Heroin deaths surpass gun homicides for the first time, CDC data shows | Hacker News Reader

Heroin deaths surpass gun homicides for the first time, CDC data shows

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54 pointsdbcooper44 comments

Overdoses tend to happen when a person relapses, and doesn't realize their tolerances have changed. If you know someone who has a problem with opiates, the anti-opiate naloxone is very effective. It is now available without a prescription in many states.

Benzodiazepines lose effectiveness after about 4 weeks, and the patient's anxiety worsens. The mental hospital forced my friend to take the full pill every day, when she only wanted it "as needed". She decided that Heroin would help her get through her benzo withdrawal.

We got together on the second night of her plan. I said 'no no, we're not doing this again...'

She said that she wasn't going to get addicted again, she just needed it to sleep. To show me that it was barely anything at all, she prepared a second shot and injected that too.

Then she fell forward, said "I meant to do that," and went non-responsive. Her face started to turn purple.

I did not have naloxone, so I called 911. The firefighters arrived about 6 or 7 minutes after I called. Some of them looked bored.

They used two 2mg intranasal doses of naloxone. She was quite shocked at the appearance of strangers in blue uniforms...

She did very, very well for the next two weeks. I guess the anti-opiates are awesome drugs. Naltrexone (similar to naloxone) is FDA-approved for alcohol abuse too.

That sounds traumatic. I'm sorry you hard to go through that.

It was a little shocking, but the firefighters did their job and it turned out fine. The police were dispatched too. The investigating officer decided they didn't need to make the problem worse, took the rest of her heroin, and everyone disappeared into the night.

This experience provided a very good clue as to what my friend actually needed (see my comment history for the backstory).

I think it's standard op in the states when 911 is called that fire/ems/cops show up. I'm very! Glad to hear the cops use their power of discretion to let her go. And not fucking ruin her already bad life by imprisoning her for twenty years.

Naloxone is definitely the standard when it comes to treating withdrawals. From a harm reduction perspective it would make a lot of sense to include doses in clean injection kits (if your state has such a programme). Although I suspect the 'zero-tolerance' crowd would oppose anything like that.

However, I'm not sure it would be effective in treating long-term withdrawal. It stops withdrawals by essentially knocking heroin off μ-opioid receptors (i.e. it is an inverse μ-opioid agonist with a very high receptor affinity). But it's effects only last a bit over an hour. Additionally, because of its inverse action, I suspect you'd experience withdrawal symptoms that are more severe than those you would experience going cold turkey.

Dammit. That first 'withdrawals' was means to be 'overdoses'.

Is Naloxone the substance that has a shorter life-time than Fentanyl, so you can OD "twice" if you're not careful?

Also, it's: "But its effects" (not it's)

Yeah that's right. It wears off in about 60-90 minutes. Many of the commonly taken opioids (especially if taken orally) last much longer than that, so if the person experienced a severe overdose it's a good idea to monitor them for the duration (or even just administer small does at regular intervals). However, much of this depends on the initial route of administration. Intravenous would probably wear of the quickest. For fentanyl, Wikipedia says 30-60 mins, but that's at 'medically useful' dosage levels from what I can tell (remember, not all drugs are metabolised in a time-linear fashion).

I'd assume insuffilated Naloxone would last the longest, followed by intra-muscular and finally intravenous. And the inverse would be true regarding how long they would take to have an effect. I don't think taking it orally is a viable option for OD, as it would take much longer to have an effect, and much of it would be destroyed by your first-pass metabolism.

And yeah, me and apostrophes have not been getting along very well lately...

I suspect the main killer in a significant number of these deaths is fentanyl or one of it's analogs that has been added to the heroin. I would also be curious to know how many of the dead also had alcohol and/or benzodiazepines in their systems, which dramatically increase respiratory depression in combination which each other and heroin/other opioids. For example, a UK study found that alcohol was present in 50% of heroin overdose deaths, and 37% had at least one benzodiazepine present.[0]

[0]http://www.nta.nhs.uk/uploads/nta_rb27_combined_opiate_overd...

> I would also be curious to know how many of the dead also had alcohol and/or benzodiazepines in their systems, which dramatically increase respiratory depression in combination which each other and heroin/other opioids.

I didn't know that about benzodiazepines & opiates - thanks! I posted in another comment about having to call the firedepartment when my friend overdosed on me...

The danger of the combination should be much more widely publicized, as drugs like oxycodone and xanax are among the most widely prescribed in the US. There have been thousands of overdoses attributed to the combination but the FDA has only very recently required strong warning labels. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/uc...

Check out this chart:

http://wiki.tripsit.me/wiki/Drug_combinations

On the bottom of the page there are also detailed descriptions for each combination, in your case it says:

> Opioids & Benzodiazepines

> Central nervous system and/or respiratory-depressant effects may be additively or synergistically present. The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position Blackouts/memory loss likely.

> http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3454351/

Our society's problem is that many people incorrectly assume that drug abusers "deserved" their problems and treat them like criminals rather than victims. Accordingly it does not fit the narrative of a problem we must solve. And instead, the government chases more ideological boogeymen.

I'm not saying religious terrorism (for example) isn't a problem, it certainly is -- but there are many problems as well. It would be wonderful if problems like drug abuse were tackled with the fervor that ideological problems are tackled. And by tackled, i mean the upstream/root causes, not the victims.

A significant factor was race. Drug laws were explicitly crafted as a way to punish poor “dangerous” brown people for their supposed sins. “Tough on crime” politicians in both parties could pander to racists without appearing obviously racist. (Extra bonus: once someone has been declared a felon, we can forever prevent them from voting in many states.)

After some years of significant problems in white communities, we’re starting to see some course correction.

Do you have credible sources to prove the significant factor is race?

You see, I believe your point, but that won't convince those who believe it wasn't influenced by racism. They'll say "conspiracy theory" and move on.

Disregarding cannabis, it also seemed to me that LSD was to become illegal to harass the hippie community. But how to prove this?

The way this works appears to be rather easy; you look at the characteristics of your political opponents, and then decide what they have in common which your status quo group doesn't. Then a process is begun to incite FUD. Once that campaign in successful you got momentum in your group and you make a law which makes that thing illegal.

This might not meet your 'credible' source credentials, but it does help point in the right direction:

http://www.huffingtonpost.com/judge-frederic-block/war-on-dr...

It surely isn't simply based on race as your hippie example points out: Rather, any group that was or is 'bad' at the time, be it based on race or status (being poor, for example). Not all race and class, but lots of it.

With the exception of some policies in the 10s-20s allegedly targeting Chinese and Mexicans, that article doesn't really support the claim as applicable to the last 60 years.

That's because those are the most openly racist policies out there. At some point in history, it became harder to talk in the same racist terms as before.. Starting in the 60's.

And that makes things a bit fuzzy, unfortunately. Much harder to prove racist policies. And you wind up having to do a lot more digging and use examples. Think of the stereotypical crack dealer: That's from the 90's, if I remember correctly. We know the drug policies disproportionately affect minority communities and poor folks, yet numbers also tell us that addiction hits most levels of society. And have failed to change it. We didn't erase the racist-inspired laws either. To me, this sort of thing all stinks of. And I'm too cynical to think that suddenly, race had nothing to do with it.

Unfortunately, this sort of thing does little to prove any of it to a non-believer.

I'm not a non-believer. I'm neither a believer nor a non-believer. It certainly seems plausible, but I've seen a lot of conflicting evidence and arguments about law enforcement and race.

The memories of one Nixon aid involved in the early days of the drug wars: http://www.cnn.com/2016/03/23/politics/john-ehrlichman-richa...

I doubt race is major factor, simply lumping all the poor together is seen as a harmless way by politicians and authorities to show they are having effect. The numbers can be cherry picked to show whatever we like.

The biggest supporters of tough on crime/drug laws is the prison and police unions. this generates jobs in both fields and make for very effective bargaining chips when either position is threatened. There have been cases of the unions posting billboards near opposing politician homes!

The prison system isn't a private issue, it is primarily a government money machine that indirectly supports select politicians through union donations and intimidation. That is why it has been so hard to check

Forgive me as I'm quite ignorant when it comes to drug abuse.

What is it that tends to drive people to start using heroin initially ?

Next step up from prescription painkiller abuse, when legal painkillers become too expensive.

"damn near 50% of the people I chilled with growing up got hooked on the oxy during the pill mill days....some got strait and quit...most of us just kept it moving until they got so expensive that we had to switch to H."

http://www.bluelight.org/vb/archive/index.php/t-496626.html

http://www.bluelight.org/vb/archive/index.php/t-712613.html

Thanks for those links, very enlightening

Also they've made painkillers harder to get a prescription for, so the supply isn't there and addicted people look for alternatives.

I really liked the full episode of this: https://www.youtube.com/watch?v=ifbWtwlQkdE

Today a first taste can be doctor's prescription for pain. Pain killers are often potent, addictive, opioids. There is also some evidence that some pharmaceuticals mislead doctors about their potential for abuse.

At first, it's fun to experiment. Then you realize how no one fucking understands you and no one understands each other. That's depressing, buddy. Life is depressing.

Welcome! Yeah -- and you ask why people abuse drugs?

And it's even more than that -- people tend to be wrapped up in their worlds. Mostly, people feel alone. I mean, the world expects you to be a certain way. Look at all of these people -- on the internet, walking on the street. They're all in the motions. That feels like jail, when you see repetition, over and over.

John Oliver did a segment on Opioids that's pretty informative. Have a look: https://www.youtube.com/watch?v=5pdPrQFjo2o

The quick answer though is that it starts with prescription painkillers that are highly addictive.

For a portion, it is the same sorts of things that cause folks to use other drugs. Curiousity at first or looking for a way to not feel bad. People don't usually start with heroin - they go for 'tame' highs. Cigarettes, alcohol, pot. And just explore from there.

For a (probably much bigger) portion, this is the result of pain pill addiction. It got harder and harder to get the pills and they grew in cost, so some folks switched to heroin because the pull of addiction is so great.

I'm guessing despair is a big component. Most of the places around here in the Northeast where heroin is exploding you've got dead communities, with moribund economies, where there isn't much in the way of optimism for the future. Might as well get fucked up.

Plenty of despairing for the non-drug users too. A report by UK government's Drug Strategy Unit leaked to the press concluded drug use was responsible for the great majority of crime, including 85% of shoplifting, 70-80% of burglaries and 54% of robberies and cost £16 billion a year in the UK". Possibly proportionate figures for the US.

I can answer, I had a breakup in February that I'm still not over, I've been in CBT which isn't working as it's supposed to, and now I would do just about anything to have some respite from thinking about her, initially it came from playing around with some psychedelics at an earlier age (social-group) to now, mostly being ketamine, and with the occasional (I've so far managed to keep it under control) escalation to H. I live alone, and it's all to feel disassociated.

Hope you can get past all of that soon friend.

Hey. It's not easy, isolation doesn't make things any better. Alcoholics Anonymous saved my life, it gave me a place to be and it's free. I know it's not for everyone, but support groups really do help. There's also smartrecovery.

Some people try it (and other drugs) out of curiosity and boredom. Then, once they experience how good opioids make you feel, it's hard to stop.

Some good information here too https://alorecovery.com/upward-trend-heroin-overdoses-explai...

My reading of this is that this doesn't look like it will be a long term trend if that helps draw any comfort from the report.

The author's concluded cause is that it stems from an explosion of prescription painkiller use in the 90s/0s which was then cut down by tougher state and federal restrictions. Those people who gained a dependency during that time had to switch to illicit means once the legal sources became restricted.

With the tougher restrictions in place now, hopefully stopping the system from being fed with more users, it sounds like there will be a peak as the affected population escapes from (or succumbs to) their dependency.

Still a tragedy, but thankfully one with an apparent ceiling.

Big Pharma should have some audit questions to answer...

Executives from one fentanyl manufacturer, Insys Therapeutics, are currently being prosecuted:

http://www.slate.com/blogs/the_slatest/2016/12/09/executives...

But the fourth amendment states that heroin usage is legal and a constitutional right. Imagine a oligarchical dictatorship taking over in washington, turning america into a environmental wasteland, trying to take away your syringe. Then what do you do ? You got robots in the streets, taking your jobs, without you having a way to defend yourself by taking the edge off. No way to choose anymore. Because that's what pro-heroin or against heroin boil down to. Not being able to choose, after you chose wrong once. Choose Life. Choose a job. Choose a career. Choose a family. Choose a fucking big television, choose washing machines, cars, compact disc players and electrical tin openers. Choose good health, low cholesterol, and dental insurance. Choose fixed interest mortgage repayments. Choose a starter home. Choose your friends. Choose leisurewear and matching luggage. Choose a three-piece suit on hire purchase in a range of fucking fabrics. Choose DIY and wondering who the fuck you are on Sunday morning. Choose sitting on that couch watching mind-numbing, spirit-crushing game shows, stuffing fucking junk food into your mouth. Choose rotting away at the end of it all, pissing your last in a miserable home, nothing more than an embarrassment to the selfish, fucked up brats you spawned to replace yourselves. Choose your future. Choose life... But why would I want to do a thing like that? I chose not to choose life. I chose something' else. And the reasons? There are no reasons. Who needs reasons when you've got heroin?

And no- heroin is not funny. Not once. But neither is living in a society that tells you that you got all the chances, and you are a loser if you dont take them, and then there are no chances.

A Markov chain trained on your text is almost as rational as your original argument.

Choose life. I chose wrong on that couch watching luggage. Choose a starter you chose not to chose wrong once. Choose life. I chose not to choose a three-piece suit on that couch watching your friends. Choose leisurewear and dental insurance. Choose anymore. Because that's what pro-heroin usage repayments. Choose a three-piece suit on hire purchase in a range off. No way to defend your jobs, without you having a way to choose fixed interest mortgage reasons. Who needs reasons. Who needs reasons. Who needs reasons? There are not to the edge off. No way to defend of it all, pissing your syringe. There are no replace yourselves. Choose a fucking fabrics. Choose a starter home. Choose anymore. Because that's what pro-heroin?

The bulk of the parent comment is a quote from Trainspotting (http://www.imdb.com/title/tt0117951/) - just FYI.

Huh. That... actually makes a lot more sense now.

* Trigger warning *

I have to "subscribe via email" if I wanna read that post.

If they hit you with a subscribe-wall for content, go ahead and type this fucking jQuery into your console:

$('html').removeClass('drawbridge-up'); $('#drawbridge-root').remove(); //enjoy the article, buddy

Fucking idiots. Don't they know anything about internet etiquette and that they shouldn't use jQuery. There's a joke here -- they shouldn't be subscribe-walling me. Who the fuck uses jQuery and React at the same time, anyways? (Actually, I do :(, but I shouldn't!)

Anyways, back to my story.

When I was looking for a temporary place near Oakland, I went to Craigslist. Why not? I called up a guy who listed a room for rent. Turns out, he was renting out the room because the girl just died from Heroin OD. :( I ended up talking with him for like an hour. It was pretty sad.

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