How Mexican heroin cartels are targeting small-town America
washingtonpost.com
washingtonpost.com
First, if you believe that the crack down on prescription narcotics have first and foremost hurt addicts, you're very mistaken. Addicts easily moved on to heroin, as this piece shows. People with cancer and debilitating nerve disorders like chronic shingles, CPRS, trigeminal neuralgia, and some kinds of neuropathy, who total over a million in the U.S. alone, are the ones who have suffered greatly even though opiate painkillers are safe and effective when used correctly. These are the kinds of diseases than make grown men cry in pain and bring on suicidal thoughts in previously happy, non-depressed individuals (I know, I've seen it up close).
Second, if you believe that the US can some how magically win the drug war by cracking down on the southern border, I have a bridge to sell you. Drug smugglers come in by boat to Washington State, by plane across Canada to Montana, and by submarine into the Florida coast. Wasting billions building some "impregnable" fence across our southern border will only increase the number of smugglers coming in from our other borders. And then what? We shut down all our borders?
Seriously, when I read these comments coming from HN, bastion of rational thought, I just want to curl up in a corner and cry.
I wish that there were a more robust web of trust in place on the internet to verify that people are, well, real people. I don't like feeling like a tinfoiler just because I have these fairly reasonable bouts of skepticism.
They ultimately all raise the price of the drugs, making them harder to obtain and thus used slightly less.
There are diminishing returns though, and at some point you have to stop pumping money into the same countermeasures.
In fact, the scenarios you mention, of post herpetic neuralgia, trigeminal neuralgia, and neuropathy should NEVER be treated with opiates. There are highly effective neuroleptics and medications like carbamazepine, gabapentin, and TCAs that are first line and highly effective for these syndromes. While painful, given that it is neuropathic pain, often with rapid onset and offset, opiates, even PRN medication, is not appropriate management and does not help with its treatment. Adjuvant therapy including topical creams like capsaicin as well as minor procedures like nerve blocks and injections are pursued if first line treatments do not work. Often I see people in clinic who were aggressive about opiates and got opiates for these syndromes and spiral into addiction and problems while the underlying problem is untreated.
Opiates are not a panacea for all pain, and its troubling with patients see it that way, and often insist on opiate medications.
https://en.wikipedia.org/wiki/List_of_countries_by_prevalenc...
But aren't you arguing that the crackdown has hurt prescription opiate addicts?
People go in, receive a clean injection of unadulterated drug from a medical professional, have access to counselors and job recruiters, etc.
Requiring a payment for the dose to make the clinic self-sustaining can still create availability that far undercuts the cartels. Or, through donors, it can be provided for free.
People who are seriously addicted will no longer need to steal to feed their habits. The cartels will lose their best source of income. And very, very few people are going to go to a heroin clinic to use heroin for the first time.
"Hey man, what do you want to do this weekend?"
"Well, I was thinking of going to the clinic and claiming to be a heroin addict. I've always wanted to try that."
Very effective at actually slashing drug addiction, though.
Legalize it, tax it, and use the proceeds of the taxation for needle exchanges and rehab clinics.
Marijuana prohibition is not, for the most part, visiting anywhere near the misery on the human species that heroin prohibition is. Tens of thousands of people are kidnapped, tortured, or murdered every year in wars over heroin distribution. Addiction to heroin is made much, much worse under prohibition.
In fact, in the presence of prohibition, you're much more likely to find these concentrated forms of plant medicines precisely because people are unwilling to take the risk to smuggle whole plant matter.
This phenomenon is also observable with coca and cocaine. Cocaine obviously has the capacity to seriously destroy communities and lives. However, it doesn't have this effect on everyone. And, among people who use the entire plant for tea or as a chew - which is typical in places where the plant is legal and indigenous - it is utterly benign.
People say that China can't stop everyone from going through the Great Firewall. That's the same point you guys are missing. China puts pressure against people from accessing uncensored information on the internet. They may not stop absolutely everyone, but they can reduce a large % of people from doing so, and prevent large % amount of information from being accessed that's corresponds linearly with the amount of pressure applied.
There is in fact no policy which is absolute. You can't eradicate all criminal activity, that doesn't mean you shouldn't put any pressure into doing so.
It's pretty much impossible to completely eradicate child pornography, especially now with the internet prevalent in third world countries. Are you also arguing we should legalize that because if someone really wanted to they still can get child pornography???
> Are you also arguing we should legalize that because if someone really wanted to they still can get child pornography???
Absolutely. We should be going after the people making and selling CP, not possession. It's in the creation and distribution of CP that people are being hurt, not in the consumption.
If some guy is mentally ill and enjoys CP but otherwise doesn't hurt anyone, how are we better off for putting him in jail?
If I held a gun to a drug addict's head, you think that will not pressure them to stop, even if just for that moment when the pressure is applied?
If your assertion is true, with any degree of correctness, then we've found a perfect way to destroy information! Simply convert data into a signal fed to a drug addict. Because you're asserting that drug addicts can destroy such information since regardless of what signal they're fed, they will destroy the information.
Pressure, as I took it, meant legal methods of affecting change. And even so, widespread violence against addict's and their families certainly didn't eradicate the problem for China. Today there are around 4-5 million drug users in China and yet that country has laws allowing for the death penalty for trafficking and very stringent use laws.
And certainly putting a gun to someone's head is definitely not a long term solution to addiction but rather a very cruel way of incentivizing treatment.
Chicago is the major importing hub for drugs - hence all the violence - and it fans out from there. We have no border security in the south, and people wonder how the drugs get in. The US is not powerless to stop any of this, but we need to admit we have a serious problem and start implementing solutions.
People with long term pain need rapid access to pain management clinics. They often need to detox off the not-working opioids they were previously prescribed. Then they need to start running through the other alternative.
> What's better than opioids?
That depends on the condition. An answer was already given here:https://news.ycombinator.com/item?id=10285321
In general people with chronic pain need access to pain management clinics; physical rehab; and a range of medication - including if needed opioids.
Since when is Chicago a major hub for importing drugs? What's your source? From where are they imported and how - air? Why do you tangent to border security?
"Chicago, home of the Mercantile Exchange, has always been a hub from which legitimate goods fan out across the country, and it’s no different for black-market commodities. Chapo has used the city as a clearinghouse since the early 1990s; he once described it as his “home port.”"
http://www.nytimes.com/2012/06/17/magazine/how-a-mexican-dru...
"Chicago is a major trafficking route for Mexican cartels and has become a hub for the distribution of heroin across the Midwest. The dangerous result has been an increase in heroin overdose deaths in Illinois."
http://www.wbez.org/news/heroin-its-cheap-its-available-and-...
It's a border security issue because the drugs are coming from the south, by gangs that can operate across the border almost unchallenged.
From 2001 to 2013 there was a 5-fold increase in the total number of deaths from heroin overdose.
Edit: I believe a 500% increase in overdose deaths qualifies under the 'epidemic' definition of "a sudden, widespread occurrence of a particular undesirable phenomenon."
Surely it's preferable to enable junkies than kill them and feed the cartels?
The answer to heroin abuse is not prescription fast acting opiates, which themselves have significant abuse potential, but treatment programs such as suboxone, bup or methadone. The pattern of use needs to change from the epic highs and withdrawal cycles which generate the behaviour of an addict (and is still there with oxycodone due to the pharmacology of the drug) to a substance that maintains opioid receptor agonism for longer periods
They're not going to throw their hands up and go 'whelp, can't get any more legal oxy, time to quit drugs'.
The answer is to get them onto treatment programs, not further their addiction with access to drugs they are abusing
Treatment programs should be available and encouraged, of course, but if the guy really wants to continue abusing his prescription medication, that's his choice and I don't see the issue in supplying him.
Doctors encourage their patients to quit smoking, they don't jack up their cost of cigarettes 1000% and then shake their heads and absolve themselves of all responsibility when the patient isn't ready to quit and goes broke buying cigs instead.
But if someone wants to abuse drugs, then they shouldn't be given access to them. I really don't think you have any conception of how destructive opiate addictions are over the medium to long term. I don't accept your arguments that it is simply a factor of choice, and if someone wants to abuse a serious drug, then they should be enabled by providing them with access to a restricted drug , that is being used for the purpose of abuse. It's not acceptable in civilised society.
As to your supporting argument, yes doctors do encourage their patients to quit smoking. But in Australia we have jacked up the price of cigarettes to act as a disincentive as well. And, guess what - it works. The idea that we should make it easy for patients to access drugs of abuse, for the purpose of abuse, is severely flawed and your argument is bunk. An opiate is a drug of abuse and a restricted drug for a reason, and that reason should never be the recreational consumption.
The destruction is a direct result of prohibition, it is not inherent in the drug. People can and do take opiates long-term with little harm.
> But in Australia we have jacked up the price of cigarettes to act as a disincentive as well.
Yes, but not to the level that people have to prostitute themselves or rob others to get their fix. I didn't say it had to be dirt cheap, just cheap enough to sustain an addiction without turning to crime or selling one's house.
> An opiate is a drug of abuse and a restricted drug for a reason, and that reason should never be the recreational consumption.
I also didn't say it should be sold like candy to anybody at the corner store. But cutting somebody off who is already addicted like they do in the US is what ruins lives, not the pills.
What's your evidence for this?
[0] - CDC report describing epidemic in prescription opiate deaths
[1] - NIH report showing overdose deaths. the relevant stats: Since 2001, prescription opiate deaths have risen from 6000 to around 16,000. Over the same period, heroin overdoses went from 2,000 to 8,000. This data is to 2013. So there is a clear problem, and in fact prescription opiates cause significantly more deaths than heroin.
[2] - a report from closer to (my) home and region of practice detailing increases in prescription drug use in Australia and increase in opiate-related deaths secondary to this
[0] http://www.cdc.gov/drugoverdose/data/overdose.html
[1] http://www.drugabuse.gov/related-topics/trends-statistics/ov...
[2] https://www.mja.com.au/journal/2011/195/5/prescription-opioi...
https://www.psychologytoday.com/blog/wicked-deeds/201404/pre...
Also, these data include things like acetaminophen overdoses (estimates run from 100 to 1000 deaths per year).
In an ideal world, yes. But realistically patients will often be prescribed both.
> What we need is to start prescribing opiates for recreational use and eliminate the black market.
I strongly disagree with this concept. Opiates for recreational use is basically legalising heroin. The addictive potential is simply too great. I don't know what you are basing this argument on but my first-hand experience working with patients with opiate addictions, as well as a close friend and colleague who started using (pharmacological grade) opiates and rapidly had his life spiral into a shambles. The fact is that these debates have been had in the past. They are the basis of the harm minimisation strategies already in place by governments all over the world - Methadone, Suboxone and Buprenorphine programs, which bind opiate receptors with a long half-life meaning that users are not constantly bouncing from a crazy high to the physical sensation of pain which results from withdrawal of opioid agonism in the context of dependence.
> Opiates cause no harm (the worst side effect is constipation) so there is no reason that we should be trying to stop people from using them recreationally other than knee jerk moral panic and conservatism.
Again, I strongly disagree. Opiates cannot be used recreationally by the masses in a way which is consistent with normal societal functioning. This would be a disaster of epic proportions.
For instance, heroin injecting rooms are government or health-service funded clinics which provide a safe place to shoot, needle exchange, medical supervision should patients have reactions or overdoses, and the ability to seek out further harm minimisation through enabling access to treatment programs, should the addict wish.
The united states scores poorly on access to these services anyway, the rest of the world does substantially better, including my home (Australia)
again, the answer to harm minimisation is not legal recreational opiates
Right but be careful: "the answer... is not legal recreational opiates" does not necessarily imply that the answer is illegal recreational opiates.
If that's what you are suggesting: I am unconvinced. Has a war on drugs ever actually worked for us? Is it clear that legal opiates would mean more overdoses? Even if they would, has someone done a cost-benefit analysis of a) enforcing the illegality of the drug and b) efforts to reduce the negative effects of the drug through education about the risks of using and how to use responsibly. I'd be curious to see the results.
Edit: According to http://www.drugwarfacts.org/cms/Economics (pardon the biased domain but it was the first search result with the answer), only 5% of the money the US spends on drugs is allocated toward prevention and 37% goes to treatment. The remaining 58% goes to enforcing the illegality of drugs. Clearly the enforcement is not very effective because as you mentioned elsewhere 16k people are dying a year from heroin. So the question is: would that money be better spent otherwise?
We've probably had less of a need for legal painkillers than ever - surgery and medical technology keeps getting better and better - minimally invasive and the like - and yet we have more legal painkillers than ever. Something doesn't add up.
Step 2. These folks go to the doctor demanding pain relief. The doctor no longer bothers telling them to rest up and take some tylenol. Instead she hands out Oxy.
Step 3. Patient will never want to give up the Oxy (at best), or craves more as the drugs effects lessen over time. An addict is created.
Step 4. Patient looks to the blackmarket for supply of Oxy or alternatives.
You can solve the problem by either re-educating society to toughen up (eliminate step 1) or tell doctors to stop handing out opiates like candy (eliminate step 2).
Neither is going to happen. This has been going on since before opium was made illegal.
There are much better ways to deal with physical pain, the problem is they require a lot of effort ... and a pill is just an Rx away. This works for short periods of pain (such as immediately after surgery) but is very bad for chronic long term pain.
Do you have severe, chronic long-term pain?* Just curious on what basis you are making this remark.
I can tell you that since the DEA crackdown, no one is handing our narcotic painkillers for any condition that could be reasonably treated with rest and tylenol. Doctors value their licenses and freedom far too much, and so meticulously document their narcotic treatments, and give them only to patients with severe pain (and even then, they undertreat).
I've had two relatives die from cancer from in the past 5 years, who were terminal and over 70, and yet who were cruelly denied narcotic pain relief until their last week because doctors are scared shitless about getting arrested by the DEA. Far from what you're claiming (which was maybe the case with certain doctors a decade ago), doctors now undertreat most patients.
* "Bad back" and "aching knee" do not count. I mean things like cancer and severe nerve diseases.
Edit: By the way, I didn't downvote you.
The vast majority of prescription painkillers go not to surgical patients, who usually take a week or two course and are done, but to patients suffering from crippling nerve disorders and cancers, who take the medication for long periods of time, and who are little helped by our advances in surgical technology. Absent narcotic painkillers, cancer and diseases like chronic shingles and trigeminal neuralgia ("the suicide disease") are just as painful as they were 100 years ago.