Comment by girvo | Hacker News Reader

Comment by girvo | Hacker News Reader

Normally, on topics like this I post under a throwaway. Now, I don't see why I should.

I'm an ex-heroin addict, and am on Suboxone Opiate Replacement Therapy. I've been clean for 9 months, after 6 years of opiate addiction (starting with Oxycodone, and moving quickly to Heroin). I'm 22 years old.

This article has a few factual inaccuracies, which I want to correct.

First: Injecting Suboxone is NOT safe. Not even close, especially with the method described in the article: unless you are a fan of Talcosis (which will kill you), you need to get a micron filter. Even then, it's not worth it. The high is minimal, tolerance builds rapidly, and it's dangerous. There are numerous complications that come from injecting pills, and it's never worth it.

Second, and this is a small nitpick, heroin users don't have "eyes like saucers" - you have eyes like pinpricks. Opiates constrict pupils, not dilate then.

Third, heroin withdrawal IS torture, at least if you have a sizable habit. Yes, Burroughs did say it was "overrated", but I can tell you from experience, it's absolute torture. It's not like fever. It's an entire body ache, down to your very bones; it's your mind crying out for relief. It's something I wouldn't wish on my worst enemy.

Just thought I'd add my two cents.

There were a number of annoying factual inaccuracies in the article, particular with respect to heroin:

> ..time-killing properties of opium or heroin, but with none of the likelihood of it stopping his heart

Opiates do not stop your heart. The notion that every single usage of opium or heroin is like a game of russian roulette, that might stop your heart, is fantasy. Opiates are actually quite safe, as drugs go. It's not until you take far too much or mix them that you are screwed. And that's true of any opiate, prescription or otherwise.

> Heroin kills, and OxyContin, unless badly mishandled, does not.

Basically not true; injected oxy requires no more 'mishandling' than heroin to kill. Both will happily shut down your respiratory system and kill you if you administer too much. Of course one could argue that the pharma is of a consistent manufacture and dosage, whereas one batch of too-strong street opiates could kill someone used to weaker stuff, but the author of this piece seems far too clueless about the subject to be making such distinctions.

Then we have comparison of marijuana's 'addictiveness' to that of opiates. The difference between psychological dependence and physical dependence is one of kind, not degree.

Injected OxyContin is worse, actually. Being 2/3rds the strength of heroin, but being in pill form, means you're running the gauntlet with talcosis, and causing other terrible and fatal medical conditions due to the nature of what is put in the pills themselves.

Heroin and pure opiates are actually "safe" as far as drugs go. I'm clean, and even when addicted held down good jobs, earning good money, and no-one was the wiser. My vitals are still perfect to this day.

It's the addiction that gets you, unfortunately.

As a child I was once in a english class for people in rehab from heroin. This was Spain in the early 90s and most of them had been addicts fOr more than 10 years. They were definitely affected neurologically, they were like a bit in slow motion and could disengage from their sorroundings quite easily. They were in the last part of the therapy, almost ready to go home, but I can't tell if that was an effect of a substitution therapy( at the time it was methadone), or they had a permanent cognitive damage.

Methadone, at least in my experience, really does "zombify" you. It has really pronounced CNS depressant effects. It's basically no different from Heroin in how it affects your state of mind: that's why I personally chose Suboxone as my ORT drug.

I've done high-level cognitive activities like programming for 5 years of methadone therapy with little to no problems. I took the GRE on methadone therapy and did better than when I was on no opiates 10+ years ago. Used properly, methadone's side effects can be minimized to almost none in most patients. I tend to get sleepy after lunch, but I honestly can't tell if that's the methadone.

Most of the "zombified" methadone users are way overmedicated, usually because this is the state they are seeking.

  > Most of the "zombified" methadone users are way overmedicated, usually because this is the state they are seeking.

I agree entirely :)

> Opiates do not stop your heart. The notion that every single usage of opium or heroin is like a game of russian roulette, that might stop your heart, is fantasy. Opiates are actually quite safe, as drugs go.

They, in large doses, stop your breathing which is close enough and will kill you (like you later said), unlike, say a benzodiazepine which you can take to your hearts content and will just knock you out senseless without killing you (unless you add alcohol or another GABA receptor drug).

They also can send you into a hypotensive crisis if you're hypovolemic, which also will kill you. So I would really be hesistant to call them "quite safe, as drugs go" because they are definitely on the dangerous spectrum. We could list a ton of drugs I'd rank higher on the safety spectrum than opioids in terms of both short and long-term effects, with opioids only "redeeming" quality being their instant reverse agent (naloxone) or partial reverse agents (pentazocine or buprenorphine).

Did you read the quoted sentence before replying? I'm not unaware that the consequences of high doses are respiratory shutdown and death.

All I'm trying to get across is that taking a moderate dose of an opiate is exceedingly unlikely to suddenly kill the naive user, as the article suggests - less so than with say, coke or meth, which can interact poorly with a wider range of health conditions and other substances.

None of which is to say that I endorse the use of opiates or recommend them. I am generally all for responsible drug use, but nearly everyone who thinks they can responsibly 'manage' the use of heavy opiates ends up losing that gamble eventually. And the costs are very, very high.

Did you read my response where i said "like you later said" then went on to list another life threatening issue with opioids, as well as your statement that it's a pretty safe drug is actually very wrong when you compare its side effect and safety profile to the vast majority of drugs on the market?

My apologies, for both my tone and for overlooking your reference back.

I think 'vast majority' of drugs is overstating it a bit, but still - I very much understand where you're coming from and do not disagree.

I regret saying that "Opiates are actually quite safe, as drugs go." I think it has some validity in it's hastily-written context, mostly concerned with countering the article author's cluelessness on his subject. In moderate dosage and without mixing substances, it's basically true - though I'm admittedly coming at it from the perspective of a long-time recreational drug user, hardly that of an upstanding mentor to the young and impressionable here. It's obviously a reckless thing to say in any context, and I would certainly hope that no-one takes it as guidance.

Subutex and Suboxone are not the same drug (I have no doubt my parent knows this, but for others edification), though both contain the same narcotic. Suboxone includes an opiate antagonist for the sole purpose of trying to keep people from injecting it. Injecting suboxone will send you into very unpleasant withdrawals immediately (I imagine there is some way to overcome that, though).

I used Suboxone to wean myself from physical dependence to opiates after years of pain management. I agree that the article glosses over how bad opiate physical withdrawals are, and my experience didn't include the emotional withdrawals. My understanding is that suboxone withdrawals are much longer, due to its long half-life, but not as intense as heroin's. For six weeks, I didn't sleep more than two hours at a time, had constant chills and diarrhea, couldn't really eat, ached everywhere, and had non-stop restless muscles. A fever, indeed!

Injecting Suboxone (Buprenopherine/Naloxone) actually has no ill effects apart from what I've posted below (hardening veins, danger in general...).

Bupe's affinity for opiate receptors is so high that the Naloxone never gets a chance to bind itself. It simply has no effect, and doesn't stop a number of people at my clinic from injecting Suboxone.

I hope you're doing better SoftwareMaven. Opiate withdrawals are hell, although mine were self-inflicted.

As another interesting anecdote: Suboxone/Subutex withdrawals are far more drawn-out (although less acute) than heroin, due to it's long half-life. They suck balls, too. EDIT: LOL, you said that yourself. I'm an idiot.

I did get better, but it took forever. Even months later, I had the continual runny nose. Interestingly, all of the symptoms stopped when I started taking a very low dose of Naltrexone (another opiod antagonist). It may have been coincidence, but the remaining symptoms cleared up within 72 hours. There is some evidence that, at very low doses, Naltrexone will increase dopamine production through its slight interference, which is what caused me to try it in the first place.

I can't even begin to empathise with what heroin withdrawal must feel like.

Back when I was going through a really rough spot, I sought solace in food and became quite the, uh, chunky chap. When I realised the destructive path I was headed down, I decided to quit junk food cold turkey. There were many, many days when I would lay on my bed trembling and gripping the sheets tightly to prevent myself from dialling out for pizza or chicken. I swear it did feel as if even my knees and toes wanted to eat, eat, EAT!

Thank you for talking about this.

Thank you for sharing your story.

Do you know why people are injecting Subutex/Suboxone instead of just taking the pills sublingually?

It does kick in quicker. There's no "rush" like Heroin, but it does hit you all in one go.

Apart from that, needle fetish, mainly. That and culture: if everyone is injecting it, if you start, you are probably going to start with the needle yourself.

Interesting thing however, Suboxone as the film has been known (anecdotally, but across a lot of people) to cause your veins to harden and become useless for fixing with.

Such a terrible idea. I did it once, at the start of my treatment, then vowed to never do it again. And I haven't :)

The article's playing down of heroin withdrawal was very strange. I have sat outside the door of someone withdrawing from heroin and they might as well have been playing The Exorcist at full volume in there. This goes on for days and usually ends up with the 'gatekeepers' breaking down and letting them out.

Also, it has never killed anyone? Mindboggling. It is well-known that year-long users can die from withdrawal (brain aneurysm in the cases I know of).

How did you first become exposed to Oxycodone?

What finally enabled you to get clean 9 months ago?

Do you feel there is a solution to prevent others from becoming addicted to opiates?

My best friend's girlfriend at that time, her father had a life-long script for it due to work induced nerve damage. Thing is, he never took them. Add to that my rather severe clinical depression and a terrible home life, and you've got a recipe for disaster.

I'd like to note, though, that I take full responsibility for my choices. Doesn't matter how bad things were: I still consciously chose this path.

I decided to get clean, because I had had enough. I simply didn't enjoy drugs (any of them) any more, and I believe that a heroin addiction isn't conducive to running your own business, which is my plan for the medium-term future.

No, there isn't a solution, I'm afraid. People will take drugs, and the people that want to most are at the greatest risk of addiction.

What saved me from blood-borne infections, and other various hazards was Harm Minimisation. We have an excellent needle exchange with a huge range of information and amazing people running it here in Brisbane (Biala, on Roma St, next to the QLD Police Headquarters ironically enough).

This enabled me to do things "right". I never shared a needle, I never re-used a needle, and I always tested my gear before "going nuts". That's why I'm still here.

Interestingly, Biala is also where I decided to get clean. They are amazing, and my case-worker is brilliant. I plan on staying this way for the rest of my life (sans the Suboxone hopefully).

Minimise harm, and let people take responsibility for their choices. That's what did it for me, at least.

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