Norway to test free heroin for drug addicts
afp.com
afp.com
In the U.S. we commonly see waves of "heroin" overdose deaths over the course of a single weekend. I use quotes because it's usually not diacetylmorphine, it's a fentanyl analog. While they're both illegal, fentanyl doesn't require large poppy fields to manufacture, and it can be more easily concealed for smuggling due to the significantly higher potency by weight and volume.
And the cause of those overdose deaths is typically a new illegally smuggled batch of it showing up in a specific area that may or may not be diluted correctly, and even if it is diluted correctly, it may or may not be significantly more potent than the batch that was being sold the day before.
The "normal" fentanyl that we use to control chronic and postoperative pain, and for anesthesia, is active and easily felt at the 12.5-25mcg level. Some of the fentanyl analogs, including some we use in hospitals, are active at less than 1/100th of that. You simply can't see that or handle it safely, so illicit "heroin" is dry mixed with other, ideally inert, powders.
This works fine for things like a cake mix, where the whole thing is going to be further processed with liquids added to it, but for a potentially lethal drug it's extremely dangerous.
As a result, people accidentally take 50x or more than they thought they were taking, and first responders like police and EMS are at serious risk of overdose themselves, simply from touching a surface or a plastic bag that looks empty.
There is virtually nothing we can do to prevent that unless we move the demand into a regulated channel like a pharmacy.
A nice side benefit to distributing the drugs for free, as long as it isn't overly restrictive, is that it can potentially destroy the blackmarket by eliminating the profit motive as well.
No intervention is going to motivate a dope-sick zombie to get to a hospital as much as the promise of being relieved of it - "can I talk you into coming in for counseling? there's going to be heroin and a nurse with steady hands."
And you entirely cut off the illegal sales market, because the government is never going to provide this service to a non-addict - there's no price at which a dealer survives this market and sells to your kid.
An addict should prefer it to the black market, because they don't have to worry about a fentanyl overdose.
If addicts are being produced out of legal opioids and switching to heroin, then this catches them before they are entirely beyond help.
All in all, this is excellent fiscally as well, because it prevents money flowing out in the dark out of the country (instead, legal imports to doctors) - and possibly, cheaper than ambulances every other week until the inevitable happens.
I know there are a lot of good responses to this argument ("you'd be paying for a jail cell anyway", "it's a net benefit to society", etc), but you have to remember that there is a very large portion of society that think drug users are inherently terrible people unworthy of help and won't listen to any logic beyond that. Although HN is made up of people who are willing to think through arguments fully and recognize why this program would result in a net-benefit to society (at least, in theory - it hasn't been tested yet), it's important to remember that people exist outside the HN bubble. To these people, the idea of helping someone obtain drugs (especially the government helping someone obtain drugs) is a terrible idea, hard stop.
I know some people will still prefer punishing others to helping them, but at that point I don't think their opinion is worth much.
It's certainly not the drug itself that is so expensive; the unit cost of an individual dose of any of the common opiates, when purchased through a pharmaceutical channel, is going to be less than a rounding error.
I'm unsure if anyone is 'entirely beyond help', but if people suffering from opioid user disorder have a point of no return that point is well after switching to heroin. Many people have recovered from a heroin habit.
> The Norwegian Directorate for Health and Social Affairs has been tasked with proposing an experimental project to identify patients likely to benefit from the programme, to examine the implementation method, and to calculate the costs...The first treatments under the project will begin in 2020 at the earliest, the health ministry said in a statement. The initiative could benefit up to 400 drug addicts, according to the daily Aftenposten.
So it is a small-scale, but still radical, experiment that may begin in a few years. This addresses my first immediate question, which was "why wouldn't this just attract heroin addicts from around Europe and beyond?".
>...93 per cent drop in theft and burglary. ‘You could see them transform in front of your own eyes,’ Lofts told a newspaper, amazed. ‘They came in in outrageous condition, stealing daily to pay for illegal drugs; and became, most of them, very amiable, reasonable law-abiding people.’ He said elsewhere: ‘Since the clinics opened, the street heroin dealer has slowly but surely abandoned the streets of Warrington and Widnes.’ https://www.spectator.co.uk/2015/05/the-case-for-prescriptio...
This is the news to me. Anyone know why? My thought is that unlike the US they aren't use to dealing with this so Narcan isn't as prevalent (this is a throw it out there guess backed by no research). I would of guessed Eastern Europe/former communist states (Poland, Bulgaria, Hungary, etc.).
The first batch of patients start in 2020, with a max size of 400. Let's see if we can help those people, who are probably chosen more carefully then a full program would be, before thinking about the issues scaling up will cause.
Norway will slowly collect addicts just as SF and LA have collected homeless. They aren't as dumb and helpless as you think, they will gravitate to places where their situation is condoned and supported.
Norway should expect a minimum of 50k Americans to scrounge together for a one-way trip...free heroin? That is a fantasy for any addict.
SF conducts a sort of census of their homeless population. One of the questions asked is where the person lived when they became homeless. The majority are from SF[1]:
> Sixty-nine percent (69%) of respondents reported they were living in San Francisco at the time they most recently became homeless. Of those, over half (55%) had lived in San Francisco for 10 or more years.
The idea that SF "collects" homeless people (from elsewhere) is a myth not supported by data.
[1]: http://hsh.sfgov.org/wp-content/uploads/2017/06/2017-SF-Poin...
It is, actually, supported by the data you just posted to refute it, which indicates nearly a third of SF homeless were not in SF when they became homeless.
What are the numbers like for other cities?
Those numbers aren't collected in a national and standardized way. Even if other cities collected data about this question, please don't compare the numbers without also comparing survey methodology.
SF and LA have higher absolute numbers of homeless because both cities tolerate it.
What’s the problem with needle exchanges?
What sort of alternative strategies do you have in mind?
If they need to commit crimes to get more drugs, then I imagine that they're likely gaining criminal records and "falling into a bad crowd". This kind of stuff makes it hard to rebuild their lives when/if they choose to.
This is out of my wheelhouse and am just speculating. I would love to see data or research on this, though, if it exists.
When did Norwegian taxpayers sign up to fund a global heroin haven?
It's pretty simple...if you are a heroin addict anywhere in the world who can afford a one-way ticket to Norway...
Of course much of the free heroin will end up being resold elsewhere, and causing misery elsewhere.
Norway could end up causing a heroin epidemic as their high-quality drugs flood Europe. This is like Christmas for organized crime...a government manufacturing a potentially unlimited supply of quality drugs.
They stop spending all their time doing whatever it takes to get heroin. They can do other things with that time. Get jobs, for example. It's basically opening the door to rehabilitation.
If by "rehabilitated" you mean "not addicted to heroin", sure, not so much. If you mean "no longer a danger to society", very much so.
From a quick wikipedia search: Heroin assisted treatment is fully a part of the national health system in Switzerland, Germany, the Netherlands, Canada, and Denmark. Additional trials are being carried out in the United Kingdom, and Belgium.
^I feel like you missed the boat on this one.
> How does free heroin rehabilitate anyone?
I don't know if you've noticed, but the current norms of tackling addication aren't working well at all. Countries that have experimented appear to be achieving good results. See https://www.theguardian.com/news/2017/dec/05/portugals-radic...
On portugal (from https://www.independent.co.uk/news/health/norway-parliament-...):
The Norwegian Health Committee is planning a trip to Portugal in February, which decriminalised personal possession of drugs in 2001. The country made the move following a heroin epidemic and the highest drug-related Aids deaths in the European Union (EU).
It now has the second lowest drug-related deaths in the EU.
> When did Norwegian taxpayers sign up to fund a global heroin haven
Here (ignoring the other part of your loaded question): https://www.independent.co.uk/news/health/norway-parliament-...
The GP asked for alternative strategies, which you have not provided, and which would be helpful.
Selling something that is free is not a lucrative business for the Mafia. I think you have to make up your mind about the exaggerated scenarios you're imagining.
Here's two straightforward policies that would ameliorate these concerns:
1) Dole out the drugs on site. This is done already all over the world all the time. No take home doses.
2) This is a last resort of Norwegian citizens who have tried other methods of recovery. If you read the article, you'd see it will affect about 400 people. This is a good start, hardly a global heroin empire.
It can only be considered truly free if the supply is unlimited per person, as in an "all-you-can-eat" model.
If I gave you 100 milliliters of milk per day then you could technically make the claim that you have milk for free, but you won't be able to drink even a full glass of it.
As for the notion of heroin addicts being able to afford plane tickets... That's hilarious and incredibly ignorant bordering on delusional and downright stupid.
This program is working for more than 20 years in many European countries already. Why would it all the sudden fail in Norway?