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Comment by teraflop | Hacker News Reader

I'm reminded of a fascinating series of Reddit threads, starting back in 2009, from somebody who convinced himself he "could handle anything once" and decided to try heroin, only to rapidly spiral out of control:

https://www.reddit.com/r/BestofRedditorUpdates/comments/wef6...

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I'm only on the second update, and it seems like this guy speed-ran addiction:

> I can't stop crying. Fuck heroin. Fuck my life. I guess I don't need to say that since heroin pretty much fucked my life for me in under two weeks, I just want to die.

The issue with Reddit is that the story is as likely as not to be fake. Particularly, here, I don't think people are at risk of serious withdrawal after only two weeks of heroin use.

Though heroin use is obviously one of the dumbest things anyone can do.

As someone who has used opiates for well over a decade (for medical reasons), heroin and stronger synthetic opioids can absolutely cause an opioid naive individual to have withdrawal symptoms after even a week.

This is why codeine OTC recommends no more than three consecutive days of use.

It depends on if you have a specific antibody that targets specific opiate compounds. For example, oxycodone was very dysphoric and caused me even more pain, whereas hydrocodone caused me the intended therapeutic effect of euphoria and analgesia

Hydrocodone has to be one of the best drugs known to man. I had a very small prescription for my wisdom teeth and I instantly understood the opioid dependency problem.

It's all about your body chemistry. I'm a redhead; red hair is a result of a mutation in the preopiomelanocortin (POMC) system, so opioids work funny on us. I've had hydrocodone/acetaminophen(paracetamol) pills, and they felt like... taking acetaminophen. No euphoria, not even increased pain relief. I quit after one dose, because what was the point in making myself constipated?

I dunno man. My mom and dad were both smack heads. They both went through recovery but had substantial relapses. My mom was as ginger as they come but really couldn't get off the horse. Dad found solace in terminal alcoholism. So.. I dunno. Thoughts?

Booze doesn't work that way, and there are a lot of mutations that can cause gingerism - but the one I have, opioids don't do much of anything.

Never had the hard stuff and not inclined to try. But the oral ones might as well be cornstarch.

Wait, you've got over-the-counter opiates in the US (I assume it's the US)? What?

The UK has codeine OTC... you assume. Everyone on the internet is american. Its funny. ahha

Not that unreasonable a guess. It's very late in Europe right now (currently 4 AM GMT, perhaps 2 AM when that was posted), and you know YC is an American company... right?

https://news.ycombinator.com/item?id=30210378

Why is the ownership structure of YC important? You know how the internet works right?

For better or worse, 'american' is the defacto standard on the internet, but please remember that only a small percentage of the global population is USian the in all probability the person you're speaking to isn't from the US.

The English (no pun intended) speaking population is more likely to be from the US than the global population.

Disclaimer: Not English. Not American.

I would say that the us accounts for less than half of English speaking netizens.

UK, Australia, new zealand Canada already add up to a sizeable chunk of the US's population. Then add in 1% of India, or China (I assume some proportion has access outside the great firewall) and you've got a population bigger than the US.

If you add up the numbers of the countries you mentioned (together with 1% of India or China), you'll realize that it's smaller than the US population...

US: 331.9 million

UK: 67.33 million AU: 25.69 million CA: 38.25 million NZ: 5.123 million IN: 1.408 billion * 0.01 = 14m

Well the 1% was pulled out of my arse.

Point is some very small percentage of the rest of the world is going to dwarf the US. Yes the US will be the single biggest demographic but less than 50% of the total.

I haven't been able to find many solid stats, but eg English language Wikipedia, the US has 22k active editors out of 59k total.

Speaking for the US, yes indeed. Loperamide is technically an opioid and available OTC, though that's rarely a sought after compound unless one is in dire straits.

Codeine is available with a pharmacist's approval alone in my state. So while it may not technically OTC by that definition (or is, I don't know how OTC is defined), it can be had without a prescription by visiting a participating pharmacy and simply requesting codeine+guaifenesin. Done it a few times myself.

Codeine + cough syrup is so popular in Texas that it spawned an entire subculture dedicated to its use. See DJ Screw in Houston (https://en.m.wikipedia.org/wiki/DJ_Screw).

Lest you think this is no longer the case - “lean”, as it is known by Houstonites (due to your tendency to lean on things while under the influence) was a major plot point of a recent mostly autobiographical Netflix series centered around Houston that was released late last year: https://www.keranews.org/arts-culture/2022-08-25/houston-ooz...

Vice released an excellent short piece on Houstonian screw & slab culture years back. Might still be on youtube! It was an excellent piece at the time, but I haven't seen it in quite a while.

For clarity, loperamide, sold under the brand name Imodium, is an anti diarrhea medication. It is an opioid; however, it does not readily cross the blood-brain barrier. It only acts on the opioid receptors in the large intestine and slows the movement of food. In very high concentrations it may get into the brain.

If I go to a developing country where I cannot guarantee access to a bathroom, I pop one or two of these every morning to keep me regular.

"A pharmacist's approval" is a prescription, just one that happens to be written by the same person who fills it. So no, not OTC, which specifically refers to medications you can get without a prescription.

I suspect this is location specific though. In the UK my migraine medication was available over the counter, I still had to have a discussion with the pharmacist every time I bought it. Conversely when ever I've needed an actual prescription medication, in an emergency or whatever, that has always had to go through my doctor to get the prescription sorted.

/me also a brit.

My go-to pain-relief used to be a product called Codis, which was soluble aspirin+codeine. It used to be available OTC, until about 8 years ago, then it disappeared. You can still buy paracetamol+codeine OTC ("Paracodol?). My understanding is that aspirin causes vasodilation, which causes more rapid absorption of codeine. Supposedly that's why Codis worked better than Paracodol.

I don't know why they took it off the shelves. There was no announcement; it just disappeared.

Codis was effective for both migraines and period pains, as reported to me (I'm not a woman, and I don't suffer from migraines).

This was migraleve it didn't have any painkilling element in the first tablet (it was 2 parts) not much point anyway as by that point I was throwing up.

asprin + codiene sounds like a based painkiller combo. Who needs a liver tbh?

It's paracetamol that's hard on the liver, not aspirin or codeine.

Well, sure, countries will have their own laws over this or anything. Ours are defined at the federal level and thus apply the same everywhere in the country; since GGP and I are both USian, that's the basis on which I replied. (I don't know enough about any other country's such laws to speak to them!)

That’s true, but the withdrawal after a week or two isnt going to be the “i just want to die” type.

Severe withdrawal comes after dose escaation and youre not going to develop that much tolerance after 2 weeks.

Im not saying it wouldnt be unpleasant, but its not goibg to be the Trainspotting version.

It's amazing how you're like a prime example of what's being talked about here and you're totally unaware of that.

I don't mean that to be a dick. I mean that because I care.

Opiates are dangerous. Very dangerous.

I'm surprised at your statement. In response to a thread about how intelligent people erroneously think their intelligence protects them from addiction, and the story of one person getting addicted, your response is "that couldn't happen to us".

>* The issue with Reddit is that the story is as likely as not to be fake.*

Maybe, but if so, it's a fake narrative they've maintained consistently for over a decade:

https://www.reddit.com/user/SpontaneousH/

I had serious withdrawal symptoms 24 hours after medicating myself with controlled doses of hydromorphone after surgery. It’s always been remarkable to me how many people confidently assert I wasn’t addicted.

Conversely I'm on long term anti depressants and I get withdrawal symptoms if I forget to take them, but no one is ever referred to as being addicted to anti depressants.

I suspect there are different (social) mechanisms at work here, but addiction is generally applied to one specific form of drug reliance.

> but no one is ever referred to as being addicted to anti depressants

People who are sceptical of antidepressants, such as Professor Joanna Moncrieff (University of College London), do speak of them as “addictive”, and consider their use to (at least sometimes) be a case of “prescribed drug dependency”, and also speak of “withdrawal” from them

I had very noticeable withdrawal after 3 weeks of using opiates as prescribed for a ruptured disc. Stopped because I was pain free a few days after surgery to fix it, and felt like I was going to die.

After a motorcycle accident I spent a week on hydromorphone, a month on oxycodone, and occasional fentanyl. I have some oxycodone left over at home and, if I'm being honest, I don't feel the slightest desire to do it. I haven't for the 9 months so far I've had it and I doubt I ever will. I live in SF as well so fentanyl is easy to come by, should I so desire it.

Reading the literature, it appears that this is the experience for 9/10 people prescribed the drug. The problem, of course, is that 10% is a large number at scale.

Obviously, I've had no experience with heroin. But considering my experience with fentanyl, I can quite easily say that most of us are not susceptible.

This strikes me as yet another example of overstating risks. PTSD is the canonical case, of course, where the majority of people experiencing trauma won't get PTSD and even a third of people experiencing major trauma won't get PTSD.

The short version is that the average human is very resilient.

This thread, and the linked AMAs, are amazing. Thanks for posting.

(Incidentally, I don't really care if they are 100% true or near-true or simply entirely plausible.)

Great story, I believe

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