It is.

Regarding your post on the evils of drugs, I understand your point of view. Drug dealers are scum of the earth. I've seen (though much less than you, I'm sure) the associated pathology during my inner-city rotations. But, I've come to a different conclusion. I think that we've been fighting the war on drugs since the 80s and you know better than me with what results (BTW, what's the drug of choice in Baltimore?).

We've spent billions of dollars on attacking the supply side (see how our prisons are overcrowding) and our results (IMO) are negligible (due to the demand and 'easy pickings' made by the dealers; you shut one up another one pops up). Unless the government starts attacking the demand side, that is the users, I think that the status quo remains.

I think that the best solution to our current problem is control through legalization. I'd rather people shoot up in clean-well lit places provided by the government where they have access to healthcare and education (not to mention the public health impact on HIV and Hep. C) than the current mess. I think that taking away the power from the dealers and starting to provide the drugs by healthcare professionals (along with the appropriate education) may be a better solution than prohibition.

Think of the things people do in order to get their fix: prostitution, theft, armed robbery, etc... Than consider that all the money we've spent on putting people people away for dealing has not done much, except to make the drugs cheaper and more available. Look at the attendant problems of HIV and Hep C. I have no desire to tear up our Constitution (if I did, I'd go live in a place like Iran; where BTW, I've heard that despite their draconian laws they've got a drug problem as well) to fight the users.

That's why I think that control through legalization might be the best option.

Miklos

Miklos, I agree with every word you said!!!

I absolutely agree with you, Miklos.

The drug of choice in Baltimore is heroin. It is estimated that 1:10 people in Baltimore city uses IV drugs at least on a regular basis. A large percentage most likely daily. Men pay for their drugs by either dealing or theft, and women mostly by prostitution. Nearly everyone using IV drugs has hepatitis C, and many have HIV. I can't tell you how sick I am of telling young people they have HIV. People my age and younger....knowing they are unlikely to change their ways, and get treatment...knowing they will likely be dead in 5-10 years one way or another.

Hitting the demand is a logical way of decreasing drug use. Imagine trying to do that in a city with 80,000 IV drug abusers. I am regularly frustrated by the lack of resources we have. We give people a list of numbers to call, and that is about it. It is rare that we see people go from the hospital to rehab. Rehabs want insurance, something most prostitution jobs just don't supply. We can try to educate kids, get them early. What the inner city kids need is a role model they can relate to. They don't want to hear some white-bread doc from the 'burbs tell them drugs are bad. Unfortunately, there aren't many positive role models for them. Most of what they look to for entertainment glamorizes the drug trade. The gangstas are the guys with the hot women and nice cars. I don't think it is economically reasonable to try this approach. There simply aren't enough resources.

An indirect is through proper education. We need to quit being so politically correct. In the current school system, teachers aren't even allowed to put red marks on papers anymore because it may hurt a kids "self-esteem". Bull doody, not being able to read will do that just fine when they are older. In sports, they don't keep score for the same reason. They allow problem children to disrupt classes day after day. A classroom can only move as fast as the slowest kid. What needs to be done, is education needs to be stressed. If a kid can't spell a word, then tell them. Put a big red mark next to it. Make sure they spell it correctly next time. If a child is always disruptive, kick them out of school. Who cares if one kid is illiterate as long as the other 29 kids in the class can move on with their lessons without interruption and actually LEARN something. Give full rides to state universities to kids from certain zip codes who have done well in school. Hell, I might even be willing to pay more in taxes for that. The only way we are going to break the cycle of poverty is through a proper education. If kids have something they can look forward to, some hope, maybe they will stay clean. Maybe they will strive to do better than mom and dad. IMHO, a large part of the problem is the welfare and education systems. We currently don't have a system that provides opportunity to the kids who need it most.

I still think drug dealers should be publically executed. If you cut down on availablity, you reduce temptation. If a kid never tries drugs, they won't get addicted.

I also agree with legalizing drugs. People won't have to steal and prostitute, can get clean needles etc. There won't be any money in dealing, which would probably almost eliminate gangs, wouldn't you think? It would affect so much. G

__________________
AUC Class of '99
Bored certified
I may be a jerk, but I'm a Jedi jerk like my father.

Some say I look like Buzz Lightyear....
(They're right)

DISCLAIMER: I have no financial stake in ValueMD, or any medical school.

If anyone wants to practice medicine in inner city, Teratos last post is a must read.

I have a different opinion, although I arrived at mine by passing through similar sentiments expressed by Miklos and Teratos.

I don't think society can educate or spend its way out of a poverty class. As long as we're a free society we'll always have the lower socioeconomic strata...it's that infamous twenty percent factor. 20% will be our social elite, 20% will be the bottom rung and the 60% will be that curve in the middle. I think they only solution is to abolish any safety net. If failure really meant failure, it might be the kick in the butt many need.

__________________
Life is sexually transmitted.

"If failure really meant failure, it might be the kick in the butt many need."

spend some time in south america then and see how far the "no safety net" will get you. everyone there is so out for themselves that they cheat and steal from each other in order to make it.

__________________
OBGYN PGY II
I see light at the end of the tunnel!!!...wait a minute its just another freakin tunnel!

"If failure really meant failure, it might be the kick in the butt many need."

spend some time in south america then and see how far the "no safety net" will get you. everyone there is so out for themselves that they cheat and steal from each other in order to make it...maybe africa is the same i am not sure

__________________
OBGYN PGY II
I see light at the end of the tunnel!!!...wait a minute its just another freakin tunnel!

People deserve the opportunity. What they do with that opportunity is up to them. Nobody should ever dig a ditch without knowing they had the chance to do something more with their lives. G

__________________
AUC Class of '99
Bored certified
I may be a jerk, but I'm a Jedi jerk like my father.

Some say I look like Buzz Lightyear....
(They're right)

DISCLAIMER: I have no financial stake in ValueMD, or any medical school.

Having lived in Central America for three years, I'll stand by my opinion.

With few exceptions, the U.S. population has every opportunity to educate their children. Since the 60's there has been a steady stream of billions of dollars allocated to inner city/disadvantaged areas with limited benefit. The data exists. Now, I acknowledge that abuses have been rampant and not all dollars have been spent on the intended, but nonetheless, schools exist and the poverty class continues to hold about the same percentage of the population as before.

I think we've given the current approach a fair run. Perhaps it's time for a new social experiment? What if we changed the education system to truly meet the needs of the students? We do that in a small way now through remedial and honors programs. If we expanded that concept and applied it across the spectrum we might impact society within a generation. We won't eliminate the poverty class, but it might be diminished a bit.

__________________
Life is sexually transmitted.

That's just a tragedy.

What do you think of suboxone (buprenorphine + naloxone) treatment for opiate addiction?

Agreed. However, I'm of the opinion that using race by itself for affirmative action purposes has its problems. But, if you were to change it to socio-economic status (independent of race), you'd find a lot more people for it.

I believe that the solution lies partly on the demand and the supply side. One can attack the supply side by hitting the dealers in the pocketbooks. No profit, no incentive to deal. As far as the demand side goes, I believe that education and prevention is key.