Heroin addiction in the U.S | Hacker News Reader

Heroin addiction in the U.S

vice.com

47 pointsmxschumacher24 comments

Of all the things that make me wish I were smarter, being able to do something with public policy about heroin addiction is very near the top of the list.

I grew up in the nineties and my set of friends and I were all self-medicating our way through our teenage angst and emotional problems to some degree or another. It seems like almost overnight heroin showed up in our scene, not because anyone was addicted to opiate pain medication, but just because someone's dealer got some, exactly like this article describes.

Within just a couple of years, the collection of friends had an enormous rift right down the middle: half had tried and become addicted to heroin, and the other half of us felt like we had no choice but to get out of the scene and get our shit together.

To this day, I have no idea what factors other than chance put someone in the former group vs. the latter. Those of us that went into the latter group weren't any smarter and we didn't have better support networks. Of the dozen or so people in the former, maybe only 2-3 came out of it successful in the long-term. Everyone else is either dead, in jail, or living as addicts. I've spent a lot of time thinking about this to no effect.

Becoming a heroin addict isn't something I would wish on my worst enemy. It's the most awful thing to see someone you love go through that I can think of. Treating it as a criminal matter instead of a public health matter is absolutely the worst possible way to deal with it.

My experience as a 28 year old former heroin addict is equally as anecdotal but contradictory. As preteen and teenager I was a big pot smoker and later cocaine enthusiast. I medicated throughout those teenage years but never saw opioid pain medication or heroin even though I was fairly deep into the NYC drug scene. If you had asked then if I would ever inject heroin I would laugh at you.

Around my freshmen year of college (2007) pain pills started showing up. They were an instant hit and all my friends start doing them. I explicitly remember sniffing my first oxycodone in my dorm and thinking "this is what I've been missing my entire life". My life spiraled downhill quickly. As a lifelong programmer / math enthusiast I managed to get to my second semester junior year before my lifestyle really caught up. By then I was homeless, facing serious felony charges, OD countless times, doing whatever I could for my fix. Oxycodone was around for a few years before they reformulated and then you needed heroin to get high. I was shooting it only a week after first trying it. For the next several years I went from a middle class college student to a IV homeless heroin junkie. I caught very serious charges and took drug court. Violated drug court 3 years in and then spent a year in a bad NY jail where I leaserned to fight and throw urine on people. I learned to act like a fucking savage. I got out and finished drug court only to get addicted again.

I finally got on Suboxone about 4 years ago. I finished my degree and went from homeless to making 6 figures in those years.

I'm literally the only success story I know. For most of my peers they died or are doing long prison bids. We all started from pills, and I can honestly say I would never have started if it weren't for them. However I recognize the need for them and don't know if serious restriction is the right way either

Wow... It sounds like you and OP are roughly the same age, and the same age as my youngest brother, who also kicked heroin addiction (he kicked it a couple of years ago). What I'm wondering is if there is something generational here.

My father also kicked heroin before I was born in the late 70s, and since his recovery was such an important part of our life as a family, when we learned my brother was using, it shocked us, because it seemed so obvious not to do it. What I've been wondering is why the current crisis is affecting your generation more heavily than the ones between (or maybe I'm selectively seeing it in your generation).

Was it the easy access of oxycontin in the late 90s that finally trickled it's way through the culture and started a resurgence? Was it some other factor (the fashion cycle that goes in and out every 20-30 years)?

I do know my brother was exposed to it from a friend around his age, and of course during a painful part of his life, but I'm curious as to the origin because I see how culture and influence work it's way though our lives, but I'd love to have some hints as to why heroin itself made such a comeback.

> wish I were smarter

> public policy

IMHO there's a sweet spot where intelligence is only a small (but essential) part of the personality matrix necessary to tilt the game towards justice and healing, prevention and empathy, and just ramping good ol' raw smarts up to 11 ain't gunna help ya hit the target.

What are the other parts besides intelligence? ('O_O) Ummm...

Charisma, symmetric features, healthy microbiome, height, conscientiousness, good humor, preternatural patience, great parents/teahers/mentors (and what does THAT mean?), a thirst for politics, etc...

This reads like something big pharma would write to shift the blame away from themselves for causing the opioid epidemic and killing hundreds of thousands of people.

> Although most users still get their first taste from one of several prescription pills, heroin is now the single most common individual opioid taken by people first trying this class of drugs, the study found.

Or said another way: there are so many prescription opioids on the market that lead to addiction that no single one wins.

I don't buy the idea that the opioid epidemic was some natural and inevitable consequence of the economy or stress or whatever. "Oh look, some people addicted to opioids never took prescription drugs. See, it wasn't our fault after all! Now let us go back to the good old days where we bribed doctors to prescribe our stuff to everyone."

Can we stop with the Big [insert capitalistic entity] already?

I'm a regular listener of Dr. Drew Pinsky's podcasts. Aside from his celebrity doctor status, he's an addiction medicine specialist and has treated addicts for decades. He knows a lot about opiod addiction and talks about it frequently; he's in the middle of making a documentary on it. One thing I've learned about the epidemic from him is that it is not primarily the result of a big pharma marketing push. The biggest factor was the right-to-be-pain-free movement of the 1990s. This was a movement initiated by lawsuits against doctors on the behalf of patients who wanted pain management via medication and happened back when it was very rare to get an opiod prescription. Doctors started getting sued for not providing their patients with enough pain relief and this resulted in a sea change in medicine. Pain management clinics emerged and the number of opiod prescriptions skyrocketed and the epidemic kicked off.

Sure, the pharmaceutical companies benefitted from this, but they didn't create this, attorneys did.

I agree completely that the opioid epidemic was inevitable either. I'm from Dublin (Ireland) where heroin just 'appeared' in the 1980s. But it didn't just appear, a few criminal families introduced it, got richer selling it in deprived parts of Dublin, then with the increased wealth, spread the drug around the larger cities in the country.

I live in Stockholm and there is pretty much no heroin here. Don't let people say "there is", there's not. Compared to any large european city, you never see strung out junkies anywhere.

I would love to know how much of the crime difference between a city like Dublin and Stockholm can be explained by heroin (just heroin - we don't have much crack or breaking-bad stuff). I expect it's the majority of crime and definitely the majority of homelessness. Heroin is like a viral infection. If it appears in a city, you have to quarantine off that area, clear the infection or it will spread and then it's just chronic management after that.

Norway recently legislated for Portuguese style decriminalisation of drug use. Dealing hard drugs will still be illegal and dealers will still be pursued, but drug use and the behaviours typical of addicts will no longer be treated as criminal matters but as public health issues. This approach has had a massive effect in Portugal, dramatically reducing use rates, medical complications from drug use and related crime.

Obviously Norway is a different country from Sweden, but do you know what made them go down that route? Do they have a significantly bigger drugs problem there?

I find rehabs to be super dodgy and really only to be used in extreme situations for really short term timelines. of course they are better than literal prison but they are fraudulent and exploitative. I am in a quasi program currently and a drug test is billed to insurance at 595.00. I also failed a drug test for opiates even despite being sober. My councilor said it was possibly from eating a bagel although I doubt I even had a poppy bagel. The concentration of chemicals in my system was higher than it was when I really did fail because I took a half gram of heroin several hours before a test. This seems like a pretty big margin of error for a clinical laboratory, or they swapped samples or something. Either way I find rehab and drug counciling to prey on addicts worse than drug dealers and I find the industry disgusting.

not every story has a bad guy

This story does.

If you missed it when it first appeared last September, the Cincinnati Enquirer's Seven Days of Heroin was a gruelling but phenomenally powerful read.

https://www.cincinnati.com/pages/interactives/seven-days-of-...

Along similar lines, The LA Times' series on opioid addiction was gripping. It offers a story of how some people fall in to worse and worse spirals.

http://www.latimes.com/projects/oxycontin-part1/

I hadn't seen that Cincinnati Enquirer article though, so thank you for sharing. I'm not looking forward to hearing about the suffering, but I feel the need to educate myself. I worry this is the new normal.

Edit: God, the pacing of that article...all the lives lost in short vignettes, names unknown, punctuated by daily death/overdose numbers for just one city? Horrifying when you realize what a tiny facet this represents of the national suffering due to this epidemic.

Having first hand experience with the addiction epidemic in the U.S., education and rehabilitation is where 90% of all resources should be allocated. Not in the penal and policing policies, budgets or systems of influence. The website I edit raises money for a non-profit structured sober living in Los Angeles called Awakening Recovery which helps men become productive members of society after giving up any mind altering substance. https://www.awakeningrecovery.org/ https://latechnews.org/we-support/

unfortunately the rehab industry is filled with questionable players and downright con-artists:

https://www.nytimes.com/interactive/2017/12/27/business/new-...

(the entire nyt series is this from is excellent)

Is there any talk of legalizing heroin to make it easier to provide treatment options?

Or at least decriminalizing its use. Maybe leaving the process of dealing in large quantities as illegal but trying to see users of it as patients rather than as miscreants.

According to this article [0] from the NYT, nothing really compares to maintaining prior abusers on buprenorphine/methadone while working through therapy as far as efficacy for the masses. Granted, I think everyone responds differently to all sorts of things and have met some phenomenal individuals two credit 12-step programs for both their sobriety and living more fulfilling lives than they had even before their addictions, so mileages will vary.

Between the two, methadone's effects on QT interval and cardiac mortality makes me think that it's morally reprehensible to get patients stuck on it, while buprenorphine also has the prophylactic effect of muting any recreational opioids that patients taking it might encounter, reducing the positive feedback loop.

Regardless, it's definitely time for us as a society to focus more on helping people rather than marginalizing them.

[0]: https://www.nytimes.com/2018/01/17/opinion/treating-opioid-a...

Nothing so far as legalizing heroin is being considered in the US, but Philadelphia is considering becoming the first US city to offer supervised injection sites [1] as a method of harm reduction, but there's a lot of understandable resistance to the idea.

Portugal has taken steps towards decriminalizing drug use and treating it as a health matter, and has had success so far [2]

[1] https://www.npr.org/sections/health-shots/2018/01/10/5767570...

[2] https://www.drugpolicy.org/sites/default/files/DPA_Fact_Shee...

So does this mean opioids are an actual gateway drug?

American govt is helping or allowing it into the country. Their actions must be stopped first. U.S. Troops Patrolling/protecting poppy fields in Afghanistan. Yeah, go war on drugs....

https://www.politico.com/interactives/2017/obama-hezbollah-d...

http://humansarefree.com/2015/02/overwhelming-evidence-that-...

https://www.youtube.com/watch?v=qW2YWqVpT4E

http://www.washingtonsblog.com/2012/10/14066.html

A more reputable source: http://www.nytimes.com/2009/10/28/world/asia/28intel.html?_r...

> Ahmed Wali Karzai, the brother of the Afghan president and a suspected player in the country’s booming illegal opium trade, gets regular payments from the Central Intelligence Agency, and has for much of the past eight years, according to current and former American officials.

...

> Now, with more American lives on the line, the relationship with Mr. Karzai is setting off anger and frustration among American military officers and other officials in the Obama administration. They say that Mr. Karzai’s suspected role in the drug trade, as well as what they describe as the mafialike way that he lords over southern Afghanistan, makes him a malevolent force.

> These military and political officials say the evidence, though largely circumstantial, suggests strongly that Mr. Karzai has enriched himself by helping the illegal trade in poppy and opium to flourish. The assessment of these military and senior officials in the Obama administration dovetails with that of senior officials in the Bush administration.

This is the truth.The war on drugs is a war on people. Did you know that in 2000, opium production had almost completely stopped in Afghanistan, thanks to the Taliban? That’s like 80% of the worlds supply of heroin. The global market value of heroine is like half a trillion. Where do people think intelligence agencies get all of their black money from? That’s the real reason that we went to Afghanistan.

I've read that before the Taliban banned production they stockpiled a lot of it, then when prices skyrocketed they sold their reserves at a much larger profit.

http://www.historycommons.org/context.jsp?item=a0700poppyban

That’s very interesting, especially the timing.

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