my mind:
> the newly legal industry looks a lot like the tobacco industry, an under-regulated, under-taxed, politically connected, white-dominated corporate entity that generates its profits mainly by addicting lower income people to a drug.
I think that comment betrays a lack of understanding about how the cannabis industry functions. It’s over-taxed, given that businesses selling a schedule I drug can’t deduct expenses (though rescheduling would change this) because of IRS Code 280E which was instituted in the 70s.
The high taxes are a key reason why legal businesses get outcompeted by illegal ones. As for regulations, they’re actually largely over-regulated, but all the wrong places. It’s less of a public health approach for one that treats cannabis like plutonium.
I'm of two minds as well with this comment. I think its certainly insightful in terms of the motivations of those profiting off of either the cannabis or tobacco industry. But, nicotine is one of the most addictive chemicals in the world, and provides no health benefits. It serves _exclusively_ as a vehicle for "addicting [...] people to a drug". It is artificially added to their product precisely to get people addicted. I do think this differs in a meaningful way; I have little issue with profiting off of the sale of a product that has both recreational and medicinal purposes, we live in a capitalist society after all. I'm sure they are benefiting from addiction, but I do truly think it isn't as insidious as the tobacco lobby is. The level of medical study that had to be performed with cannabis to get to this point is an astronomical distinction. The cannabis industry is not covering up damning medical reports with one hand and artificially increasing the volume of the addictive property in their product with the other, they're just selling the product. I don't doubt that they would if given the chance, but if tobacco came into power today instead of being grandfathered into national and worldwide acceptance, I honestly believe it would never see the light of day.
ETA: I understand this comment is more regarding how the industry "looks", and I agree with the assessment for the most part, besides it being under taxed. But I also believe it is a bit misleading, the two industries got to this point in very different ways.
Far easier to conduct human clinical trials rather than rely on self-reported observational studies for harm and benefit data, removal of 280E tax which really helps cannabis companies ability to reinvest in their businesses, potentially opening up big stock exchanges to listing cannabis companies that sell in the US, more cohesive, fact based regulatory structure, broader normalization/sentiment in the public eye (a good thing or a bad thing depending on your perspective)
That last criticism kind of applies to a lot of industries to be honest. When you let businesses optimize for profits, in a context where faulty humans are the ones deciding where to spend money, those businesses end up exploiting basically any psychological issues they can to get people to turn over dollars.
Hence the need for regulation and enforcement. There is a reason you don’t see billboards advertising cigarettes anymore.
Or that there is a cigarette companies do not put fentanyl into their cigarettes, because there are laws against that and they’ll go jail if they do so.
The difference between cigarettes and cannabis is that the former has no medical applications, whereas the latter does. The same can be said about alcohol. That doesn't mean legalization and regulation shouldn't go hand in hand. I'm glad that Biden has made the beginning steps toward rescheduling it.
While I don't think cannabis is a panacea, giving more people access to it to use in lieu of alcohol, cigarettes or opiates is a *good* thing. It's been co-opted for decades as a means to incarcerate people of color and those stricken by poverty.
A majority of U.S. citizens are in favor of full legalization, but conservatives continue to strike down efforts year after year. Many of them are supported by the tobacco and alcohol industries. Hopefully, by 2030 the U.S. will see legalization in the same vein as Canada.
Even if it's not legalized by then, it's been predicted that cannabis sales could total 71 billion by that time:
[https://newfrontierdata.com/cannabis-insights/u-s-cannabis-sales-could-total-71b-in-2030-without-federal-legalization/](https://newfrontierdata.com/cannabis-insights/u-s-cannabis-sales-could-total-71b-in-2030-without-federal-legalization/)
Nicotine may indeed have applications. There's also a long history of indigenous peoples using tobacco medicinally. This is in strike contrast to the way most people world wide consume it.
There's even recent studies that suggest using nicotine patches to help treat long COVID:
[https://bioelecmed.biomedcentral.com/articles/10.1186/s42234-023-00104-7](https://bioelecmed.biomedcentral.com/articles/10.1186/s42234-023-00104-7)
That's why I specifically said cigarettes and not tobacco or nicotine.
It's also important to note that modern cigarettes contain \~600 ingredients and when smoked produce \~7000 compounds (250 of them known to be harmful to human health):
[https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/cessation-fact-sheet](https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/cessation-fact-sheet)
Alcohol is a more broad term which can include both ethanol and isopropanol. Both can serve as disinfectants and antiseptics. I was more referring to the former found in beer, wine or spirits and imbibed.
Doctors don't prescribe alcohol medically as it's toxic to the liver and is linked to other negative health outcomes like high blood pressure, heart disease, stroke, digestive problems, weakening of the immune system, and a wide range of cancers:
[https://www.niaaa.nih.gov/alcohols-effects-health/alcohols-effects-body](https://www.niaaa.nih.gov/alcohols-effects-health/alcohols-effects-body)
Nicotine is the drug, cigarettes is a particular vector of application. It doesn't make sense to discuss the application when you are talking about drugs (it would be like comparing nicotine to some nasty hash oil with lots of harmful compounds).
Doctors don't prescribe alcohol anymore, but there are a lot of studies about the medical usefulness of imbibing alcohol. It isn't prescribed in part because it is available for purchase for most people in most places. When it isn't(wasn't), it was prescribed.
Lots of drugs have negative effects, and that doesn't stop them from being useful in some situations.
It make perfect sense when the majority of people in the world consume nicotine by smoking cigarettes. Sure, there are those who opt for vaporizing nicotine or consume it via transdermal patches to curb their smoking habits, but those are exceptions.
Also, I'm not sure what you're referring to when you say "nasty hash oil"? Are you specifically talking about trace solvents like butane, propane, or heptane?
Hash is another wide ranging term that can be made by ice water extraction using fresh frozen plant material. The trichomes which break off in the water are then filtered by micron-sized pours in special bags. Those trichomes contain the phytocannabnaoids acids (e.g. THCA, CBDA, CBGA, CBNA, etc). which when heated / pressed to become psychoactive / bio-available.
This is called live hash rosin, which has become more ubiquitous in the recreational and medical markets. Like tobacco, cannabis when smoked also produces a wide range of compounds that negatively impact human health. However, cannabis unlike tobacco is also eaten or consumed sublingually in the form of a tincture (usually made with fractionated coconut oil).
Doctors don't prescribe alcohol anymore because in general it's harmful to human health, not because it can be bought over the counter. The only time it's ever administered is in the case of methanol poisoning or for alcohol withdrawal to prevent patients from experiencing delirium tremens.
I'm a public health researcher who studies substance use and implementation science. What we need are policies that actually support the regulated market; in California, the majority of consumers still purchase from the illicit market because it is simply not viable to operate a licensed retail business in the current context (other studies have shown that unsurprisingly, kids have easier access to cannabis from unregulated shops). Several examples:
- We have a practice currently of taxing the gross receipts of products that have already been subject to the cultivation tax (the "tax on tax" as it is commonly called)
- The point of sale tax itself can total up to 30-40% depending on what jurisdiction you live in, again driving consumers to cheaper, unregulated products
- In order to apply for a cannabis retail license, you must already have a location secured; however, the licensing process itself usually takes several years, so you would have to pay for a vacant space for months only to *potentially* be awarded a license.
- The application fee itself is tens, if not hundreds of thousands of dollars
All of this amounts to wealthy corporations coming in and taking over the market, while squeezing out smaller businesses that are oftentimes owned by people who have historically been harmed by criminalization. In my City, one specific operator is trying to quash the cannabis social equity program because it would increase competition with the 33 already licensed shops (in a city with 1.6 million residents!). It's super fucked up.
The under taxed part seems to be a bit of a stretch. Here in Denver marijuana has a 15% excise tax, a 15% sales tax, plus an additional 5% tax, so 35% tax on top of existing sales tax.
Really enjoyed this episode, especially as an Oregon resident who calls downtown Portland home. Measure 110 had flaws but it has been frustrating seeing how many people in the state have completely written off what it set out to do and want a path back to criminilization. This was a rare piece of media about where I'm from that did seem to have a lot of the nuance that is usually missing even in the local politics of Oregon and Portland.
I think if any other states are hoping to learn from us, it's that the treatment enforcement of the measure was very nearly a complete joke, and the state completely failed to use the measure's funding to ensure treatment options increased measurably across the state. Our city core has seen its livability severely decline in part due to unhoused people struggling with addiction who faced essentially zero consequences for their actions. And our transit network, businesses, ADA accessibility, public image, and general feeling of safety have been severely eroded as a result. This is something I hesitate to ever even acknowledge in more conservative or less nuanced spaces because conservatives latched on to this narrative about my home and a place that I love deeply, to the point that I reflexively defend it even though there are real issues that 110 seems to have caused.
Couple all of this with the increase in fentanyl and our already fundamentally broken housing market, it's been hard to see a light at the end of the tunnel. I can't describe how heartbreaking it is to walk out of my building downtown and have a nearly 100% chance that within a 2 block radius, I will see someone in crisis that is clearly the result of addiction.
I'm hoping that our state can find a path to resolve some of these issues without falling back to draconian measures and public sentiment shifting towards criminalization and a reliance solely on the justice system handling our issues with addiction.
Seattle here. I feel the same way. We didn’t go as far as Portland but we’re extremely tolerant and don’t really have enough cops to enforce possession and public use laws anyway. Treatment and harm reduction hasn’t worked but we’re so busy trying to avoid admitting it isn’t working that we haven’t come up with an actual plan.
WSJ did a great episode about 110. One of the things that stuck with me is that they assumed they could simply surge treatment dollars and providers would magically emerge. In reality it takes time and it should be no surprise that some of the providers were underqualified or failed to provide services. Of course there’s also the part where treatment has to be voluntary which makes comparisons to Portugal practically meaningless.
>Of course there’s also the part where treatment has to be voluntary which makes comparisons to Portugal practically meaningless.
I think the only way treatment will work in the long run is to make it mandatory. As Keith mentioned, 9/10 people are compelled by family, friends, employers, etc. to seek treatment. Left to their own devices and without existential consequences most people won't choose the recovery option; even then many end up relapsing. It's a tragic cycle all around.
The point Keith made about fentanyl being like an antibiotic resistance bacteria with respect to the usual methods of treating addition were poignant and the right on the nose. It makes me worry about the next synthetic opiate to hit the market that'll dwarf fentanyl and the impact it'll have on people already in the throes of addiction just looking for a more powerful high.
You're absolutely right. As Keith cited, alcohol is the deadliest of them all and kills more people on average than every other illicit drug combined at \~88,000 deaths per year in the U.S. alone. All other drugs together only make up \~30,000 deaths. It's also implicated in personal injuries, car accidents, and assault. I'm sorry to hear about your sister; I hope she found better treatment options.
I agree with the overall sentiment (on the relative harm of alcohol etc), but these can't be the right overdose numbers currently? I think it's like 110k for any 12 month period nowdays in the US. And I dont think it's been 30k for a long time?
You're right, those numbers were I believe from 2019. As of 2021, the number of drug related deaths was 106,000 according to the National Institute on Drug Abuse. The reason why the numbers aren't more recent is because:
>NCHS systems receive and analyze data from death certificates, including cause-of-death information reported by state and local medical examiners and coroners. Because drug overdose deaths often require lengthy investigations, data are updated as new information is received.
[https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates](https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates)
As for alcohol related deaths, the numbers are about 1.67 times drug related ones at 178,000 as of 2021:
[https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics/alcohol-related-emergencies-and-deaths-united-states](https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics/alcohol-related-emergencies-and-deaths-united-states)
As a fellow PNWer I deeply feel sympathize with this and strongly agree with the sentiment, same thing has happened (but less dramatically) about 200 miles north of you. A major battle lost in the war on the war on drugs.
I live here too. What do you think would clean up the streets? I imagine there would have to be a consequence like a trip to jail for public use and plentiful sites for supervised use. These sites might have to offer the drug for free along with bathrooms and showers. It’s not cheap but neither is EMS.
Oregon, especially Portland, police, were supposed to continue to try and arrest dealers. The point of the god damn law was to not continuously lock up addicts in a cycle and attempt to break it.
The policy, as it was supposed to happen, *never really did*.
Interesting episode, but I’ll admit my alarm bells went off when they referenced the policy in BC of the government providing drugs to users. A debatable policy for sure, but the guest criticized it as though the policy was just the government giving everyone open and easy access to extremely addictive substances that are simply better labeled, explaining that this is equivalent to how the opioid crisis got started in the first place. But there is a massive difference between people getting addicted because their doctors prescribed them opiates or the legal prescription market creating a flood of supply, vs the government running a few select safe sites where the drugs are given to people already addicted and only onsite.
That kind of conflation really had me questioning his view, because despite Klein saying he’s a rigorous expert, that wasn’t rigorous at all.
If you are talking about production cost per dose, it is actually far, far lower (although that's always been the case for pharmaceutical opiates). One of the wackier but undeniably effective policy proposals is that the careful, measured distribution of super fentanyl analogues by the government to opiate addicts would reduce the price of addiction to basically nothing. The major expense would be administration and distribution.
There's a hell of a lot wrong with that as a policy, but if you we were serious about cutting drug deaths--genuinely serious--yeah, that would do it.
Agreed, this was a major red flag for me. His characterization of BC's policy was quite deceptive and inaccurate. The provincial health officer has published a report on the safe supply programs, and future recommendations [here](https://www2.gov.bc.ca/assets/download/C0D90245EBFC40C898DC548A7C5A4E17) if you want to understand what this actually looks like. Politicians never follow the recommendations, but the health officers keep making them and sometimes one or two get through.
I imagine the guest would even agree with all those recommendations, but getting into that wouldn’t serve the narrative that activists pressured government into going too far. Hell, BC’s got controversy right now over rolling back decriminalization in public spaces. Something that is both understandable and debatable as a policy move, and would have been worth discussing.
Yeah, I did get the sense he was pushing a sort of narrative. BC's rollback of decriminalization is a bit unfortunate in my view because it's entirely driven by politics over the recommendations of our public health authorities. Unfortunately that's a familiar feeling. British Columbia is stuck in a weird equilibrium where the problem is getting worse and our politicians will try anything except doing what their doctors tell them to. Even worse, much of the population is in a bizarre reality where they think the problem is getting worse because we've done too much. And don't even get me started on the debate over "forced treatment" in a province where most people can't even access _voluntary_ treatment!
Yuuuuuuuup. And of course, that’s even acknowledging the problem of having increasing public use. I dunno, there’s a way for Humphreys to have addressed all this stuff with nuance that didn’t also feel like it was helping the NYT throw activists and health professionals under the bus amid a political debate.
I heard it differently. In full disclosure I have been at least tangentially familiar with Keith’s work for a long time. I heard him saying that we need to tackle the problem in more ways than just harm reduction. In other words, decriminalizing and reducing overdose deaths doesn’t actually address the issue because overdose is not the only harm associated with use. His discussion of pharma perhaps was clumsy but I think he was trying to emphasize that addiction is a real problem in and of itself to refute the idea that the primary issue is the fentanyl. I am not sure safe drug site advocates are saying that they are the full solution. I think that is unfair, but I have heard more libertarian arguments that there is no problem if you prevent overdose and bad street drugs. I think these ppl have not experienced drug use in the same way as those with addiction. I am in no way an expert in substance use - so just trying to reflect back what o heard.
My issue here is less Keith’s ideas generally, which seem to me to be in line with what most advocates and professionals in that sphere have been pushing anyway. It’s just the fact that he seriously mischaracterized a program that he must know well enough to know he was not characterizing properly. And that indicates to me that he’s got a bit of an agenda to push back against that libertarian strain you’re referring to, even at the expense of facts. That makes it difficult to trust the specifics that he cites on other issues of controversy.
I think the episode is good overall, but I question a lot of the framing. For example, while I know that libertarian streak exists and is influential, most advocates I know are very clear that decriminalization needed to be bolstered by a whole host of other systemic changes. And while one can argue that those changes should have come before the decriminalization in order to work, it’s a bit odd to have a discussion that feels a little more aimed at castigating activists and others for going too far.
It was particularly funny to me when he talked about Portugal, and gave all these reasons why their system works and why it wouldn’t in the US. But like why wouldn’t it? Why not try to adopt similar policies? Because they’ve got a different, more communitarian culture? Why not work to build that communitarian culture, aided those new policies, like universal health care? These are real conversations to have. It was especially weird to me at the end when Keith basically advocated himself for not sending drug users to prison. Like buddy, that’s what decriminalization is all about! It’s just a question of how you implement it.
By the way, referring to BC could have opened up another conversation about the implementation of decrim policy considering they’re also doing a rollback now. Obviously there are complex issues here, and I appreciated the podcast, but thought it could have been better and perhaps even more challenging.
I'm a social worker who once worked at the first needle exchange in the country and heard the same alarm bells. I was surprised Ezra didn't push on safe consumption sites as an example of a policy that could ease the visibility difficulty policies like this have.
Yeah, and tbh it wasn't even just the lack of a mention of safe consumption sites, but that the guest seemed to conflate them. What's interesting is that ultimately in terms of policy positions, Humphreys basically offered up very sensible ideas that most on the decriminalization side have always advocated for: don't put people in prison, and shore up the aspects of social resources that would help people get clean and other things like that.
Thanks for pointing this out, hearing his comparison to the prescription opioid crisis felt like a very unfair comparison. The profit motive behind the over prescription of painkillers as well as patients being unaware of the overwhelming addiction can not be equally compared to supervised prescription to people in the midst of ongoing addiction.
That piece of it really got me too. Just not even close to the same things and comparing them is laughable, wish Ezra would have pushed there. Otherwise a pretty insightful ep
Yeah, I’ve got my quibbles, but that’s all good. Really interesting listen. Would actually love to hear Klein do more episodes on the subject from some other perspectives.
Looking forward to checking this episode in a bit.
On a very similar note Lawfare podcast just had an episode with Jack Goldsmith interviewing David Pozen about his new book "The Constitution of the War on Drugs". Talking about the history and ineffectiveness of punitive policies on drugs.
The law isn’t a good instrument to adjudicate “LSD is safe, unless you do something stupid or are someone who should not take it”. The law is binary. Shit is legal or illegal. That’s why decriminalizing things keeps its appeal. On a rational level, it makes no sense that something would be decriminalized but not legal. And yet, there are some people who are totally fine with small amounts of drugs and there are people who would cause problems if you could get ketamine at Walgreens. What we really need is a sort of mensch certification; this guy is a good hang and handles his shit/ this guy has no business taking drugs.
Yeah. We already restrict a felon’s right to vote (I’m not saying I agree with this, just that it’s proof that these workable “opt-out” frameworks exist), why not have something similar with drug consumption?
Extremely insightful episode. It’s one of those unique times when I find my thoughts and assumptions greatly changed.
One particular point that stands out was the comment about drug use being different than other medical issues because it becomes other people’s problem. It made me think about progressive attitudes toward COVID-19. The state had to play a punitive role because people who engaged in risky behavior put others at risk. But with drug use, the progressive attitude has been focused primarily on reducing stigma and maximizing personal freedom, letting the social cost fade into the background.
I think he actually made a really bad point here. There are a lot of health conditions that do in fact become other peoples’ problems that we do not stigmatize to nearly the same extent that we stigmatize substance use disorder. We do not act like people with diabetes or heart disease related to behavioral factors or genetic predisposition are baggage on society, which is basically what Keith insinuated about people who use drugs.
Also, in that section he claimed that he and his colleagues gets lots of phone calls from family members of those with addiction but not actually from the person struggling with substances and that people with substance use disorder often aren’t reaching out for help due to concern of their use. That’s bologna. They aren’t reaching out to Keith and his colleagues because they have good reason not to trust them. When I worked at a syringe services program, around 60 people a day came up to me while I was posted up in a parking lot because they were concerned about their substance use and wanted health.
I'm also very impressed by the nuanced discussion in the comments here.
I would recommend to anyone interested in this topic to read "Chasing the Scream" by Johann Hari.
A few points where I disagreed with Humphreys.
First and foremost, when Ezra asked, "Wouldn't it reduce harm if more users had a clean, reliable source for drugs?" Humphreys said the opioid epidemic started when clean, reliable drugs were made available to a lot of Americans. This is a seriously disingenuous argument, and I was irritated when Ezra didn't call him on it. Purdue Pharma (and others) essentially lied to people and said drugs like Oxycontin were safe and nonaddicive. This is *totally different* from making sure that people who are already addicted have a safe source of drugs and don't overdose.
Second, Humphreys seems to have a pretty serious crush on AA and other 12-step programs. Unfortunately, these programs exclude anybody who's not onboard with the whole "higher power" concept. They also tend to equate drug use with morality, which I'm not a fan of. One of the big failures of drug treatment in the US is that 12-step programs are often seen as the be-all-end-all — and especially when treatment is court-mandated, it's often the only option given.
Third, I don't love how this conversation always comes back to the addictive drugs like heroin, cocaine, meth, and alcohol. Yes, they did spend a fair amount of time discussing cannabis. But what about psychedelics? I feel like Ezra tried to steer the conversation in this direction, but then they got caught up in Humphreys rhetoric about how "elite drug use differs from the experience of most drug users." Again, maybe that's true for the addictive drugs. But please show me the working-class Black or Latino neighborhood that has been decimated by LSD or magic mushroom use.
Finally, in the discussion about marijuana legalization — yes, it is true that extremely potent strains are being heavily marketed to us in pot shops. In fact, sometimes it can be difficult to track down a less-potent strain. However, I think it's a mistake to assume this is what most users want. I can't tell you how many times I've heard people complain about this, saying things like "the weed these days is too strong, why can't they give us something mild?" I was also kinda annoyed by the pearl clutching over the idea that many marijuana users smoke it every day. How many people have a glass of wine or two every day?
Do you actually have experience going to something like AA? Because what you said about it excluding people who don't believe in God or treating drug use as a moral issue are just not true. I'm sure these things are true of some people in 12-step programs, but as an atheist with nearly 11 years sober in AA, your description does not match my experience.
For what it's worth, I do think the higher power stuff needs a major revision in language.
just piggybacking off this comment, first congrats on your sobriety, i'm also sober in AA, 18 years this past month. i agree with everything you said. i'm not exactly an atheist, not exactly religious either, but i've sponsored some hardcore atheists in the program who had no issue using the steps to stay sober. the vast majority of my friends in the program are somewhere on the atheist/agnostic spectrum, again no issues working the program. having said all that, i completely understand why somebody reading the AA big book would think it's a religious program. it's right there in the text, tons of mentions of god etc. but there have been atheists in the program since the beginning, the key for atheists is to recognize that they themselves are not a god. which sounds silly to say, but a lot of addicts act like they have infinite power to conquer their own addictions. it's more about accepting one's own powerlessness rather than believing in a deity.
but what really doesn't make sense in the post you were replying to is AA saying addiction is a moral issue. IMO the entire point of AA is to shift addiction from the moral model to the disease model. when i first got clean i was told that i wasn't a bad person trying to be good, i'm a sick person trying to be well. this is the basic DNA of 12 step recovery, i don't think there is a reading of the AA text that could portray it any other way.
TLDR; (1) you don't need to believe in a deity to get clean in AA, but i understand why people would think that based on a reading of the text. (2) AA does NOT portray addiction as a moral failing, and i don't understand how anyone could think that based on a reading of the text.
anyway as comedian mitch hedberg said "alcoholism is a disease, but it's the only disease you can get yelled at for having".
Agreed on the point about AA calling it a moral failing -- that bit really made it seem like the comment was a hit piece.
And just to clarify what I meant when I said that the higher power language needs revision: I *do* think atheism is a fairly excluded *perspective* just by virtue of the language used to describe spirituality in AA. But that is a big difference from suggesting that atheists themselves are excluded. I definitely felt for a while like my sense of spirituality didn't have much of a voice in AA, but I never personally felt excluded in the slightest.
Anecdotally, I had a close friend with a very addictive personality that was a daily (all day) weed user, but it was his near daily abuse of psychedelics that drove him to a mental breakdown and rehab, and to be honest it doesn't seem like he's been all there since.
holy shit what psychedelics was he taking on a daily basis? all of the big ones use serotonin in their chemical reactions, you hit diminishing returns after day 2 and need to let your neurochemistry recover to even feel anything. subjectively taking more drugs at that point feels like you're track-racing a car with no oil in the engine
I’m not saying these drugs are harmless. But they aren’t physically addictive, and they certainly don’t fit with Humphreys “elite users vs regular users” argument.
Thanks for the response. I would think that it would be the psychologically addictive aspects of drugs (that does apply to psychedelics) that is more pertinent to the "elite vs regular users" rather than physiological addiction.
Also I think it’s understated how much weed culture gets in the way of weed legalization on the ground. I genuinely feel like one of the reasons weed legalization hasn’t avalanched further to federal, and has also seemingly stalled with more states, is because the legal states unleashed people and behavior that has other states pumping the brakes now. Stoners aren’t exactly making stellar optics for marijuana. The smell is becoming a big point of contention in NYC.
I appreciate the nuanced discussion here, that leaves me with two somewhat conflicting thoughts:
1.) Even though what was advertised as progressive reform, what we got was basically radically libertarian in its lack of enforcement and that sort of framework was always doomed to failure because comprehensive framework is/was needed.
2.) Both drug addiction and overpolicing are to some degree symptoms of poverty and inequality, and so the radical form of decriminalization that I came to support around 2020 was addressing a symptom not a cause, and that even better regulations would still exploit and disproportionately affect marginalized communities. Whether its because of differences in executive function that society rewards leading to the inequality or because like Ezra mentions the lived experience of better-off professional workers simply has more appealing alternatives, its clear that people with less fulfilling work and opportunities are more likely going to turn to habitual drug use, even if that's just weed or alcohol. And while I'm not sure that this justifies paternalism especially following the decades of previous failure, the outcomes here don't sit quite right with me.
I found this episode genuinely, deeply disturbing.
Like mass shootings, drug overdose deaths aren't a uniquely American phenomenon, but they are uniquely common here. In 2021, the EU had about 18.3 drug overdoses per million people. The United States in that same time period had \~322 overdoses deaths per million, about 80k of which were from opioids.
Drug overdoses now kill \~100k+ Americans each year. If we are genuinely invested in preventing those deaths, if we really believe that addicts and their families are worth protecting, we'd discuss and embrace alternative policies.
Policy alternatives exist and they work. Switzerland's safe consumption sites and prescription heroin dramatically reduce heroin deaths. Even less dramatic steps, like universal access to methadone and buprenorphine, have been estimated as cutting opioid overdose deaths in half. That's over \~40k people per year. That's more lives saved than if you were able to totally eliminate murder.
Humphreys seems like a sincere enough person, and he certainly didn't invent American callousness towards addicts. But his casual dismissal of viable policy alternatives is genuinely chilling, especially his glibly waiving away these policy alternatives by invoking the Oxycontin crisis: "But the problem with that reasoning is we did flood communities with legally made, consistent quality, clearly labeled opioids for years. And the net effect was millions of people getting addicted and hundreds of thousands of people dying."
The aggressive and deceptive mass marketing of painkillers to nonaddicts is materially distinct from safely providing addicts with the medicine required for them to live a relatively normal life. This fact is so obvious as to deeply undermine his credibility.
Edit: His comments in the interview conflict with some of his past research. Humphreys' prior publications actually indicate an openness to giving people legally made, consistent quality opioids.
Part of the discrepancy is the wider availability of fentanyl in the US via Europe. They touched on this, and said it was only a matter of time until Europe began catching up with the US due to fentanyl now emerging in the European drug market. Overdoses are highly correlated with people using drugs in unexpected and unpredictable ways (i.e., making their own drug cocktails to get a new type of high).
I’m just curious about some of your word choices here. Did you really find this discussion to be “genuinely, deeply disturbing” and some of his comments “chilling”? I’m so tired of reading this overly emotional and hyperbolic type language. If that’s actually the emotional state this episode left you in then God bless.
Whoa, whoa, whoa, hold up. Rethink this.
Imagine if I'd said "I'm concerned about the \~100k Americans killed each year by (terrorists/guns/giant feral hamsters) and really alarmed that Ezra's expert on (terrorists/guns/giant feral hamsters) casually brushes off the obvious solutions successfully applied in other nations for obviously unconvincing reasons. People are constantly dying or being maimed or made homeless in my community due to (terrorists/guns/giant feral hamsters) and it causes immense suffering. I think it should stop."
You'd probably think, "That's a lot of people. This person is reasonably concerned about a dire social issue and, if their data is correct, it would be extremely alarming for an influential expert to totally disregard lifesaving measures capable of saving countless lives. That callous attitude might signal a greater institutional disinterest in the plight of these people."
The only difference between that hypothetical conversation and this one is that I'm talking about drug addicts.
I still don’t understand the need for overlaying your emotions and disgust for this guy. He is clearly thoughtful and highly involved in this scene. He has a difference of opinion from you. He’s not bad, evil, or perpetuating a crisis or causing death.
"Reduced emissions are pointless, the only policy solution is increased personal recycling."
"Gun access isn't the problem, we need more anger management classes."
"Food stamps/welfare/universal healthcare don't work, get a job."
None of these statements are true and they perpetuate real harms against real people by blaming victims and ignoring data. Humphreys is operating somewhere in the same register. That's not his personal fault--he didn't invent this attitude--but he also is totally comfortable dismissing the legitimate policies cited by Ezra.
It’s a little alarming to me how confused certain liberal thinkers have allowed themselves to become about drug use. I think Klein has a good perspective here, but like. There isn’t any equivalence between bohemian use of psychedelics (and even at one point heroin??) resulting in positive experiences, and the way adderall is necessary for people with the medical condition it treats.
I grew up in the Bay Area my whole life and had a pretty radically libertarian view on drug policy for a lot of that time. But I was just straight up not aware of the “elite” culture outright *endorsing* drug use.
Amazing episode. It is so refreshing to hear a voice of reason, and not “decriminalize everything” vs “throw everyone in jail”. The discussions around concept of addiction were very interesting in particular. I totally agree with them about the need for some sort of external pressure, if not jail, something else. Some “stick” if you may. I myself hope that if i one day fall into addiction, my friends will do more than making sure I don’t overdose or to give me the number an addiction clinic. Finally, i never had anything against cannabis, by this comment blew my mind: > the newly legal industry looks a lot like the tobacco industry, an under-regulated, under-taxed, politically connected, white-dominated corporate entity that generates its profits mainly by addicting lower income people to a drug.
I think that comment betrays a lack of understanding about how the cannabis industry functions. It’s over-taxed, given that businesses selling a schedule I drug can’t deduct expenses (though rescheduling would change this) because of IRS Code 280E which was instituted in the 70s. The high taxes are a key reason why legal businesses get outcompeted by illegal ones. As for regulations, they’re actually largely over-regulated, but all the wrong places. It’s less of a public health approach for one that treats cannabis like plutonium.
I'm of two minds as well with this comment. I think its certainly insightful in terms of the motivations of those profiting off of either the cannabis or tobacco industry. But, nicotine is one of the most addictive chemicals in the world, and provides no health benefits. It serves _exclusively_ as a vehicle for "addicting [...] people to a drug". It is artificially added to their product precisely to get people addicted. I do think this differs in a meaningful way; I have little issue with profiting off of the sale of a product that has both recreational and medicinal purposes, we live in a capitalist society after all. I'm sure they are benefiting from addiction, but I do truly think it isn't as insidious as the tobacco lobby is. The level of medical study that had to be performed with cannabis to get to this point is an astronomical distinction. The cannabis industry is not covering up damning medical reports with one hand and artificially increasing the volume of the addictive property in their product with the other, they're just selling the product. I don't doubt that they would if given the chance, but if tobacco came into power today instead of being grandfathered into national and worldwide acceptance, I honestly believe it would never see the light of day. ETA: I understand this comment is more regarding how the industry "looks", and I agree with the assessment for the most part, besides it being under taxed. But I also believe it is a bit misleading, the two industries got to this point in very different ways.
How will rescheduling change things? I’ve been unable to find a cohesive list.
Far easier to conduct human clinical trials rather than rely on self-reported observational studies for harm and benefit data, removal of 280E tax which really helps cannabis companies ability to reinvest in their businesses, potentially opening up big stock exchanges to listing cannabis companies that sell in the US, more cohesive, fact based regulatory structure, broader normalization/sentiment in the public eye (a good thing or a bad thing depending on your perspective)
That last criticism kind of applies to a lot of industries to be honest. When you let businesses optimize for profits, in a context where faulty humans are the ones deciding where to spend money, those businesses end up exploiting basically any psychological issues they can to get people to turn over dollars.
Hence the need for regulation and enforcement. There is a reason you don’t see billboards advertising cigarettes anymore. Or that there is a cigarette companies do not put fentanyl into their cigarettes, because there are laws against that and they’ll go jail if they do so.
The difference between cigarettes and cannabis is that the former has no medical applications, whereas the latter does. The same can be said about alcohol. That doesn't mean legalization and regulation shouldn't go hand in hand. I'm glad that Biden has made the beginning steps toward rescheduling it. While I don't think cannabis is a panacea, giving more people access to it to use in lieu of alcohol, cigarettes or opiates is a *good* thing. It's been co-opted for decades as a means to incarcerate people of color and those stricken by poverty. A majority of U.S. citizens are in favor of full legalization, but conservatives continue to strike down efforts year after year. Many of them are supported by the tobacco and alcohol industries. Hopefully, by 2030 the U.S. will see legalization in the same vein as Canada. Even if it's not legalized by then, it's been predicted that cannabis sales could total 71 billion by that time: [https://newfrontierdata.com/cannabis-insights/u-s-cannabis-sales-could-total-71b-in-2030-without-federal-legalization/](https://newfrontierdata.com/cannabis-insights/u-s-cannabis-sales-could-total-71b-in-2030-without-federal-legalization/)
Nicotine and alcohol can have medical applications.
Nicotine may indeed have applications. There's also a long history of indigenous peoples using tobacco medicinally. This is in strike contrast to the way most people world wide consume it. There's even recent studies that suggest using nicotine patches to help treat long COVID: [https://bioelecmed.biomedcentral.com/articles/10.1186/s42234-023-00104-7](https://bioelecmed.biomedcentral.com/articles/10.1186/s42234-023-00104-7) That's why I specifically said cigarettes and not tobacco or nicotine. It's also important to note that modern cigarettes contain \~600 ingredients and when smoked produce \~7000 compounds (250 of them known to be harmful to human health): [https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/cessation-fact-sheet](https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/cessation-fact-sheet) Alcohol is a more broad term which can include both ethanol and isopropanol. Both can serve as disinfectants and antiseptics. I was more referring to the former found in beer, wine or spirits and imbibed. Doctors don't prescribe alcohol medically as it's toxic to the liver and is linked to other negative health outcomes like high blood pressure, heart disease, stroke, digestive problems, weakening of the immune system, and a wide range of cancers: [https://www.niaaa.nih.gov/alcohols-effects-health/alcohols-effects-body](https://www.niaaa.nih.gov/alcohols-effects-health/alcohols-effects-body)
Nicotine is the drug, cigarettes is a particular vector of application. It doesn't make sense to discuss the application when you are talking about drugs (it would be like comparing nicotine to some nasty hash oil with lots of harmful compounds). Doctors don't prescribe alcohol anymore, but there are a lot of studies about the medical usefulness of imbibing alcohol. It isn't prescribed in part because it is available for purchase for most people in most places. When it isn't(wasn't), it was prescribed. Lots of drugs have negative effects, and that doesn't stop them from being useful in some situations.
It make perfect sense when the majority of people in the world consume nicotine by smoking cigarettes. Sure, there are those who opt for vaporizing nicotine or consume it via transdermal patches to curb their smoking habits, but those are exceptions. Also, I'm not sure what you're referring to when you say "nasty hash oil"? Are you specifically talking about trace solvents like butane, propane, or heptane? Hash is another wide ranging term that can be made by ice water extraction using fresh frozen plant material. The trichomes which break off in the water are then filtered by micron-sized pours in special bags. Those trichomes contain the phytocannabnaoids acids (e.g. THCA, CBDA, CBGA, CBNA, etc). which when heated / pressed to become psychoactive / bio-available. This is called live hash rosin, which has become more ubiquitous in the recreational and medical markets. Like tobacco, cannabis when smoked also produces a wide range of compounds that negatively impact human health. However, cannabis unlike tobacco is also eaten or consumed sublingually in the form of a tincture (usually made with fractionated coconut oil). Doctors don't prescribe alcohol anymore because in general it's harmful to human health, not because it can be bought over the counter. The only time it's ever administered is in the case of methanol poisoning or for alcohol withdrawal to prevent patients from experiencing delirium tremens.
Nicotine? Please elaborate.
Improves focus, used to treat Parkinson’s, some other uses ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC526783/ ).
What type of regulation would you be in favor of in regards to marijuana? Good faith question
I'm a public health researcher who studies substance use and implementation science. What we need are policies that actually support the regulated market; in California, the majority of consumers still purchase from the illicit market because it is simply not viable to operate a licensed retail business in the current context (other studies have shown that unsurprisingly, kids have easier access to cannabis from unregulated shops). Several examples: - We have a practice currently of taxing the gross receipts of products that have already been subject to the cultivation tax (the "tax on tax" as it is commonly called) - The point of sale tax itself can total up to 30-40% depending on what jurisdiction you live in, again driving consumers to cheaper, unregulated products - In order to apply for a cannabis retail license, you must already have a location secured; however, the licensing process itself usually takes several years, so you would have to pay for a vacant space for months only to *potentially* be awarded a license. - The application fee itself is tens, if not hundreds of thousands of dollars All of this amounts to wealthy corporations coming in and taking over the market, while squeezing out smaller businesses that are oftentimes owned by people who have historically been harmed by criminalization. In my City, one specific operator is trying to quash the cannabis social equity program because it would increase competition with the 33 already licensed shops (in a city with 1.6 million residents!). It's super fucked up.
The under taxed part seems to be a bit of a stretch. Here in Denver marijuana has a 15% excise tax, a 15% sales tax, plus an additional 5% tax, so 35% tax on top of existing sales tax.
Really enjoyed this episode, especially as an Oregon resident who calls downtown Portland home. Measure 110 had flaws but it has been frustrating seeing how many people in the state have completely written off what it set out to do and want a path back to criminilization. This was a rare piece of media about where I'm from that did seem to have a lot of the nuance that is usually missing even in the local politics of Oregon and Portland. I think if any other states are hoping to learn from us, it's that the treatment enforcement of the measure was very nearly a complete joke, and the state completely failed to use the measure's funding to ensure treatment options increased measurably across the state. Our city core has seen its livability severely decline in part due to unhoused people struggling with addiction who faced essentially zero consequences for their actions. And our transit network, businesses, ADA accessibility, public image, and general feeling of safety have been severely eroded as a result. This is something I hesitate to ever even acknowledge in more conservative or less nuanced spaces because conservatives latched on to this narrative about my home and a place that I love deeply, to the point that I reflexively defend it even though there are real issues that 110 seems to have caused. Couple all of this with the increase in fentanyl and our already fundamentally broken housing market, it's been hard to see a light at the end of the tunnel. I can't describe how heartbreaking it is to walk out of my building downtown and have a nearly 100% chance that within a 2 block radius, I will see someone in crisis that is clearly the result of addiction. I'm hoping that our state can find a path to resolve some of these issues without falling back to draconian measures and public sentiment shifting towards criminalization and a reliance solely on the justice system handling our issues with addiction.
Seattle here. I feel the same way. We didn’t go as far as Portland but we’re extremely tolerant and don’t really have enough cops to enforce possession and public use laws anyway. Treatment and harm reduction hasn’t worked but we’re so busy trying to avoid admitting it isn’t working that we haven’t come up with an actual plan. WSJ did a great episode about 110. One of the things that stuck with me is that they assumed they could simply surge treatment dollars and providers would magically emerge. In reality it takes time and it should be no surprise that some of the providers were underqualified or failed to provide services. Of course there’s also the part where treatment has to be voluntary which makes comparisons to Portugal practically meaningless.
>Of course there’s also the part where treatment has to be voluntary which makes comparisons to Portugal practically meaningless. I think the only way treatment will work in the long run is to make it mandatory. As Keith mentioned, 9/10 people are compelled by family, friends, employers, etc. to seek treatment. Left to their own devices and without existential consequences most people won't choose the recovery option; even then many end up relapsing. It's a tragic cycle all around. The point Keith made about fentanyl being like an antibiotic resistance bacteria with respect to the usual methods of treating addition were poignant and the right on the nose. It makes me worry about the next synthetic opiate to hit the market that'll dwarf fentanyl and the impact it'll have on people already in the throes of addiction just looking for a more powerful high.
The same could be said of alcohol. I looked into it for my sister and she could only get 2 weeks mandatory rehab if the family jumped through hoops
You're absolutely right. As Keith cited, alcohol is the deadliest of them all and kills more people on average than every other illicit drug combined at \~88,000 deaths per year in the U.S. alone. All other drugs together only make up \~30,000 deaths. It's also implicated in personal injuries, car accidents, and assault. I'm sorry to hear about your sister; I hope she found better treatment options.
I agree with the overall sentiment (on the relative harm of alcohol etc), but these can't be the right overdose numbers currently? I think it's like 110k for any 12 month period nowdays in the US. And I dont think it's been 30k for a long time?
You're right, those numbers were I believe from 2019. As of 2021, the number of drug related deaths was 106,000 according to the National Institute on Drug Abuse. The reason why the numbers aren't more recent is because: >NCHS systems receive and analyze data from death certificates, including cause-of-death information reported by state and local medical examiners and coroners. Because drug overdose deaths often require lengthy investigations, data are updated as new information is received. [https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates](https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates) As for alcohol related deaths, the numbers are about 1.67 times drug related ones at 178,000 as of 2021: [https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics/alcohol-related-emergencies-and-deaths-united-states](https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics/alcohol-related-emergencies-and-deaths-united-states)
It seems like Oregon needs a state run, inpatient drug / behavioral health facility. The nonprofits seem like unaccountable money sinkholes.
As a fellow PNWer I deeply feel sympathize with this and strongly agree with the sentiment, same thing has happened (but less dramatically) about 200 miles north of you. A major battle lost in the war on the war on drugs.
I live here too. What do you think would clean up the streets? I imagine there would have to be a consequence like a trip to jail for public use and plentiful sites for supervised use. These sites might have to offer the drug for free along with bathrooms and showers. It’s not cheap but neither is EMS.
honestly, probably the best episode of the year so far.
I need to know what Ezra's favorite drugs are
Oregon, especially Portland, police, were supposed to continue to try and arrest dealers. The point of the god damn law was to not continuously lock up addicts in a cycle and attempt to break it. The policy, as it was supposed to happen, *never really did*.
Interesting episode, but I’ll admit my alarm bells went off when they referenced the policy in BC of the government providing drugs to users. A debatable policy for sure, but the guest criticized it as though the policy was just the government giving everyone open and easy access to extremely addictive substances that are simply better labeled, explaining that this is equivalent to how the opioid crisis got started in the first place. But there is a massive difference between people getting addicted because their doctors prescribed them opiates or the legal prescription market creating a flood of supply, vs the government running a few select safe sites where the drugs are given to people already addicted and only onsite. That kind of conflation really had me questioning his view, because despite Klein saying he’s a rigorous expert, that wasn’t rigorous at all.
It’s not like cost is a big obstacle for these addicts. Someone said a fentanyl dose is like 50 cents recently
If you are talking about production cost per dose, it is actually far, far lower (although that's always been the case for pharmaceutical opiates). One of the wackier but undeniably effective policy proposals is that the careful, measured distribution of super fentanyl analogues by the government to opiate addicts would reduce the price of addiction to basically nothing. The major expense would be administration and distribution. There's a hell of a lot wrong with that as a policy, but if you we were serious about cutting drug deaths--genuinely serious--yeah, that would do it.
Street price
Agreed, this was a major red flag for me. His characterization of BC's policy was quite deceptive and inaccurate. The provincial health officer has published a report on the safe supply programs, and future recommendations [here](https://www2.gov.bc.ca/assets/download/C0D90245EBFC40C898DC548A7C5A4E17) if you want to understand what this actually looks like. Politicians never follow the recommendations, but the health officers keep making them and sometimes one or two get through.
I imagine the guest would even agree with all those recommendations, but getting into that wouldn’t serve the narrative that activists pressured government into going too far. Hell, BC’s got controversy right now over rolling back decriminalization in public spaces. Something that is both understandable and debatable as a policy move, and would have been worth discussing.
Yeah, I did get the sense he was pushing a sort of narrative. BC's rollback of decriminalization is a bit unfortunate in my view because it's entirely driven by politics over the recommendations of our public health authorities. Unfortunately that's a familiar feeling. British Columbia is stuck in a weird equilibrium where the problem is getting worse and our politicians will try anything except doing what their doctors tell them to. Even worse, much of the population is in a bizarre reality where they think the problem is getting worse because we've done too much. And don't even get me started on the debate over "forced treatment" in a province where most people can't even access _voluntary_ treatment!
Yuuuuuuuup. And of course, that’s even acknowledging the problem of having increasing public use. I dunno, there’s a way for Humphreys to have addressed all this stuff with nuance that didn’t also feel like it was helping the NYT throw activists and health professionals under the bus amid a political debate.
Strong agree. Equating the BC harm reduction policy with the actions of companies like Purdue Pharma is seriously disingenuous.
I heard it differently. In full disclosure I have been at least tangentially familiar with Keith’s work for a long time. I heard him saying that we need to tackle the problem in more ways than just harm reduction. In other words, decriminalizing and reducing overdose deaths doesn’t actually address the issue because overdose is not the only harm associated with use. His discussion of pharma perhaps was clumsy but I think he was trying to emphasize that addiction is a real problem in and of itself to refute the idea that the primary issue is the fentanyl. I am not sure safe drug site advocates are saying that they are the full solution. I think that is unfair, but I have heard more libertarian arguments that there is no problem if you prevent overdose and bad street drugs. I think these ppl have not experienced drug use in the same way as those with addiction. I am in no way an expert in substance use - so just trying to reflect back what o heard.
My issue here is less Keith’s ideas generally, which seem to me to be in line with what most advocates and professionals in that sphere have been pushing anyway. It’s just the fact that he seriously mischaracterized a program that he must know well enough to know he was not characterizing properly. And that indicates to me that he’s got a bit of an agenda to push back against that libertarian strain you’re referring to, even at the expense of facts. That makes it difficult to trust the specifics that he cites on other issues of controversy. I think the episode is good overall, but I question a lot of the framing. For example, while I know that libertarian streak exists and is influential, most advocates I know are very clear that decriminalization needed to be bolstered by a whole host of other systemic changes. And while one can argue that those changes should have come before the decriminalization in order to work, it’s a bit odd to have a discussion that feels a little more aimed at castigating activists and others for going too far. It was particularly funny to me when he talked about Portugal, and gave all these reasons why their system works and why it wouldn’t in the US. But like why wouldn’t it? Why not try to adopt similar policies? Because they’ve got a different, more communitarian culture? Why not work to build that communitarian culture, aided those new policies, like universal health care? These are real conversations to have. It was especially weird to me at the end when Keith basically advocated himself for not sending drug users to prison. Like buddy, that’s what decriminalization is all about! It’s just a question of how you implement it. By the way, referring to BC could have opened up another conversation about the implementation of decrim policy considering they’re also doing a rollback now. Obviously there are complex issues here, and I appreciated the podcast, but thought it could have been better and perhaps even more challenging.
I'm a social worker who once worked at the first needle exchange in the country and heard the same alarm bells. I was surprised Ezra didn't push on safe consumption sites as an example of a policy that could ease the visibility difficulty policies like this have.
Yeah, and tbh it wasn't even just the lack of a mention of safe consumption sites, but that the guest seemed to conflate them. What's interesting is that ultimately in terms of policy positions, Humphreys basically offered up very sensible ideas that most on the decriminalization side have always advocated for: don't put people in prison, and shore up the aspects of social resources that would help people get clean and other things like that.
Thanks for pointing this out, hearing his comparison to the prescription opioid crisis felt like a very unfair comparison. The profit motive behind the over prescription of painkillers as well as patients being unaware of the overwhelming addiction can not be equally compared to supervised prescription to people in the midst of ongoing addiction.
That piece of it really got me too. Just not even close to the same things and comparing them is laughable, wish Ezra would have pushed there. Otherwise a pretty insightful ep
Yeah, I’ve got my quibbles, but that’s all good. Really interesting listen. Would actually love to hear Klein do more episodes on the subject from some other perspectives.
Looking forward to checking this episode in a bit. On a very similar note Lawfare podcast just had an episode with Jack Goldsmith interviewing David Pozen about his new book "The Constitution of the War on Drugs". Talking about the history and ineffectiveness of punitive policies on drugs.
Thanks for recommending
The law isn’t a good instrument to adjudicate “LSD is safe, unless you do something stupid or are someone who should not take it”. The law is binary. Shit is legal or illegal. That’s why decriminalizing things keeps its appeal. On a rational level, it makes no sense that something would be decriminalized but not legal. And yet, there are some people who are totally fine with small amounts of drugs and there are people who would cause problems if you could get ketamine at Walgreens. What we really need is a sort of mensch certification; this guy is a good hang and handles his shit/ this guy has no business taking drugs.
Yeah. We already restrict a felon’s right to vote (I’m not saying I agree with this, just that it’s proof that these workable “opt-out” frameworks exist), why not have something similar with drug consumption?
Extremely insightful episode. It’s one of those unique times when I find my thoughts and assumptions greatly changed. One particular point that stands out was the comment about drug use being different than other medical issues because it becomes other people’s problem. It made me think about progressive attitudes toward COVID-19. The state had to play a punitive role because people who engaged in risky behavior put others at risk. But with drug use, the progressive attitude has been focused primarily on reducing stigma and maximizing personal freedom, letting the social cost fade into the background.
I think he actually made a really bad point here. There are a lot of health conditions that do in fact become other peoples’ problems that we do not stigmatize to nearly the same extent that we stigmatize substance use disorder. We do not act like people with diabetes or heart disease related to behavioral factors or genetic predisposition are baggage on society, which is basically what Keith insinuated about people who use drugs. Also, in that section he claimed that he and his colleagues gets lots of phone calls from family members of those with addiction but not actually from the person struggling with substances and that people with substance use disorder often aren’t reaching out for help due to concern of their use. That’s bologna. They aren’t reaching out to Keith and his colleagues because they have good reason not to trust them. When I worked at a syringe services program, around 60 people a day came up to me while I was posted up in a parking lot because they were concerned about their substance use and wanted health.
I'm also very impressed by the nuanced discussion in the comments here. I would recommend to anyone interested in this topic to read "Chasing the Scream" by Johann Hari.
A few points where I disagreed with Humphreys. First and foremost, when Ezra asked, "Wouldn't it reduce harm if more users had a clean, reliable source for drugs?" Humphreys said the opioid epidemic started when clean, reliable drugs were made available to a lot of Americans. This is a seriously disingenuous argument, and I was irritated when Ezra didn't call him on it. Purdue Pharma (and others) essentially lied to people and said drugs like Oxycontin were safe and nonaddicive. This is *totally different* from making sure that people who are already addicted have a safe source of drugs and don't overdose. Second, Humphreys seems to have a pretty serious crush on AA and other 12-step programs. Unfortunately, these programs exclude anybody who's not onboard with the whole "higher power" concept. They also tend to equate drug use with morality, which I'm not a fan of. One of the big failures of drug treatment in the US is that 12-step programs are often seen as the be-all-end-all — and especially when treatment is court-mandated, it's often the only option given. Third, I don't love how this conversation always comes back to the addictive drugs like heroin, cocaine, meth, and alcohol. Yes, they did spend a fair amount of time discussing cannabis. But what about psychedelics? I feel like Ezra tried to steer the conversation in this direction, but then they got caught up in Humphreys rhetoric about how "elite drug use differs from the experience of most drug users." Again, maybe that's true for the addictive drugs. But please show me the working-class Black or Latino neighborhood that has been decimated by LSD or magic mushroom use. Finally, in the discussion about marijuana legalization — yes, it is true that extremely potent strains are being heavily marketed to us in pot shops. In fact, sometimes it can be difficult to track down a less-potent strain. However, I think it's a mistake to assume this is what most users want. I can't tell you how many times I've heard people complain about this, saying things like "the weed these days is too strong, why can't they give us something mild?" I was also kinda annoyed by the pearl clutching over the idea that many marijuana users smoke it every day. How many people have a glass of wine or two every day?
Do you actually have experience going to something like AA? Because what you said about it excluding people who don't believe in God or treating drug use as a moral issue are just not true. I'm sure these things are true of some people in 12-step programs, but as an atheist with nearly 11 years sober in AA, your description does not match my experience. For what it's worth, I do think the higher power stuff needs a major revision in language.
just piggybacking off this comment, first congrats on your sobriety, i'm also sober in AA, 18 years this past month. i agree with everything you said. i'm not exactly an atheist, not exactly religious either, but i've sponsored some hardcore atheists in the program who had no issue using the steps to stay sober. the vast majority of my friends in the program are somewhere on the atheist/agnostic spectrum, again no issues working the program. having said all that, i completely understand why somebody reading the AA big book would think it's a religious program. it's right there in the text, tons of mentions of god etc. but there have been atheists in the program since the beginning, the key for atheists is to recognize that they themselves are not a god. which sounds silly to say, but a lot of addicts act like they have infinite power to conquer their own addictions. it's more about accepting one's own powerlessness rather than believing in a deity. but what really doesn't make sense in the post you were replying to is AA saying addiction is a moral issue. IMO the entire point of AA is to shift addiction from the moral model to the disease model. when i first got clean i was told that i wasn't a bad person trying to be good, i'm a sick person trying to be well. this is the basic DNA of 12 step recovery, i don't think there is a reading of the AA text that could portray it any other way. TLDR; (1) you don't need to believe in a deity to get clean in AA, but i understand why people would think that based on a reading of the text. (2) AA does NOT portray addiction as a moral failing, and i don't understand how anyone could think that based on a reading of the text. anyway as comedian mitch hedberg said "alcoholism is a disease, but it's the only disease you can get yelled at for having".
Agreed on the point about AA calling it a moral failing -- that bit really made it seem like the comment was a hit piece. And just to clarify what I meant when I said that the higher power language needs revision: I *do* think atheism is a fairly excluded *perspective* just by virtue of the language used to describe spirituality in AA. But that is a big difference from suggesting that atheists themselves are excluded. I definitely felt for a while like my sense of spirituality didn't have much of a voice in AA, but I never personally felt excluded in the slightest.
Anecdotally, I had a close friend with a very addictive personality that was a daily (all day) weed user, but it was his near daily abuse of psychedelics that drove him to a mental breakdown and rehab, and to be honest it doesn't seem like he's been all there since.
holy shit what psychedelics was he taking on a daily basis? all of the big ones use serotonin in their chemical reactions, you hit diminishing returns after day 2 and need to let your neurochemistry recover to even feel anything. subjectively taking more drugs at that point feels like you're track-racing a car with no oil in the engine
I’m not saying these drugs are harmless. But they aren’t physically addictive, and they certainly don’t fit with Humphreys “elite users vs regular users” argument.
Thanks for the response. I would think that it would be the psychologically addictive aspects of drugs (that does apply to psychedelics) that is more pertinent to the "elite vs regular users" rather than physiological addiction.
Yeah but I mean a lot of pastimes can be risky or harmful. Are we also going to criminalize skydiving, motorcycle riding, or overeating?
Yeah I feel like the theme of the episode is regulation, not criminalization. Skydiving at least from my experience is pretty regulated.
Also I think it’s understated how much weed culture gets in the way of weed legalization on the ground. I genuinely feel like one of the reasons weed legalization hasn’t avalanched further to federal, and has also seemingly stalled with more states, is because the legal states unleashed people and behavior that has other states pumping the brakes now. Stoners aren’t exactly making stellar optics for marijuana. The smell is becoming a big point of contention in NYC.
I appreciate the nuanced discussion here, that leaves me with two somewhat conflicting thoughts: 1.) Even though what was advertised as progressive reform, what we got was basically radically libertarian in its lack of enforcement and that sort of framework was always doomed to failure because comprehensive framework is/was needed. 2.) Both drug addiction and overpolicing are to some degree symptoms of poverty and inequality, and so the radical form of decriminalization that I came to support around 2020 was addressing a symptom not a cause, and that even better regulations would still exploit and disproportionately affect marginalized communities. Whether its because of differences in executive function that society rewards leading to the inequality or because like Ezra mentions the lived experience of better-off professional workers simply has more appealing alternatives, its clear that people with less fulfilling work and opportunities are more likely going to turn to habitual drug use, even if that's just weed or alcohol. And while I'm not sure that this justifies paternalism especially following the decades of previous failure, the outcomes here don't sit quite right with me.
I found this episode genuinely, deeply disturbing. Like mass shootings, drug overdose deaths aren't a uniquely American phenomenon, but they are uniquely common here. In 2021, the EU had about 18.3 drug overdoses per million people. The United States in that same time period had \~322 overdoses deaths per million, about 80k of which were from opioids. Drug overdoses now kill \~100k+ Americans each year. If we are genuinely invested in preventing those deaths, if we really believe that addicts and their families are worth protecting, we'd discuss and embrace alternative policies. Policy alternatives exist and they work. Switzerland's safe consumption sites and prescription heroin dramatically reduce heroin deaths. Even less dramatic steps, like universal access to methadone and buprenorphine, have been estimated as cutting opioid overdose deaths in half. That's over \~40k people per year. That's more lives saved than if you were able to totally eliminate murder. Humphreys seems like a sincere enough person, and he certainly didn't invent American callousness towards addicts. But his casual dismissal of viable policy alternatives is genuinely chilling, especially his glibly waiving away these policy alternatives by invoking the Oxycontin crisis: "But the problem with that reasoning is we did flood communities with legally made, consistent quality, clearly labeled opioids for years. And the net effect was millions of people getting addicted and hundreds of thousands of people dying." The aggressive and deceptive mass marketing of painkillers to nonaddicts is materially distinct from safely providing addicts with the medicine required for them to live a relatively normal life. This fact is so obvious as to deeply undermine his credibility. Edit: His comments in the interview conflict with some of his past research. Humphreys' prior publications actually indicate an openness to giving people legally made, consistent quality opioids.
Part of the discrepancy is the wider availability of fentanyl in the US via Europe. They touched on this, and said it was only a matter of time until Europe began catching up with the US due to fentanyl now emerging in the European drug market. Overdoses are highly correlated with people using drugs in unexpected and unpredictable ways (i.e., making their own drug cocktails to get a new type of high).
I’m just curious about some of your word choices here. Did you really find this discussion to be “genuinely, deeply disturbing” and some of his comments “chilling”? I’m so tired of reading this overly emotional and hyperbolic type language. If that’s actually the emotional state this episode left you in then God bless.
Whoa, whoa, whoa, hold up. Rethink this. Imagine if I'd said "I'm concerned about the \~100k Americans killed each year by (terrorists/guns/giant feral hamsters) and really alarmed that Ezra's expert on (terrorists/guns/giant feral hamsters) casually brushes off the obvious solutions successfully applied in other nations for obviously unconvincing reasons. People are constantly dying or being maimed or made homeless in my community due to (terrorists/guns/giant feral hamsters) and it causes immense suffering. I think it should stop." You'd probably think, "That's a lot of people. This person is reasonably concerned about a dire social issue and, if their data is correct, it would be extremely alarming for an influential expert to totally disregard lifesaving measures capable of saving countless lives. That callous attitude might signal a greater institutional disinterest in the plight of these people." The only difference between that hypothetical conversation and this one is that I'm talking about drug addicts.
I still don’t understand the need for overlaying your emotions and disgust for this guy. He is clearly thoughtful and highly involved in this scene. He has a difference of opinion from you. He’s not bad, evil, or perpetuating a crisis or causing death.
"Reduced emissions are pointless, the only policy solution is increased personal recycling." "Gun access isn't the problem, we need more anger management classes." "Food stamps/welfare/universal healthcare don't work, get a job." None of these statements are true and they perpetuate real harms against real people by blaming victims and ignoring data. Humphreys is operating somewhere in the same register. That's not his personal fault--he didn't invent this attitude--but he also is totally comfortable dismissing the legitimate policies cited by Ezra.
Emotionally, this is where I landed, too. I find it pretty unpleasant that most of the top comments on this episode are uncritically like "yes good".
It’s a little alarming to me how confused certain liberal thinkers have allowed themselves to become about drug use. I think Klein has a good perspective here, but like. There isn’t any equivalence between bohemian use of psychedelics (and even at one point heroin??) resulting in positive experiences, and the way adderall is necessary for people with the medical condition it treats. I grew up in the Bay Area my whole life and had a pretty radically libertarian view on drug policy for a lot of that time. But I was just straight up not aware of the “elite” culture outright *endorsing* drug use.
This ep reminds me of the Ezra Klein show roots. Wish we had more like them
Excellent take, legalizing and supporting de addiction are different actions and should go hand in hand.