They should also sell heroin in pharmacies so people can inject an accurate dosage. This would greatly reduce overdoses and drug trafficking.
> Heroin assisted treatment is fully a part of the national health system in Switzerland, Germany, the Netherlands, Denmark and the United Kingdom.
They found using pharma grade heroin worked better than methadone in weening addicts off heroin but it is difficult to get from Europe, so they did another study to see if hydromorphone worked just as well and it did, effectively cutting costs for any prescribed opiate treatment program. They also found by prescribing it, the addicts no longer were getting arrested everyday or participating in the black market, and made long term goals like savings since they no longer needed to live day to day committing crimes to support the addiction.
As for injection sites I hope Seattle doesn't make the mistake of not making sure treatment is also available or else they'll end up like Vancouver with a growing number of injection sites because of the months long waiting list to get into treatment. These facilities are majority used by street addicts too so you still have a large amount of fentanyl overdoses since it's casual users dropping dead in their houses who don't frequent the clinics.
Another issue with these facilities is there's constantly a crowd of gangsters out front ready to sell you drugs on your way in or collect debts from addicts in the lineup so some addicts don't go to the injection sites.
Patrick K Kroupa of LoD/Cult of Dead Cow managed to clean himself up with ibogaine doses and a lot of self discipline http://ibogaine.mindvox.com/articles/heroin-ibogaine-patrick...
There are only about 300 doctors with the correct licence to prescribe diamorphine to addicts.
http://www.nta.nhs.uk/uploads/uk-focal-point-report-2014.pdf
> Drug treatment in the UK encompasses a range of available treatments and services including community (and primary-care) based prescribing, community one-to-one and group-based psychosocial interventions to support recovery, inpatient treatment, day programmes, and quasi and fully residential drug treatment and rehabilitation support. Prescribing (principally methadone) for drug dependence is provided for stabilisation, detoxification, maintenance and relapse prevention. The National Institute for Health and Care Excellence (NICE)107 also provides guidance on a number of drug-treatment related topics and these are reviewed and updated regularly based on the latest evidence. Treatment interventions in any given area are expected to include advice and information, care planning, psychosocial interventions, community prescribing, inpatient drug treatment and residential rehabilitation. In addition, drug misusers should be offered relapse-prevention and aftercare programmes; hepatitis B vaccinations; testing for hepatitis B and C and HIV; access to hepatitis and HIV treatment; and needle exchange. Oral opioid substitution treatment (OST) with methadone is the most common pharmacological treatment used in treating heroin addiction; buprenorphine is also prescribed and injectable opioids, such as injectable methadone and injectable diamorphine, are also available but are not commonly used. Naltrexone108 is recommended as a treatment option to prevent relapse in detoxified formerly opioid- dependent people who are highly motivated to remain in an abstinence-based programme
There's some guidance available: https://www.evidence.nhs.uk/formulary/bnf/current/guidance-o...
Here's some statistics about numbers of people going into treatment. Frustratingly they don't appear to break it down by treatment type. https://www.ndtms.net/Publications/downloads/Adult%20Substan...
Frankly some stuff is really bad and should be kept away from people.
Safe injecting facilities are not about helping people be strung out. They're about reducing harm, both to the addict and to the rest of society, coming from drug addiction.
I think it's maybe too early to tell what impact CO/WA/etc legalization has had on MJ use.
I consider myself fairly well insulated from drug use. In my entire social group I know of only one person that has ever tried methamphetamine (which is rampant here in Australia), and none that have tried heroin. Despite that, if you set me to the task of aquiring heroin I'd be pretty confident in my ability to do so. I doubt I'd have to go through more than 3 levels of friends to find someone that could hook me up. And that's not even taking into account darknet markets (which I imagine would be fairly easy to learn how to use as a software engineer).
If I woke up tomorrow and decided to try heroin, there wouldn't be very much in the way of obstacles in my path.
So for me at least, there's not that much difference between the current situation and legalisation. Especially if said legalisation requires a prescription. Arguably convincing a doctor that I'm an addict and in need of heroin is more of a barrier to entry than finding someone that sells it now.
1. Buying it illegally funds criminal organizations
2. Quality is terrible, it's certainly adulterated
3. Association with low class and poor people
You can ingest or smoke opium products, too, if the needle is the off-putting part of heroin.
But yeah, another anecdotal perspective: I've had prescription opioid painkillers but don't have any particular interest in continuing to use them after the pain goes away. So if opioids were legal tomorrow, I don't think it would change my behavior at all either.
Heroin isn't too different, really. It's very addictive, has a low LD50, and when it's easy to get, people effectively get a free ticket to a brothel on an accelerating rocket-fuel train with rarely stops. If a drug can have that much power over the body, people might think we could create microdoses, and sell those, and then it'd be safe. But then, the market for heroin/tar/etc. would still be there, and would continue underground.
It's not as simple as "selling it at CVS w/o prescription will lower overdoses and dissolve the underground H market"
Most of the poorer Asian countries have been like this in my experience.
The next step is to provide safe injection and drug-exchange sites with immediately available drug counseling and detox. So an addict can trade 1g street-grade nasty drug for 1g medical-grade drug. Medical help needs to be available to swoop in right as they are coming down from the drug high. Hell, provide some free heroin to wean the drug addicts off of it on the condition that they participate in the detox programs.
This might sound like the unholy lovechild of libertarianism and nanny-state socialism, but I bet this ?pragmatic? approach will be cheaper in the long run, and centralize addiction/voluntary treatment in a location we [the people] can control. It would drastically cut down on ER visits from addicts, which is already a growing issue.
Yeah shame on people for having a different opinion then yours.
Meanwhile, with proper health care and psychiatric care, the same people who could have stayed within the system, could have greatly boosted research into all kinds of conditions that compel people to take hard drugs in the first place and we could have had this issue solved long ago.
Instead, the medical industry is hamstrung in helping them almost as much as the addicts themselves. But politicians from the left to the right get to look good on camera, and journalists can bravely declare more drugs will be off the streets as they show children walking to school, ensuring nobody will ever suspect they're setting those same children up for severe problems that will go untreated.
>Prescribed heroin would save thousands of lives and billions of dollars in ER OD cases and the acquisitive crime that this disorder causes.
Under what circumstances do you think doctors would be prescribing heroin? Because a person wants to give it a try? For recreational use? Doctors already prescribe (under heavy regulation) narcotics for pain relief. If they were to prescribe heroin, I can't imagine it would be cavalierly prescribed for anything, other to address existing addiction, not unlike methadone treatments today.
... and this is where most Heroin addicts start, actually, through prescription opiate use. Once a physical addiction is formed, heroin can be a cheaper or more accessible alternative to a prescription for say, Oxycontin.
I thought John Oliver had a good segment on it:
Something is wrong with the system for prescribing Oxycontin if black market heroin is ever cheaper or more accessible.
I mean first -
> If you get a prescription for heroin that would probably lead to addiction right?
Decently sure OP is suggesting replacing obtaining heroin from the street with obtaining it through a doctor. As such, only existing (and new) addicts are effected; you would not create addicts.
Alternatively, this story you have told is already the case with other prescription opiates.
> Now as an addict you want more
> continually up the dosages prescribed, no?
I mean, do alcoholics do this? Or gamblers? Adrenaline junkies? Yes and no.
Basically, most of what you know about drugs is inaccurate, and addiction (and escalation of addiction) is complicated. For instance, the rat park experiments indicate that addiction is a coping mechanism - rats in individual cages experience addiction; rats in group cages, not so much. Simply by obtaining the drugs from a sympathetic ear, you can reduce the dependence on the drugs.
Here's a thing:
https://mic.com/articles/110344/14-years-after-portugal-decr...
The first abstract actually describes a theory that cannot be correct given the Rat Park experiment as described on Wikipedia, due to group PC (no new rats were supplied to that group). Or, rather, a theory that does not explain group PC.
Apparently the results have been pretty good so far: http://sciencenordic.com/heroin-clinics-improve-addicts-live...
The idea is you stabilize people's lives. Prescribe them heroin for say 3 months to start with. Their lives are no longer endless crime, prostitution, police cells etc. They can get housing and other things sorted without having to also find $1000s a month for a drug habit.
From that the community is already seeing a benefit (less crime and the market for black market heroin mostly vanishes), and then from that you can start helping people reduce their dose and get proper drug treatment while living a far more normal life.
There will probably be some black market dealing, but it will be much smaller scale and won't have anywhere near the scale.
Because it's off topic?
You can't seriously think HN is not anti-prohibition?
To move forward we need to be practical.
One city in the entire US is getting an injection room.
Why start talking about the legalisation of heroin? If it works but it can't be implemented why discuss at this point when we are discussing something that does greatly help and is being implemented.
These are different approaches, not necessarily mutually exclusive but by changing the topic you devaluing the important discussion of injecting rooms.
This article is about injecting rooms not ending prohibition I think it is off-topic?
There are plenty of articles on decriminalisation and legalisation out there to have that discussion.
If you think it's inappropriate for HN, feel free to flag the submission and move on.
If the LD50 is very easy to arrive at in everyday usage, then I don't see this helping out very much. You could sell heroin in doses << LD50 for a high regulated price, but then you will end up with black markets which sell much larger doses at lower prices (if the substance is easy to produce in various quality levels). If the price to get "safe" heroin is not artificially increased, then it would be way too easy to accidentally have too much, especially if herion is highly addictive, which, it supposedly is.
People would just end up riding their doses up to dangerous levels, in which case they would now have a dependency on heroin. Would it bet better for everyone to have a safe, controlled dependency on heroin, or for 5% of people to have an unsafe, uncontrolled dependency on heroin?
For an answer, you can just look at alcohol, which is typically assessed as having roughly similar social harm to heroin (although it varies by source). Were things better during prohibition, or today?
Edit: Ideally, humans wouldn't be consuming poison? But, what is poison? It's a lot more complicated than "alcohol is bad" or "heroin is bad". Maybe you are right, letting down the flood gates will surely kill people who don't have control, and we'll be OK asymptotically. Making alcohol legal certainly killed people who wouldn't have died, and saved people who would have died. At some point, this is just a variation of the trolley problem. If heroin was made CVS-able without prescription, I would not guarantee that I wouldn't try it, and that scares me because I know how dangerous it is.
When it comes down to it, not all drugs are equal. Heroin isn't "alcohol but worse". People who drink tend to get pretty nasty sometimes, and that's a social harm that someone who's nodding doesn't perpetrate. And in terms of physical harm, heroin is actually pretty low compared to alcohol. Lots of people destroy their livers with alcohol and die early, while there's an awful lot of rockstars who do piles of heroin and cocaine and live to their 70s and beyond (we need to start worrying about the kind of world we're going to leave for Keith Richards).
The harm comes from getting bathtub stuff of uncertain potency and purity, and from the things people need to do to afford their fix. If it's clean and affordable you tend to do fairly well on both the 'personal' and 'social' harm aspects.
Obviously that's not how DARE told you to feel, but the fact is that the current state of things is not the only one that is ever possible. You don't know what social use would look like in a society with legalized heroin usage.
If you eliminate the need to commit crime to obtain black-market drugs at obscene prices, a lot of the harms of heroin go away. Some people will still choose to do it, but we free up a whole bunch of police money that can be redirected to free treatment resources to help people quit when they realize they aren't going to find happiness in drugs.
If everyone did heroin today - instead of drinking - the world would fall apart.
Can you imagine 50 000 people at a Football game, all doing smack? Sure, it would be a fun game. Within days, 10% of them would be full on addicts. Within weeks maybe 50% of them would. Those people would go through hell or high water to stay permanently high.
Giving them 'cheap and safe' smack at Walgreens is not going to help them - it would destroy them.
"If you eliminate the need to commit crime to obtain black-market drugs at obscene prices, a lot of the harms of heroin go away."
Have you actually ever met an addict - do you realize how insanely destroyed their lives become? Do you think that by making the drug cheaper and more accessible that this is going to 'make them better'? No - it's only helping to kill them.
Your perspective seems very out of touch with the reality of things, and I question whether you've actually really talked to any of them at all, and instead are simply arguing in respect to some caricature of one.
> Can you imagine 50 000 people at a Football game, all doing smack? Sure, it would be a fun game. Within days, 10% of them would be full on addicts. Within weeks maybe 50% of them would. Those people would go through hell or high water to stay permanently high.
You sound like my middle school DARE teacher talking about how our brains would fry like scrambled eggs on MDMA. (ie those numbers are pulled out of your imagination)
Here's probably the most strict source on drugs saying that the addiction rate is 23% https://www.drugabuse.gov/publications/drugfacts/heroin
That's still terribly high, and I think your ideas have an element of truth, but your approach to using unsubstantiated numbers and overall tone of self-assuredness is just kind of sad to see.
I get what you are saying, but I don't think you're applying the general context: everyone doing heroin as common as they drink - that would lead to massive addiction and total health crisis.
So it's not '1 game' of 50 000 users, it's every game.
Frat parties, bars, dinner parties, 'netflix and chill', I mean pervasive open used of opioids. This is 'where people drink alcohol' - so now replace alcohol with opioids.
23% addiction in narrow circumstances, but considerably higher across the board.
A 'University' that had widespread use of heroin - as widespread as alcohol - would crumble very quickly. Near 100% of the student body would be addicted.
Nicotine is addictive to 100% of people if they smoke enough packs - the chemicals just do their job, and that means pushing the body to 'demand more'. For some, it means more smoking than others, and many would chose not to smoke enough to get hooked - but it will get you 100% of the time, with enough cigarettes.
"d I think your ideas have an element of truth, but your approach to using unsubstantiated numbers and overall tone of self-assuredness is just kind of sad to see."
No. Absolutely not - and you proved it yourself: a 23% addiction rate over a small sample would lead to considerably more over time.
Can you imagine 23-70% of regular people addicted to heroin (because that's what would happen if they did heroin as much as people drank alcohol).
'23% of the population hooked on heroin' (and this would be a low, conservative number) would be totally devastating to civilization - that's not an 'extreme' or 'irrational' position.
It is 'extreme' and irrationally 'self assured' to posit that alcohol and heroin represent the same level of public health risk to society.
They are totally different substances.
For the record I've been prescribed opioid derived drugs and did not get hooked. Why? Because I know how addictive it can be, so I popped some to see what it was like and trashed it.
This world where everyone uses opioids pervasively won't happen because people would know or soon figure out how pointless and devastating it is. It's like asking why we don't have cultural customs where everyone murders a new family member each monday. Any culture dumb enough to try no longer exists.
In reality there is perhaps a good historical example of mass opium addiction you could tie your narrative to though: https://en.wikipedia.org/wiki/History_of_opium_in_China
http://www.economist.com/blogs/dailychart/2010/11/drugs_caus...
https://en.wikipedia.org/wiki/David_Nutt#Government_position...
This is absurd.
There is no place on earth where it is 'typical' to consider alcohol to be more dangerous than heroin.
The ridiculous 'research' on alcohol v. heroin make comparisons as to 'how many accidents are caused by each' etc. in society, which is obviously not a fair comparison considering once is widely used, the other very infrequently.
Opioids are extremely addictive, and destructive in almost all cases of use.
Demonstrably false. The vast majority of opioid users are recovering from surgery, taking Tylenol 3, etc. You're basically just talking out of your butt here.
1) Dosage/concentration uncertainty
2) Contamination of a lower strength opioid (say, morphine or heroin) with a much higher strength one (fentanyl or fentanyl analogues)
3) Poly-drug use -- such as combining opioids with benzos to exploit synergistic effects
When it comes to pharmaceutical-grade opioids, the doses are known and measured and there's no risk of contamination with unknown amounts of fentanyl analogues. Indeed, the mechanisms of drug prohibition actually incentivize the use of extremely high potency/volume opioids such as fentanyl.
The third issue, poly-drug use, also is a consequence of prohibition -- the prices of opioids in the black market are artificially inflated (if you don't have the requisite permission slip for the drugs, you need to invest in all sorts of countermeasures to avoid being put in a cage and your product seized), so users need to economize, and this sadly happens by combining benzos with opioids, which can lead to fatal respiratory depression. This is also a symptom of prohibition and is not inherent to opioid use.
There are definitely real harms involved with / caused by opioid use today -- but most of those are caused by (or greatly worsened by) opioid prohibition.
As for the LD50 issue -- yes, opioid-naive (non-tolerant) users will have a low LD50 but they also won't need much a dose to get the effects. As people get opioid tolerant, the dose that will kill them also increases in step. It's not a case of "user needs higher and higher dose but needs to not cross a fixed LD50 threshold". Because opioids mostly just affect opioid receptors (unlike stuff like alcohol, which is hepatotoxic), tolerance means the LD50 increases in step with the effective dose.
The popular picture of the heroin addict who has to use higher and higher doses to get the desired "high" is a creation of prohibition -- there's no inherent need to do anything of the sort if one has proper medical access to the right dose of prescription opioids. Moderate and safe opioid use is difficult under prohibition if only because it's hard to moderate oneself without precise and pure measured doses.
There's plenty of people who engage in moderate long-term opioid use, between pain patients or "high functioning" heroin users. Those people tend not be the face of opioid use precisely because they have access to the drugs in ways that are stable, safe, not life-ruiningly expensive, and doesn't place them in regular contact with criminal organizations. They aren't exposed to the worst harms of prohibition and that's why they're able to keep using (without anyone knowing that they use) and have a stable career/family.
To be clear, none of this is to say that opioids are harmless or that should be handed out like candy -- they're serious drugs and should be used responsibly by people who are aware of the risks/contraindications.
Yes, it is. It's extremely addictive, and is very well known to destroy lives.
Total nonsense.
Please tell me what 'harms' come from heroin treatments?
The primary 'treatment' for heroin addiction is to simply 'not do heroin'.
Stop doing it.
Ultimately, that's the only way out.
" I think we simply have to accept that people are going to want to use these substances, and make it as safe as possible for them to do so."
No - again false. Law of Supply and Demand: if we make it hard enough to get, and raise the barrier of supply, and also try to push back demand by teaching kids not to use it - then it becomes rare.
Enabling users lowers the 'difficulty of access', like lowering the cost curve - and creates more usage.
Anyhow who is caught in public, high on heroin, can be asked to go to a dry out clinic where they won't have access to it. They have to go through withdrawal.
This is true for people who do not consume heroin a priori. For the others, suddenly stopping heroin use can be life threatening. Most people need assistance to wane off of things like that. Also, I think you are right that enabling will increase usage, but you must also consider the black markets which are enabled in response to disabling the regulated markets.
It seems like a majority viewpoint on this thread is that it's better for more people to be using real opioids safely than to have a smaller, effectively invisible/black-market population using "opioids" very, very dangerously.
Wikipedia gives the overdose level at 75-600mg[2], and Erowid reports the recreational dose at 5mg[3] (both for "opiate-naive" individuals, i.e. no tolerance). >10x is a high safety margin; alcohol is of the order of 10x for reference.
The piece you're missing here is that the primary risk of accidental overdose is greatly increased with illicit heroin where the purity is unknown, and can fluctuate wildly as it always cut to some extent, but seldom predictably so.
In the case of heroin, most of the harm from usage is directly caused by prohibition.
[1]: https://www.ncbi.nlm.nih.gov/pubmed/11705488 [2]: https://en.wikipedia.org/wiki/Heroin#Overdose [3]: https://www.erowid.org/chemicals/heroin/heroin_dose1.shtml
Only a single order of magnitude is not enough of a safety margin, depending on the substance, and how easy it is to administer the substance. Is alcohol's LD50/dose ratio an apt comparison? Does alcohol require a higher administration energy than heroin? It seems like it would be easier to "accidentally" consume half a gram of heroin in a small amount of time, as opposed to "accidentally" consuming 100 beers (or 2 handles).
Drug users experiment across this mere 10x range effortlessly, according to your source:
> As usage increases, however, the doses get much higher
Apparently, they get to 100x. Crazy!:
> The Swiss found that users offered unlimited quantities would, on average, max out at between 300 and 500 mg
This seems to support my view. I can't help but imagine a dystopian future (past?) where they start selling a soda called "HeroHera" which has trace amounts of heroin in it.
Anyways, it seems pretty dangerous for brains to depend on the naive-LD50 of heroin. Forgetting to consume it after one has an established a dependency must surely be an issue. How do we know that a potential widespread dependency on heroin and a requirement for widespread heroin sanctuaries won't actually cost more than the war on drugs?
Any pharmacy that administered or dispensed pharmaceutical grade heroine would suffer public backlash from their communities. They would be forced to specialize and essentially become a new flavor of methadone clinic.
Plus, there is the whole acting in good faith and professional judgement thing that seems like it would be a large hurdle to overcome.