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Comment by benbreen | Hacker News Reader

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...

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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 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.

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).

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?

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

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

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