NotAnEconomist

I came across most of my sources while studying for proposals to open another one, and don't have them convenient anymore.

However, looking through NIH reports --

The site in Vancouver appears to lower the fatalities marginally (1-10 less fatalities per year). Several other studies indicate that fatalities related to opioid overdose, ambulance calls, etc decrease in the immediate area of various sites.

I can't find anything on the Vancouver site in the last decade, it's all circa 2006 or 2007 -- and seem to recall in my earlier research that the initial results looked good, but later studies basically reported that we saw a decrease in fatalities that was offset by an increase in usage, and the whole thing came out as sort of a wash.

RAND seems to suggest that supervised consumption is not settled in terms of scientific study, even now. [0]

> We conducted our own assessment of the individual studies and found that the evidence base concerning the overall effects of SCSs is limited in quality and location. Although we identified 65 outcome-related articles (as opposed to commentaries or studies that gauge opinions), none involved an RCT, and just nine employed a quasi-experimental design with control groups. These nine studies were based on just four SCSs in three cities: Sydney (five studies), Vancouver (two studies), and Barcelona (two studies). There was considerable overlap in the design, methods, authorship, and data employed, so that four of the nine are arguably superseded by later studies using better methods or longer time series, in some sense reducing the effective number of quasi-experimental studies to five.

Worth noting, however, that many of these seem to indicate reduced petty crime in the area immediately around the site. Indicative I might be wrong, but not conclusive because of problems in the methods used, samples chosen, etc.

Looking at a compilation by Brookings, broadly on the topic [1] --

> New work by Packham and Wells (2018) suggests that syringe exchange programs—a staple of harm-reduction efforts—reduce HIV rates as intended but unintentionally increase opioid-related mortality by making it easier, cheaper, and safer to use heroin.

> Another popular harm-reduction effort is distributing naloxone, a drug that can save someone’s life if administered during an opioid overdose. Recent work by Doleac and Mukherjee (2018) finds that broadening naloxone access had mixed results. While some states saw beneficial effects of these policy changes, broad naloxone access increased opioid-related mortality by 14 percent in the Midwest, the region hardest-hit by the opioid epidemic.

So reports that I do find seem to suggest that this is a concern that is valid, at least in some contexts, and that the studies purporting to show outcomes are a) very narrowly done, b) often don't measure what I'd consider to be the complete set of externalities, and c) aren't particularly scientific.

It certainly seems reasonable that narrow focus on improving the outcomes of the addicts, particularly a narrowly defined set of metrics, actually lowers the group outcome.

Sorry I can't provide better sources to support that, though.

[0] -- https://www.rand.org/pubs/research_reports/RR2693.html

[1] -- https://www.brookings.edu/blog/up-front/2018/12/07/research-...

> The new law maintained the status of illegality for using or possessing any drug for personal use without authorization. However, the offense was changed from a criminal one, with prison a possible punishment, to an administrative one if the amount possessed was no more than a ten-day supply of that substance.

You seem to be mistaken about how their policy operates.

You're also working from a different premise than me: I believe people fundamentally have agency, and so they're influenced by their circumstances, but their problems are not causal from them -- they made a choice to adopt that habit as a coping strategy.

And frankly, I disagree with you about how to confront that: I think we should be accepting of how they got there, but I absolutely disagree with things like HAES which suggest that their choice isn't a problematic one.

To borrow a phrase from a friend, and use it somewhat out of context: I can love a sinner without enabling or accepting the sin.

> Are you implying we kill/let die the "sickly"?

What's the choice? Make other people ill and have the original sick people die anyways?

That's all slowing mortality down in heroin abuses does, and it's definitely not how we treat other kinds of diseases, particularly those which have reached epidemic proportions, where the prime objective is arresting transmission.

So, yes -- I think we should follow standard medical practices, and it's unfortunate that strong measures are needed to confront an epidemic level problem. Just like it always is when you have to make medical triage decisions.

But we have to prioritize maintaining the healthy population ahead of the comfort or longevity of the already ill, in broad strokes.

Yes -- that's the logic I was referring to.

However "safe injection sites" are anything but safe to the surrounding community, and may increase usage rates while only mildly decreasing fatality rates.

By keeping the sickly ones around, we're actually making the whole herd less healthy -- particularly when we enable them spreading their illness.

I think the medical professionals involved in "safe injection sites" should be seriously questioned about their medical ethics: they're failing to quarantine sick patients, and in treating them without that buffer, spreading the disease to the healthy population.

It's quack "medicine", just like HAES/HAMS.

So it's the same logic as, "Well, we should let them do heroin -- just try to make it as safe as possible"?

Seems like a meme we should minimize the transmission of, to me.

> Consider that there is essentially nothing that medical science has for people who are chronically fat except a gastric sleeve.

It also yields ridiculous statements like this. Medical science has some very clear advice for fat people: eat less and exercise more.

They're making an entire movement to justify why they're lazy and undisciplined.

I've noticed that they don't actually believe "Healthy At Any Size", because they routinely skinny- or fit-shame people.

So I've started referring to them as "Healthy At My Size", which is their real argument -- that their overweight size is healthy.

It also yields a more appropriate initialism.

> perhaps the government quietly permits more profit motivated blackhat operations in exchange for some intelligence sharing

I've long wondered if we're going to see cyber warfare "letters of marque" at some point.

In retaliation to cyber attacks on US companies, the US government could designate Chinese firms with connections to the Chinese government (and particularly those which support the Chinese military) in letters of marque, allowing retaliatory IP theft, permission to cause damages, etc.

If the Chinese government is behind these attacks on US companies, than we are in a de facto state of warfare.

I spent most of my college evening getting drunk with philosophy majors and pretending my math degree meant more than my CS fallback -- but I haven't found the corporate interview system to be that terrible.

I do however think it's a game that conflicts with certain personality types, including myself early in my career.

I'm always curious what you (or anyone else!) think could be done better.

> I never got this working from a coffee shop thing.

This is an old tradition.

Cafes, bars, tea houses, etc have served as social hubs and placed to read or work on documents (now computers) for literally thousands of years, everywhere on the planet. There's simply a social need for a space like that, because it's a more efficient usage of space to have people work on a revolving basis in a shared space than everyone have a private space of their own or not be able to work.

It's only with the modern invention of corporate coffee shops that misvalue social fabric that we see the churn happening. (PS -- those corporate stores are wrong about the short term boost from churn improving their long term fortunes, at least from what I've heard from the big ones.)

I also find it interesting you approve of one "office-like" usage -- having a chat or meeting -- but disapprove of another -- working on documents.