My experience of losing a friend to heroin (2020)

It's much more tempting to seek out another hit if you have nothing better to do that day.

The result has been a disaster. People on meth run around the streets at night causing chaos. Homeless people on heroin leave needles everywhere. People avoid transit and parks now because there is regularly someone losing his or her mind nearby.

Long sentences aren’t the answer of course. But I do think that sending someone to a Nordic-style prison for a few weeks would be better for these folks than just letting them run free.

By the way, free mental healthcare doesn’t actually work because many of these folks don’t want help and won’t seek it willingly. There needs to be a way to forcefully separate them from the addictive substance for a time, stabilize their drug crisis, and then help them find long term care.

I think the ideal system is some sort of government-run one that is not out to profit, and keep on suggesting that maybe you don't need any drugs, but will give you some if you insist and are willing to watch a safety video.

Fixed that for you. Truly sorry for your loss, but people make choices, and those choices have consequences.

Can we hold these two things to be true at the same time:

1. No one is forcing people to take these drugs. The choice to start is theirs. They are ultimately responsible for their choice to become addicted.

2. We should view an addict’s behavior through the lens of addiction, not the lens of a rational person making destructive choices. Addicts won’t respond to incentives like a normal person will.

We need to find ways to make it extraordinarily costly to start using drugs. This is how you prevent the crisis we’re in currently.

That means prison time for users. Heroin and fentanyl pour across the border due to demand for it. New users dabble in it because the perceived cost is low. If people understand that possessing or using means automatic and significant jail time if caught, then people are much less likely to even dabble.

Ultimately, people will still try it regardless, get hooked, and eventually get caught and sent to prison. And that’s a good thing. That means there are less users who are on a path to homelessness, overdose, and dependency on family, friends, and government programs. It also means less users out there to persuade others to start using. If we’re not going to run mental health hospitals with involuntary commitments, then prison time is what you’re left with.

Prison terms for using are five times as long as it takes to get users clean. Once they get out, if they’re caught again, the sentence is ten times as long as it takes to get clean. Each consecutive offense ratchets upward.

The result is twofold: users have ample opportunity to get clean and stay clean in prison, but most importantly, we create a society in which we simply do not tolerate drug use. It’s really that simple.

We are going to have as much drug addiction and use as we’re willing to pay for. If you lower the cost of using, you get more usage. Free usage sites with free needles and less risk will, and already has, resulted in more usage. The fact that people won’t recognize this is mind boggling.

But they execute you if you have over 500 grams of marijuana so a bit extreme.

I am not sure that the solution is a pharmaceutical product…

And I say this as someone who has been pro-science his whole life. It’s just that training people that a pill will solve their problems is a recipe for creating addicts?

That said, I haven't lived your experience, so I can't really know what you're feeling...

Also see el Chapo. Did either of those high profile busts make one iota of difference? Did the price of cocaine change (hint, it did not) and I all but guarantee the same can be said for meth, heroin and fentanyl. They all cheap to produce and extremely easy to obtain while still being pretty cheap when it hits the streets

It seems like every solution in this thread is something other than “punish people who buy or sell drugs.”

Can we at least try ruthless enforcement before we try free drugs for addicts paid for by taxpayers?

(1) https://drugabuse.com/featured/drug-and-alcohol-abuse-across...

I don't much regret my drinking days because I had fun and met many people. But then I realized I want to do other things than just get drunk and get a hangover.

I think, based on my experience again, that AA with its confess your sins and label yourself an alcoholic may help some people. But I think it's best to think what you want to do and accomplish, in life. Then do that. No need to keep on repeating you are an alcoholic. You're no more alcoholic than anybody else I would say. It's just that you have decided to drink and keep on drinking. It's your choice.

But maybe we can change things on a larger level. Create a society where heroin isn't as appealing by comparison. Where there are spaces for socializing that aren't about social competition, or at least one where there are more distinct and equally good ways to "win". Maybe one where, if you fall, you don't have to carry the guilt that your family will be dragged down with you.

I was lucky enough to grow up with the historical teetotaller community, since my grandfather was a leader of sorts in it. They used to be very adamant on seeing alcohol use (and of course drug use) as a social problem, not an individual one born out of "weakness of will" or genetic factors. They quite deliberately tried to create new social arenas without alcohol, and cultivate a sense of community and common purpose which could make it more than yet another arena for social competition. But they quite literally couldn't keep up with the times. The social venues they made were of types that were extremely popular in their day, but are exotic at best today (e.g. lodges). And along with the rest of society, they gradually embraced AA's medicalized, individualized understanding of alcoholism, turning the message from one of collective self-defense ("we're building this to defend ourselves as a community from the scourge of alcohol") to one of sympathy with the medicalized Other ("We're abstaining out of solidarity with those individuals who will become alcoholics if they touch alcohol").

I think alcohol, tastes disgusting in general. It's fun to mix with other things to have a stronger effect, but I've always enjoyed everclear to accomplish that, which basically is just pure ethanol.

I never understood alcohol culture, bars, going out, etc.

And I always related that to not being "popular" or feeling calm in a new city or such. I think it's so strange to go to a place, have to wait in line, pay admission/cover, to talk to a bar tender that expects tips, and then pay extravagant costs for something that can be purchased cheaply anywhere else (yes, I understand the transaction/food/beverage/hospitality.)

Never will get it.

Another argument against it, why not turn the mirror on yourself. Why are you not richer, stronger, more popular, happier? Maybe you are somewhat of all those things already, but a wild guess is that your not the strongest, richest, most famous and happiest person in the world. So why not, are you weak, lazy and shallow? Or, perhaps is the truth a bit more complicated?

most people are social animals. it's easy to be an individualist if you have the trait and nigh impossible if you don't.

What about Bipolar and Schizophrenia, do you think about them same as depression?

> "I am depressed". No, you are depressing yourself.

You're assuming a brain that's in good working order. It's difficult to imagine a different one. Consider that not everyone's window into consciousness works like yours does.

You say you know it is harsh—that's already a reason not to do it here. Maybe "harsh" can do some good when there's already a strong relational connection with the other person. (Emphasis on maybe, because people who take harsh stances generally are paying more attention to their own ideas than to the person they're commenting on—but no doubt it does happen sometimes.) Here, however, you're broadcasting to thousands of people over the internet, with zero relational connection. In such a context, it's merely provocative and destructive, and one could even say selfish.

If you wouldn't mind reviewing https://news.ycombinator.com/newsguidelines.html and taking the intended spirit of the site more to heart, we'd be grateful.

Well, we've had health insurance for my entire life so I guess we had "access" to it, but as far as I know my dad never used it, and I didn't see a psychiatrist until I was 26 (and I wasn't drinking much before that, certainly not enough to be considered an alcoholic). He certainly didn't have access to it until he finished school, growing up in a relatively poor family.

I think at least in my dad's case, he saw how much his dad's alcoholism screwed things up, and decided that he was going to try and avoid that fate no matter what, sort of using his dad as an example of "what not to do." As I was growing up, I think I saw my dad drink a grand total of four glasses of wine, all of which were done on different New Years events, and never enough to get "drunk" or anything like that. As he's gotten older (and as his kids have all grown up), he's relaxed on that a bit and I will occasionally see him drink slightly more frequently, but I think that habit of sobriety has been somewhat ingrained into him at this point.

Yes they are. Before fentanyl contaminated heroin came around most heroin overdoses were because of massive differences in product purity. You know the dosage for your usual 10-20% heroin and when you get a batch of 60%+ you are doing over 3 times your usual dose without having a clue and because heroin has a low delta of LD50 to active dose, your usual dose is now letal.

If medical grade heroin was available, with known purity and no contaminants, heroin deaths would drop to almost 0. The drug itself isn't even that distructive in normal dosage, apart from the crippling withdrawl that btw is not letal and dosen't even require hospitalization, unlike benzodiazepine and alcohol withdrawals which can be fatal.

Rich people can afford the absolute top-tier rehab (and probably can just start doing coke w/o repercussions).

If there is a positive part to the book it is indeed some very small sense of social justice outside of the legal system (which failed to hold them to account). Nan Goldin is an artist who lead the way in organizing protests and press that would lead to their names being taken off the very museums and universities they had paid to put their name on. They had worked hard, over multiple generations, to have clean name despite their business. Nan and others did a lot of work to make sure that changed.

I don't suppose that Giga$ makes you happy. I'm not sure what "social status" is like; is that the same as having friends who own Giga$?

I possess what I'd call "social status" - I'm not a pariah, my neighbours greet me on the street, and my kids and my ex-wives treat me as a friend. I own my home, and I have no debts. That's quite enough "status" for me. I consider myself pretty fortunate.

And a pride that is essentially about avoiding shame; shame being the primary currency of those with an authoritarian bent.

It's writing people off as lost cases. And many addicts WANT to be written off as lost cases, because a) they already did so themselves, but feel guilty about it, an official confirmation would be nice and b) it will give them access to painkillers.

Which is why I'm very skeptical of involving doctors in the first place in free methadone programs, if such programs should exist. It shouldn't be anyone's job to validate you if you say you're a lost cause.

It's really the abstinence only attitude I was talking about: why is it a big deal to give someone medication for the rest of their live if we know it will keep them alive, healthy, and allow them to live a fulfilled life? Addiction is just like any other disease, and it turns out medication assisted therapy is very effective.

Methadone works, and so do other medications, but it's only a partial solution. We need a rapid and massive expansion of these programs. We also need programs and medications to target people who go on Methadone, but keep going off. Why not give them Herion, if we can do it safely? What about if there is evidence they can become productive members of society?

Again, it's my view that although people OD from drugs, it's really the prohibition of drugs that are killing people through the incredibly unsafe and unreliable drugs people get. Supervised opiates are not dangerous, and unlike other drugs, cocaine, meth, benzos, you can safely be on them for years at a time nearly no long term effects. At least the long term effects of staying on them pale in comparison to the consequences of an OD.

60,000 people OD per year. What we are doing isn't working!

If you give out free product, you not only kill the primary demand, but most dealers themselves don't have a reason to continue taking risks - because they can benefit from the free product too.

Purely profit oriented dealers will remain in the market, which is now much smaller and even riskier, since they can only sell to recreational users.

New people will still be introduced to drugs, but there are definitely network effects in opiate addiction that can be mitigated when supply is transferred from an illegal source that requires people to organize and recruit new users with cash, to one that is organized and paid for by the government.

It's not perfect, but even decriminalization has had a pretty remarkable effect on Portugal, at least that's what the latest studies are saying.

With heroin, I d argue people are definite victims. It's absolutely not like tobacco, the craving is physically painful for long, not just the mild annoyance of tobacco.

To give you a few exemples: it takes me 3 days to a week of being irritated to stop cigarets for a full year, cold turkey. For injected heroin, it's 2 weeks of extreme pain with possibility of hospitalisation, for Subutex, an alternative pill, it's around a month (so many addict complain it s easier to take a break from heroin than the progressively reducing alternative medicine).

My dad is a pharmacist in France where we treat drug addicts who want to recover as victims and help them get alternative subutex or methadone for free: he told me he never saw someone truly stop. They can reduce and live with it, but they cannot possibly stop.

Your increasing tax solution seems unfair, while it seems fair for me with cigarets: it's my fault and I can stop. Not an heroin addict. I dont have a magical solution, in France we focused on stopping the violence due to the craving with free Methadone in pharmacies and it changed the criminal landscape, but destroying the product supply at the source while keeping the last addicts on Methadone seems like the only path, if the goal is to free people from opioids in France.

In the US it's different: opioids became a for profit pharmaceutical entreprise, and most of the crisis there is due to opium sold hidden as painkillers totally legally on a large scale.

"It's easy to quit smoking. I've done it scores of times."

Interestingly, I think if hard drugs were legal, very few people who don't already use them would go out tomorrow and give them a try, "just because", so its' not like we would have a complete societal meltdown if it happened.

I just think the US should look to other countries, and start off by implementing what works there. Even that is radical!

The Swiss are roughly 1/10th as likely to use opioids as Americans and of their users ~85% are in rehab. Relatively speaking it’s a tiny illegal drug market.

I've seen a lot of smart people fall to drugs. Sure, if they get in too deep too early, they won't have a degree when they die, but they could have had one.

And yes, as an HR person in a comparatively small company, this person is easily replaceable. On a country scale, however, you can't simply replace him - you need the numbers of highly educated smart people and you can't simply "hire" them back from another country. Look at the stereotype of the asian genius - disregarding the other factors, China simply has 3-5 times [0] the population, so they will statistically have 5 times the geniuses to start with. You can't compete when your best bets have a 5% chance to whither away due to drugs.

> If you want to know what kinds of sacrifices are required to win a war on opiates, Mao is the "best" recent example.

How so? I don't know what specifically you're pointing to, but given that other countries handle the situation better with less "sacrifices", I don't think they're necessary.

[0] Depending on US or EU perspective.

I think part of our problem is we put first value on people by their economic output. We need to realize there's more to being a person other than how much money you can make some rich dude.

I was never addicted to drugs, but for the first ~25 years I struggled in life in much the same way. No education, no real job, no real direction, future, or perspective, no real friends, no girlfriend, what's the point? I suppose my situation wasn't quite as hopeless, or maybe I'm just a different person, and it probably also helps that drugs usually just make me feel weird in a bad way and never enjoyed it much.

Plus, I never stopped programming, or lost my interest in it. It just took a long time to scrape together the confidence to actually apply for jobs. For a time I was either jobless and programming stuff at home, or working minimal wage jobs and programming after work. At one place I managed to "hack" the computer used to scan barcodes and during night-shifts (with often hours of nothing to do) I would write some toy programs to pass the time (more fun than smoking weed outside like some of the other people were doing). I sometimes wonder what would have become of me if I hadn't learned programming as a young teenager, or had lost interest somewhere along the way.

Either way, we'll likely never know what "talent" Jack did or did not posses as he never really seems to have developed any due to a combination of his personality, environment, and just "bad luck". Even the most talented and gifted programmers I know don't "just" do it automatically; they still need to apply themselves and develop their talent. For all you know you might have it in you to be a word-class guitar player, actor, soccer star, or some such. But if you've never played guitar, acted, played football, etc. and developed this talent then you'll never know.

Jack might not be the best example of "raw human talent", but people like him contribute to the economy that are hard to measure, and of equal worth to anyone else.

I'm of the opinion that we shouldn't compare lives, but I guess we could compare economic value, and for the thousands in lost lives, even working the most menial jobs, that's still tremendous worth in a country where our birth rate is shrinking faster than ever.

20 years ago, sure, who cares about the DEA, they put dope and guns on the table and largely stayed out of peoples way. Now, we have around 60k thousand deaths per year from the opiate crisis that reaches almost everyone in America. Law Enforcement has no solution, just carry around Narcan while drugs come in through every major port and postal facility in the country.

Let the cops do what they are good at: reduce violence, enforce property rights and keep communities safe, but stay out of healthcare. Give the DEA the best grads, and that won't change the fact that they are working in a system where they simply don't have the power to stop two consenting individuals engage in a prohibited behavior.

It's complicated for some people to admit the 'war on drugs' has failed maybe, but that's a different issues all together.

My partner had a post-cancer DIEP flap reconstruction last month at a top cancer center in NYC, and due to the nature of the surgery, couldn't take NSAIDs, which are typically most effective for her (they have blood thinning side effects and were banned for 2 weeks post-surgery to avoid risk of hematomas). So she was left with taking over the counter Tylenol plus prescription opioids. They prescribed opioids 2 days of pills at a time, which required me to constantly drive to pick up new prescriptions (since obviously she couldn't drive), and it felt like some kind of interrogation each time she'd call up and report her current pain levels. As if they assumed by default she was lying or was a drug addict or something, versus someone recovering from major surgery that doesn't heal in 2 days, and furthermore is not allowed to take anything else that's effective (NSAIDs). Hours spent writhing in pain trying to get some pills prescribed and picked up. It only got resolved once the two-week NSAID ban was up. Then she stopped calling about the opioid-based analgesic and just started taking large ibuprofen doses instead. Problem solved, since you can buy as much ibuprofen as you want. But a pretty shit two weeks up until that point.

As a result, I strongly dislike a number of aspects of the anti-opioid backlash. It made our lives worse and caused us more suffering.

Having to do it on the regular would be just cruel.

> I have a friend in the US who told me they have an app on their phone where they can just tap a button and the next day they can refill their benzo prescription, and it's been like that for years without having seen a doctor again.

Is this the "request a refill" feature that every US pharmacy offers? Granted, benzodiazepines are less restricted than stimulant drugs¹, but a doctor in the US need to at least review a prescription twice a year.

Chronic (daily) of benzodiazepines is bad, and doctors will not² start new patients on this.

There's still a lot of legacy patients who are on chronic benzodiazepine treatments -- doctors should work with them to wean them off, but it's very challenging and disruptive.

Requiring a patient receiving a benzodiazepine at a non-daily level (e.g. for seizures, anxiety, occasional insomnia) to go back to see their doctor when nothing's changed several times a year is just pushing medical costs (money/time) on the disabled.

¹: e.g. Adderall, which can't be refilled

²: Providers are trained not to these days, at least

Docs in the US tend to think they are above being marketed to, but Purdue Pharma knew better, and they paid their drugs reps a ton to go out to "everytown US" and convince doctors that they had made a non-addicting opiate. Enough docs bought it, and here we are.

How did they do? Well, 20 years ago drug reps used to be able to take doctors on trips: to sports games, to see the dog races, to museum trips, the price of a day trip with you and one or two loved ones was to sit through an hour (or two) lecture by a rep that convinced you to to prescribe a drug. Not a bad deal!

There were complex reasons why the opiate crisis started, but the environment was ripe for an upstart company like Purdue to come in, reformulate an old opiate, pretend the addiction problem isn't there, then sell a miracle drug because opiates are extremely effective short term analgesics. Long term, we're still paying for it!

I've looked a lot into the opiate crisis, and it's a pretty bad stain on the US medical institution, particularly our medical science. We fucked up.

The Sackler decision had a pretty big effect on me. It's hard not to grow up when I did, lose people you know to the opiate crisis, and not feel a deep sense of unfairness and wrong when the people responsible for so much suffering stay out of jail with a million dollars.

As much as you can blame them for that one act, it's the iron law of drug prohibition at play: Meth becomes Crystal, and opiates become more concentrated. Easier to smuggle, better profit margins, it really only goes one direction: the drugs get more potent every year prohibition is in effect.

I've literally not seen a used needle in at least a decade, but again, I'm not sure it's because of policy, it seems more likely that people have just, for the most cases, switched to different drugs.

Well, that's the issue. No one area within a zone of free travel can exclusively do this. That is, if Ohio did it, druggies throughout the US would go there.

But, as I understood the idea, the free drugs were required to be consumed on premises under the watch of a professional. So why would any drugs even leave the facility.

I do think I got the dates wrong. What I'd like the US to do is adopt a similar liberal approach to prescribing medication assisted therapy, and go as far as we need to go in finding the medication that work for people, like is done today in CH. I don't think the "free firezone" approach is a good idea (akin to "hampsterdam" in The Wire), but getting addicts healthcare and a medically supervised substitute is what I meant. The big part of that in the US, IMO, is fighting the social stigma around adopting science based approaches large scale addiction management, and right now the only acceptable solution is to get people off drugs, then have them OD when they get back on. There is a better way!

The aspects of the Swiss approach I wish the US would take the most are the willingness to try something fundamentally different. For the Swiss, it took a few tries to ultimately work out, but I don't see why the current solutions to the problem they use wouldn't work in the US.

Nitpicking, but since political correctness seems to be all the rage nowadays, please consider removing "or alcohol" from that sentence (at least mentally) since alcohol is a drug, just like heroin or coffee or nicotine or LSD, only with varying degrees of effects, damage and dependency.

Disclaimer: Have tried most common drugs at least once in my life and find alcohol to be one of the most dangerous ones, since dependency tends to creep up so slowly (years) and is practically impossible to get rid of once acquired, barring abstaining completely.

Edit: Saw that you replied but then deleted, referring to common parlance of the English language. Yes, that's exactly why I posted this. It's established (boomer) language to say "drugs and alcohol" and it needs to change. Hence I referred to changing the sentence mentally. This change will take time though and/but it'll happen, one person at a time.

I suppose people seem to look at "drugs" as illegal drugs and everything legal as non-drugs. So now with weed widely decriminalized it'd go from "drugs or alcohol" to "drugs or alcohol or weed". Maybe? /tangent

Edit2: I also suppose people don't want to look at themselves as drug users. This is probably due to anti-drug propaganda, associating any drug user with a "junky". It's also a mental image that needs to change. Most people in the western world are functional drug users and that's fine. Or should be.

You should read the post, exemplifies how it usually ends up not 100% on the person addicted. It affects their family and people around them.

SMART recovery doesn't involve any religious beliefs, doesn't require you to deny that you have agency, and doesn't require you to say "recovering" if you've actually recovered. For some people, it works better than 12-step.

A big part of Christian spirituality is feeling joy even while in pain, and of finding hope even when there is no reason to hope. In the Book of Job, Job is tested in his faith by having almost every suffering in the book thrown at him. Christian martyrs were known for embracing their martyrdom. Catholicism teaches us to find joy in suffering (St Theresa of Avila, Doctor of the Church, said 'Lord, either let me suffer or let me die'). These are all spiritual tools 'installed' at a young age. They are installed via phrases our parents and community member's mention and bring up children in. Things like 'God sees all', whenever someone is slighted, or 'just pray' (which I know drives some people here nuts).

Today, such practices are often criticized. Mother Theresa is currently castigated for this aspect of Catholic spirituality, mainly by a society that sees any problem as fixable with just the right 'stuff'. A lot of the confusion in this thread is from people whose own views were challenged by this story. The story fit none of their preconceived notions of what causes drug abuse and none of their 'stuff' (policy solutions, chemicals, etc) could clearly fix it. However, such practices are vital.

I'll give you an example. My wife and I lost seven children before birth. Now, this is a very traumatic experience, especially with not having had any children before that. I'm not going to claim I'm a great person, or even a great Catholic. I was angry at God, upset with the church, mad at life basically. I stopped going to mass for several months (as did my wife). We basically lived alone, and cut off all friends / community. These are unhealthy reactions. Things changed when a deacon who I was friendly with told me to go to confession, and to embrace the cross God has given. Broadly speaking he was correct. The basic part of Christian hope (that by our continued suffering, God will save us) was absolutely vital. After seven miscarriages (some very late), no medical answers whatsoever (all doctors were stumped, nothing wrong with either my wife and I after many tests), my wife and I fought all the time. We frequently had thoughts of suicide, etc. Many today would suggest a therapist, but confession and meditative prayer helped more.

Church teaching on suffering gave me a purpose. Catholics believe that in our moments of suffering, we are taking on the cleansing of the entire world. By offering our sufferings to God, we make the world a better place. Such a thing probably sounds ridiculous to many non-Catholics, but this process of taking the worst possible outcomes and believing that such a thing actually serves to help others and your community really helps when you're feeling down.

It's very difficult to explain. Confession for me broke the cycle of despair. I'd go almost daily at the beginning, half the time just to talk to someone else in confidence, and tell him that I hated and cursed God (which was my main sin at the time). I don't think any therapist could substitute here, since a therapist could potentially encourage me to distance myself from God, and certainly wouldn't speak on behalf of God, but the priest would. For example, when I confessed hating God and despising him, the priest told me that's okay, because God loved me still anyway. Was that frustrating to hear? Yes... but ultimately it's true. From that it transformed into meditative prayer (i.e., praying the Jesus prayer while walking... this is a common Orthodox practice). From that into asking God to accept my own personal trials as penance for the world. And from that, I started feeling better about my own place in the world and in fact, I found that I was being pulled to do good for other people, which helped provide meaning. Eventually, we did end up having living children, which was also nice, but these experiences have stuck with me. Again... I'm not a perfect Catholic. My confessions are still littered with all kinds of sins (and sometimes very serious ones), but just knowing what to do when things go bad is important.

https://meaningness.com/nihilism https://meaningness.com/nihilist-apocalypse

(And in places where heroin is legal, addicts rarely die from overdose.)

That said, death is not all that can ruin a life.

I'm not taking about weekend poker players, here... I mean people who've lost their wife, kids, house, and job to a gambling habit. They have zero savings, mountains of debt, and if you lend them $20 to get groceries, they'll go hungry after gambling it away?

Modern video games are designed by highly paid, PHd-level behavioral scientists to be as habit-forming as possible. If you're vulnerable to it, you're going to have the same kind of struggles getting away from video games as a heroin addict would from junk.

The lack of immediately lethal consequences is only part of the problem... Addicts can ruin their lives, and take their families and friends to the point of no return, even without the possibility of something as serious as an overdose.

What a weird thing to say. Please, what is the reason AA is the way it is? Other than religious brainwashing.