Trapped by the ‘Walmart of Heroin’ | Hacker News Reader

Trapped by the ‘Walmart of Heroin’

nytimes.com

88 pointspmcpinto50 comments

A problem that could easily be solved by simply prescribing them all heroin. This was successful when it was done in the UK (https://health.spectator.co.uk/the-case-for-prescription-her...) although of course the government eventually shut it down.

Well, maybe not "easily," but I agree. Worth noting that heroin prescriptions have been happening in Switzerland for going on 20 years now, with excellent results.[1]

The article was fantastic reporting by the way. Hard to read, but difficult to put down once you start.

[1] https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

It's becoming a logistical problem in Switzerland to have so little replacement as they've aged.

There aren't enough to warrant many centers anymore, but each closing means some would have travel further, possibly dropping out.

The US doesn't have to worry about these kinds of problems.. or about who will buy it's newly acquired crop domestically with veterans such as the one in the article coming home with trauma and addictions.

Still, a little sad for the US if Portugal and Switzerland are the first signs of European dominos -- Russian and domestic customers can't make strong demand for agriculture at US scale.. Asia is too brutal about drugs and Africa too poor..

Continued financial support for Afghanistan and less black money for operations. Is this an example of nothing is ever easy or of nothing ever goes to plan..

> It's becoming a logistical problem in Switzerland to have so little replacement as they've aged.

this sounds like a pretty good problem to have.

> this sounds like a pretty good problem to have.

Think that one through. Who pays for the disabled, unemployed, and elderly?

unless I misread the post, the logistical problem is that there aren't enough new heroin addicts to justify keeping so many centers open. not sure what that has to do with paying for the unemployed and elderly.

20 years is enough to quit anything. Something here doesn't add up.

Have there been a lot of new heroin users entering this system over the past 20 years? Or have these governments been supporting the drug addiction of a small handful of people who refuse to kick the habit, despite 20 years of therapy?

Also, who fills the prescriptions? Or do the doctors just prescribe whatever the patient can get from a dealer? How does free healthcare the dealer?

GP's great article is paywalled.

It's not necessarily bad to support the drug addictions of a small handful of people for 20 years.

Some people just suck at life, due to mental illness. They're going to be addicts regardless. It is insanely cheaper to just give them drugs than to close your eyes and let the other costs of them being unpredictable, homeless and sick add up.

But isn't the point that you require treatment alongside the drug? And yes, supporting addiction over decades is hugely damaging.

Also, please be more empathetic towards your fellow human. Giving up on someone doesn't help.

"Predisposed to addiction" is how we say it in the industry, and it really means "has a shitty life."

The diagnostic criteria for addiction are whether the person can't stop doing the thing despite wanting to, and whether doing the thing causes problems. If they're stable-- whether on or off medication of any kind including opiates-- then the addiction is considered successfully managed.

Also, mental illnesses are never cured. They're managed, and the best possible outcome is stability over a lifetime. Typically stressors induce un-managed relapse, so staying on dope and keeping tolerance stable really is the best outcome for people living in adverse circumstances.

So, instead of helping these people with their "predisposition", these countries are helping with their habit. How is this admirable?

Because it's better for them to have legal access to a controlled, safe supply than to be robbing houses for money to score who-knows-what off the street?

Making drugs illegal has never stopped anyone from doing drugs, it just adds additional problems to their life (hey, they have a felony record now, no one will hire them).

It’s the worst solution, except for all the rest.

Because you can't just wave a magic wand and cure all of someone's problems, and because being a heroin addict with a reliable, legal, relatively safe supply is probably a lot less bad than being a heroin addict without that.

And why are you assuming that these people are not getting any other help? The two aren't mutually exclusive. In fact, not having to deal with all of the risks and stresses of scoring illicit drugs probably makes it significantly easier to make improvements in other areas of your life (which, as well as being a good thing in itself, might in turn make it easier for you to kick the addiction).

Absent convincing evidence to the contrary, it's entirely plausible that this approach is doing a good job of getting people off heroin, as well as improving the lives of those who stay on it. The fact that some people remain addicted doesn't undermine that.

> And why are you assuming that these people are not getting any other help?

To the contrary, I'm wondering how effective is this help, if it fails to wean someone after 20 years. Or, there must be some constant influx of new users.

Is your goal to get people to stop using drugs, no matter what? Because we've seen how well that's worked in the U.S.

If they're solving all the other problems in these addict's lives - if they're able to be functioning members of society - isn't that enough? Why would you upset all that progress by making stopping drugs priority #1?

A lot of people are still under the impression that using Heroin daily has extremely damaging physical effects along the lines of a serious meth habit. A lack of education about the issue is what leads to this kind of outrage, ime.

I'm concerned about a loss of empathy due to drug use. Over years of drug use, neuroplasticity could cause a permanent reduction in the capacity for empathy, and concern for other people & society at large.

It's like CBT but in reverse.

Couldn't that be true for other prescription drugs like Prozac? Or maybe for NSAIDs which I think have had unexpected affects due to sensory changes.

Given that the FDA requires no long term testing of any nature, it seems contrived to pick on one longterm prescription as flawed because you have some kind of problem with not blackmailing people into treatment they don't want and that isn't helpful.

Forced therapy is a form of punishment, and the real intention behind mandating it for something you could just manage is to try to use the addict as an example of applying the stick to people with the "wrong values" for the rest of society.

The result of that is cross generational addiction problems because prisoners have children, children get traumatized by stressing their parents and trauma is addiction predisposition.. "a shitty life."

Why does it matter if they stay addicted? As I already said all the downsides of drug use are fully avoided by using medical grade drugs. It's like eating fast food without getting fat.

Street drugs cause loss of life, health problems and financial distress which leads to an increasing population of chronically homeless people, higher medical costs, loss of tax income, theft or becoming drug dealers themselves to pay for drugs, etc.

Imagine for one second that you could solve all of these problems at once with medical grade drugs and all you have to do is let drug addicts visit a doctor regularly. How is this not admirable?

Drugs of abuse are incredibly cheap, and doing dope for decades doesn't harm anyone.

You can take solace in the knowledge that these recalcitrant addicts will face eternal torment in Hell for refusing to kick the habit

Not just the UK. Switzerland, Belgium, Germany, Denmark and The Netherlands too.

The Netherlands had a very bad heroin epidemic in the 90's which has virtually disappeared thanks to this approach.

The two main takeaways in my opinion are: Treat heroin addiction as a health issue instead of a criminal issue and don't just give out heroin, always couple it with social services, treatment, etc.

Note that this approach mostly solves the visible issues. Encampments with heroin users are gone, along with all the trash, safety issues and health issues. The addicts are still addicts but the enormous cost to the community and the health of the users is enormously lessened. Also, because there's nearly no business for drug dealers anymore, there are virtually no new users. Nearly all heroin users in The Netherlands are over 40 years of age.

There are clearly huge benefits to this approach. However, according to some addicts there is also a downside. Now that there's a great way to solve all the visible issues, there is less of a focus on getting the addicts clean they say.

See:

1. https://www.cleveland.com/metro/index.ssf/2018/07/in_amsterd...

2. https://www.tdpf.org.uk/blog/heroin-assisted-treatment-switz...

3. https://news.vice.com/en_us/article/xwp74q/only-in-the-nethe...

4. https://www.rollingstone.com/culture/culture-news/treating-h...

Of course, the one thing that all of those countries have in common is universal healthcare. "Treat addiction as a disease and prescribe heroin for it" doesn't really work so well when the overwhelming majority of addicts most likely don't have insurance or the means to pay for medical treatment out-of-pocket.

This is surely true, but the US can and does cover certain medical expenses as part of Medicare/Medicaid. The political obstacles are much harder to overcome than the logistical ones.

They are also all quite small, and much more culturally and ethnically homogenous.

Germany is more than two Californias in American units, not that small.

It also eliminates the Fentanyl contamination.

And smuggling of fentanyl from China.

It's good results for society but bad for the addict and their families. They are the ones pushing back. And they have a point.

Worse than overdosing in the streets?

This seems like a classic case of the perfect (being off drugs completely) being an enemy of the good (off the streets but on prescribed heroin).

IMO the family is actually much better off, especially children. A big part of the problem is over valuing the addicted parent and the shadow life they should have been.

Not fixing the problem let's them keep a lot of blame for reality being far from expectations on the new environment, and probably that is pretty healthy. But it doesn't mean this solution is actually wrong.

Being able to not be a criminal, to not be arrested, to not die on the street, this is dramatically better than the alternative. No one can be prevented from buying street drugs in western countries, where there is demand someone will meet it. But this is far better for society too.

How do you think people would react to a major corporation selling heroin?

Is that going well for the existing companies selling OxyContin?

Is it going well for the people prescribed it, or are they abusing/ODing on that as well?

Purdue Pharma is still doing pretty damn well. The problem isn't in using opiates to treat pain - it is Purdue's marketing actively lying about the addiction potential of OxyContin.

You mean for example Bayer? They lost the Heroin trademark the same time they lost the Aspirin trademark, due to the war. Both were a product of the acetylate all the things school of medicinal chemistry.

yes, for instance bayer, a company that still regularly gets trotted out to highlight the evils of pharma companies for among other things selling heroin one hundred years ago

You do realise that heroin is still used in hospitals all across the world on a daily basis for routine surgeries. A company is making and selling that heroin.

The closest we have here is methadone. I am proud to say that I have managed to stay the fuck out of Kensington for almost three years. I could not have done it without methadone.

Seems like it would be cheaper and safer to continue giving them the opioid derivitive medications they were already using until they are willing to go through treatment.

The weirdest X of Y I've ever heard of...

I understand why they are killing their dealers in the Philippines. How can you watch these people poisoning your city and suffer them to live.

Holy shit. The town I'm in is becoming like this too... To think I was just about to head that way to escape this place...

Addendum to The Great Universal Basic Income Debate:

  A large portion of UBI funds will 
  get dumped into places like this.

Or maybe free from the stressess of poverty they will finally have the stability to get clean.

I hope UBI goes into these places. It will end a lot of misery and give people an escape ladder out of that world.

...and? If UBI replaces money obtained from crime, then does the overall social cost rise or diminish?

We have a decent social security system in my country, and as I often like to tell well-off people whinging about their taxes being given to the "spongers" - social security keeps society secure against poor people.

Please don't take HN on offtopic tangents unless it's in a little-discussed and curious direction. The last thing we need is for threads to get sucked into the black holes of generic flamewar topics.

Philly Proud

if this was reddit we'd recite the lyrics of a certain song...

The last time was in Kensignton was to buy a, probably hot, used bicycle when I was in grad school out of a weird artist space.

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