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Comment by tcj_phx | Hacker News Reader

> It'd be far more cost-effective to reduce the need for acute care by providing access to addiction treatment before things get to this point. Easier said than done I suppose.

Johann Hari has pointed out that it's very effective to just give heroin addicts pure heroin and a safe place to inject it. Switzerland has 'essentially' [edit] eliminated opiate deaths with this strategy:

[edit: added 'essentially' in response to tptacek's comment below because the swiss probably haven't gotten rid of 100% of their opiate deaths]

https://www.irishtimes.com/news/health/johann-hari-heroin-in...

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In reports about the Swiss strategy and in this story about Hari I see plausible claims that Switzerland has eliminated deaths due to needle-borne HIV, but no claims anywhere that prescribing heroin has eliminated all opiate fatalities. Can you cite a more rigorous source?

> but no claims anywhere that prescribing heroin has eliminated all opiate fatalities. Can you cite a more rigorous source?

I have edited the comment above to add a word.

The friend who taught me about her opiate addiction knew how to manage her dose pretty well. Then the mental health industry got her addicted to benzodiazepines, which changed her tolerance. She overdosed on me when trying to get off the benzos. The fire department revived her, then disappeared into the night. Those two doses of Naloxone stabilized her for about 2 weeks...

A lot of the deaths in the United States' present opiate overdose epidemic has to do with contamination of the heroin supply with more powerful synthetic opiates. When the supply includes elephant opiates, addicts don't know how much to use.

I see credible claims that Switzerland has reduced overdose deaths from opiates with this strategy, but none saying they've "effectively eliminated" them. I didn't look very hard, and you see familiar with the subject. Can you point me to a resource establishing this?

The thing I see reports saying Switzerland has effectively eliminated is deaths due to needle contamination. That's not hard to believe (but then, you could get that effect by giving addicts clean needles).

In the article you posted, I see Hari saying that Switzerland's practices have eliminated wounds and abscesses he attributes to drug contamination. That, too, is very plausible. But most opiate fatalities are not caused by injection site wounds; they're caused by overdose.

I think there might be some confusion. Switzerland itself claims that nobody has died from overdose of officially prescribed heroin. That, too, is totally plausible. But Switzerland still has a street opiate drug market problem!

> But Switzerland still has a street opiate drug market problem!

The planet's various governments created the street drug marketplace by making desired substances illegal. The United States government created the country's drug culture by lying to people about the actual hazards of these desired substances.

Perhaps Switzerland has not eliminated opiate deaths, as my comment originally indicated, but the Swiss are doing better than everyone else in making progress at helping people with opiate addictions.

  Results from the Swiss studies, however, show that 
  mortality among patients in heroin assisted 
  maintenance programmes is low, and lower than for 
  patients in other maintenance programmes.14 In 
  addition, the wider safety concerns could not be 
  empirically confirmed in Switzerland or the 
  Netherlands.15 Finally, the incidence of heroin 
  dependence has decreased greatly in Switzerland 
  since the start of the trials, and currently 
  heroin has a more negative image than it did 15 
  years ago.16

- http://www.bmj.com/content/336/7635/70?variant=full

ref #14 (above) says:

  CONCLUSION: Mortality in heroin-assisted treatment 
  was low compared to the mortality rate of Swiss 
  opioid users 1990s (estimated to be between 2.5 
  and 3%). It was also low compared to mortality 
  rates of opioid users in other maintenance 
  treatments in other countries as reported in the 
  literature. The SMR was also lower than that 
  reported in the only meta-analysis in the 
  literature: 13.2 (95% C.I. 12.3-14.1). The low 
  mortality rate is all the more noteworthy as 
  heroin-assisted treatment in Switzerland included 
  only refractory opioid addicts with existing 
  severe somatic and/or mental problems.

- https://www.ncbi.nlm.nih.gov/pubmed/16002023?access_num=1600...

Not quite "eliminated", and I don't have a source in English, but drug overdose deaths fell by about two thirds between 1995 (Heroin prescriptions started in about 1994) and 2012:

http://www.suchtmonitoring.ch/de/3/7.html?opioide-mortalitat

In 2015, there were about 10 cases of needle-borne HIV infections in Switzerland, out of a bit more than 500 overall.

Vancouver is doing this too:

http://www.cbc.ca/beta/news/canada/crosstown-clinic-heroin-a...

Hari is a self-admitted liar.

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