In days gone by, heroin addicts knew how much heroin they needed to 'stay well'.
A major factor in the escalation of deaths in the modern era is the contamination of the street pharmacy's heroin supply with more potent synthetic opioids (fentanyl, etc).
Overdoses happen when street drugs are more potent than the user expects, or when the user's tolerance has changed. Two factors in my girlfriend's OD were having been sober for 5 months and having been made addicted to clonazepam (a benzodiazepine that increases the potency of opiates - she'd only wanted this 'as needed', but the professionals at the hospitalization preceeding her OD thought she needed to take the full dose every day). That batch of heroin could also have been contaminated...
A clean supply of heroin would be quite helpful in preventing people from killing themselves while self-medicating. Until the politicians find courage to acknowledge that it was a mistake to trust organized crime to control the supply of addictive substances, at least 'safe injection sites' is an intervention that can actually prevent people from causing their own premature expiration.
> Until the politicians find courage to acknowledge that it was a mistake to trust organized crime to control the supply of addictive substances, [...]
What would be a better solution in your opinion? Legalizing it, or allowing it with prescription? I see some problems with those alternatives as well; there's probably no magic bullet here.
Make everything legal to obtain or manufacture with a license attainable though education and certification – something in between what it takes to get a driver's license and an AA degree.
If you want to buy heroin you have to understand it's addictive qualities, how human biology is affected, and how to recognize the negative consequences.
Attach liability to the licensee for anything purchased that resulted in harm and to distributing substances with incorrect descriptions.
The death grip of heroin is mostly unrelated to the actual medical properties of heroin (or most opioids). The worst health effects come from the impurities in the substance (Strychnine, a common additive, is generally speaking not a substance beneficial to your health), the conditions under which it's used (shared needles, lack of hygiene) and the treadmill of having to organize funds for the next shot. Medically speaking, heroin is less harmful than alcohol. It's very hard to actually overdose if the purity is constant. It's a preferred drug for pallative care in many countries since it's effective and relatively easy to use (similar tor morphine).
So if you truly care about the health of the afflicted persons, legalization with a strict control is the most effective option that is currently on the table.
Heroin wasn't historically a problem because the users died. Heroin's been a problem because of just how far people will go to get it, and how a massive amount of people will drop everything else in life just to get a steady supply of it.
Opiates are the most addictive substances in the world. Once someone gets a taste of it, their life is forever changed. People can smoke a cigarette a couple times and decide it's not for them. People can have beers once in a while and move on. There aren't many people who try heroin a couple times then realize they're busy and drop it forever.
I've been on hydromorphone. It's 8x more potent than morphine on a gram basis. Heroin is only 3x more powerful than morphine. I was on hydromorphone for 4 months, and then went DOWN to oxycodone for another 6 months. After 6 months, went on hydrocodone. By all measurements of addition, I was 100% addicted.
Yeah, it felt good having the drugs. But I also quit taking them sooner because I felt my mind fogging up. I didn't like that, and took more pain to be able to think clearly. But no, your assertions that people will just drop everything to get it is blatantly false.
Homeless people will go after heroin, if they can afford it. But those that choose this route are trying to numb the fact that people don't care about their condition, and that they have very little chance to raise themselves up. It's a social reason - if I cant have a better life, I can check out with drugs.
And the problem is the people that are dying of heroin aren't the Silicon Valley tech workers with good jobs and homes that make up the majority of hacker news. They're people living in shithole towns like my hometown. The jobs left decades ago and people are just scraping by. They don't have enough savings to pack up and leave. I've got friends and family dying because it's way too accessible, and the idea of making it legal and even more accessible doesn't appeal to me or my common sense. I trust the average person to use heroin as responsibly as they'd use a military helicopter if they could afford one from a day's work--and that's not at all.
So congrats on being able to take opiates and not have a problem. If you have stable employment, your situation is in no way relevant to the people this problem is afflicting. We already know that soldiers who abused drugs during the Vietnam war were able to quit them easily upon returning because their lifestyle improved. Addicts don't have a chance to just up and get a happier life.
> And the problem is the people that are dying of heroin aren't the Silicon Valley tech workers with good jobs and homes that make up the majority of hacker news.
My girlfriend grew up in a "1%" household. She developed substance abuse problems because she was born premature, because she was adopted, because of some "adverse childhood experience", and because her doctors thought she was a candidate for chemical castration with Provera (which makes some women suicidal).
"Stress" is the main factor in addiction. For some people stress is emotional, for others it's economic, and for others it's biological...
> I trust the average person to use heroin as responsibly as they'd use a military helicopter if they could afford one from a day's work--and that's not at all.
Do you trust organized crime to provide heroin to people who are going to use it anyways?
> And the problem is the people that are dying of heroin aren't the Silicon Valley tech workers with good jobs and homes that make up the majority of hacker news. They're people living in shithole towns like my hometown.
First problem - assuming I'm in SV or other high tech areas. I'm not. I'm in south Indiana. By definition, it's a flyover state at best. BTW, most of Indiana is "shithole towns". Thanks for playing.
> The jobs left decades ago and people are just scraping by. They don't have enough savings to pack up and leave.
That's most of the USA, except for the sweet money in those big city coastal areas. Mining is done gone. Manufacture is gone - where it has come back, is 95%+ automated. IT work is menial tier 1 call center jobs, if you can find them. Trucking is still prevalent, but we all know where that's headed.
There's service jobs. That's what those sweet sweet '60s, '70s, and '80s jobs turned in to. Work your ass off for what, $8/hr? Or maybe you're "lucky" and got a $2.35/hr server job. Or maybe you work healthcare service. Oh, so you're an in-home-health aide? You physically help people with many tasks to be functional? Well, you're worth $7.35/hr . And you get to drive to and fro clients houses. And they will want you to drive them places... That's commercial driving so you're driving uninsured. Enjoy those sweet benefits.
> I've got friends and family dying because it's way too accessible, and the idea of making it legal and even more accessible doesn't appeal to me or my common sense.
Uh huh, like illegalization has made it impossible to get. Oh, that's right. That's why heroin is being cut with all sorts of shit, including fentanyl, strychnine, and other fun things. Many heroin users die cause their supply has been fucked with.
Legalizing it would provide a pure source, and accurate dosage. And it deprives criminal enterprises from capitalizing on these people. And people who are suffering real chronic pain can get their pain fix without dealing with a damned moralistic gatekeeper.
> So congrats on being able to take opiates and not have a problem. If you have stable employment, your situation is in no way relevant to the people this problem is afflicting.
More ass-umptions. I got in a nasty bike accident while working at starbucks. They put me on unpaid medical leave. Job didn't pay well to begin with, and their insurance ended up covering none of my physical therapy. Great insurance it wasn't. I was soon laid off for not being able to do the job. So yeah, I did over a year of opiates, while being unemployed and unemployable. Just blows your narrative all to hell, doesn't it?
> Addicts don't have a chance to just up and get a happier life.
Did it occur to you, that drugs provide a temporary "happier life"? Our society sure as hell isn't interested in fixing these chronic problems of homelessness, lack of food, poverty. They're still thrown away - out of sight, out of mind. Or, it's their problem for being lazy or laggard or making bad choices or getting the wrong degree or joining the military.
So yeah, if we're not willing to start providing ways up for these people, then yeah, provide drugs. It at least provides a snapshot of "not suffering", albeit for a while.
I knows several people that tried Heroin a few times and gave it up, but where addicted to cigarettes. Different people have different drug preferences ans I doubt we have good statistics on this stuff.
I like many people where given opioids post surgery and ended up tossing the pills vs finishing the prescription, yet people get really addicted to the same medication.
Indeed, it's entirely possible for people to take heroin at the weekends or similar, and put it down without problems, and I know several friends who do it irregularly without getting addicted - although only smoking, I've never heard of anyone injecting IV heroin who wasn't an addict...
Injections are apparently much more potent than smoking, so it makes sense that people already addicted prefer that to keep the required amount lower. For recreational uses, smoking would just be much more practical.
Indeed. The bio-availability from 'chasing the dragon' on tin-foil is something like 50% or even less, although in the UK at least powdered heroin is adulterated with things like caffeine (which causes heroin to vaporize at a lower temperature) to make smoking more effective. Obviously IV injecting gives 100% bio-availability, though.
I’d like to take the opportunity and thank you for posting here. It’s hard enough to find reports of people that are going through a withdrawal, so being able to engage in a discussion is a rare opportunity.
I wish you all the best in that process.
> There aren't many people who try heroin a couple times then realize they're busy and drop it forever.
Millions of people have used legal opioid painkillers and moved on with their lives. Some people get addicted but for the legal opioids it's far from true that "once someone gets a taste of it, their life is forever changed."
Is heroin that much more addictive than the legal variants?
No it isn't. You don't get addicted straight away, you have to work at it.
Just like cigarettes, you have one and don't like. Tastes foul, gives you a headache. But if you persevere, smoke 1, then more then more. Then after 10 days / 2 weeks of daily smoking you are starting to get addicted, same for heroin. You use it once, and if is any good, you are sick, violently so (vomiting, not dope sick), but persevere for 1-2 weeks the addiction will take hold.
Addiction tends to happen more with heroin, because people who would tend to trying it have other issues on in their life to give them the impetus to keep on trying it.
I've noticed a lot of people on HN are for all drugs being legalized, but they look at it from the perspective of fairly wealthy and highly educated tech workers with stable lifestyles. Coming from a small town in the rust belt where people struggle to even imagine a future, heroin is way too easy of an escape.
I think helping people who've become addicted is good, but these aren't things that should be legal and accessible for people to start using.
10% is the rate of the people that ever try, and those are currently likely to be the people that are predisposed to develop an addiction. I don't think this can be generalized to the whole population.
> but these aren't things that should be legal and accessible for people to start using.
Then impose a full ban on alcohol as well? It's about as addictive and ranks higher in danger to health than heroin. And it's pretty much freely available to any adult. Well, the US tried, it didn't work out all too well.
> I think helping people who've become addicted is good, but these aren't things that should be legal and accessible for people to start using.
When addictive substances are illegal they're more accessible than when they're managed appropriately.
Johann Hari tells in Chasing the Scream about a city in the UK that used to have a legal heroin program. Addiction rates were a fraction of the rate of a nearby city with similar economic prospects. The difference was that the addicts who lived under prohibition had to advertise to their friends to support their habit.
Patients who could get what they needed from the NHS had no need to promote heroin/cocaine/etc to their friends.
I understand what you are saying. I agree that heroin by itself is not very harmful to the body relative to some other drugs.
But let me be more clear about what I mean by "death grip".
When someone cares so much about a drug that it becomes the focal point of their lives, where they become so utterly ruled by the object of their addiction that friends and family and all else not the drug become secondary fixtures in their lives, then they have become the walking dead and are very much in the death grip.
I have seen it with friends. Some are still breathing, some are not.
Sure people on medical grade heroin regimens can continue to exist, but the drug will kill them inside nonetheless.
Revitalization is possible of course, but it is exceedingly difficult.
The point of medical heroine is that people on that regime can and do become well-functioning humans again. It’s not the drug that kills them, it’s the loss of all social support network and the ill effects that come with the situation.
The point of medical heroin, or other harm reduction programs, is to allow people to get on with their actual life without the all consuming addiction being front and centre all the time. I'm currently on a methadone program in the UK (there aren't any heroin based programmes as far as I know here) and it lets me keep up my job as a software engineer without daily worries about having to make sure I can score and not be 'sick' (i.e. withdrawing) and unable to work or go to the office. A heroin prescription would accomplish the same thing for me, and for people in a worse situation - perhaps unemployed or homeless - it would mean even more, since they could devote their energy to rebuilding their life.
Personally, I don't really need a safe injecting space - I own my own home and have a pretty stable lifestyle, but again, I can see how for other addicts it would be incredibly helpful. Again and again, as seen in other comments, it can be seen how despite objections these places provide an objective positive benefit to society.
Heroin addiction is 90% looking for or doing something to get more. It’s an incredible time sink. It’s impossible to have a meaningful life like that.
What medically administered heroin does is allow people to get that time back so they can rebuild their lives. Once they see that things are better, they become more successful when finally coming off of it. Even if it takes forever, they are still productive members or society instead of a drain.
Like 'skellera says in the sibling comment, heroin is an incredible time-sink. The methadone programme I am on (provided free by the UK NHS) is something that will let me gradually reduce the amount of heroin I'm taking, and eventually yes, get clean. After a couple on months in, I'm down to ~25% of what I was taking daily before, and that should reduce further to zero over time.
A methadone maintenance program will gradually increase the amount of methadone prescribed, while the user reduces the amount of heroin they take, until the user is 'stable' and no longer using heroin. After that I certainly would like to then stop taking methadone too, but in some cases the maintenance can continue indefinitely and it would still be considered a net positive outcome...
Like others have said, folks won't actually stop using the stuff. Keep it illegal and folks have a higher chance of getting bad stuff, not injecting cleanly or properly, and increases overdose deaths.
At least with legalization, you get some science based education before you even try it the first time. For most folks, this is way before they start to inject. You can more easily have physicians and/or pharmacists having frank talks with patients about signs of addiction and have science-based plans to help folks wean off of the prescription drugs. You can have injections done by a trained professional, who calculates your dosage. You can make sure it is the strength on the package. You can be referred to a clinic for addiction.
Maybe we can even use some of that money we saved on incarceration to let folks rest at home after injury/surgery without losing their house or their job so that we use less pain medication and reduce risk. We can offer medicine-based addiction services as well instead of AA and NA being the standard treatments.
And sure, it won't stop everyone, just like cigarettes. But no one currently starts cigarettes thinking they are completely safe - I surely didn't and I started 20 years ago, though I'm down to 3-4 a day now. We can also not use as many of the scare tactics we use today and be honest about the positive effects folks get from this stuff along with the bad. For some, we might have better alternatives (different ways for coping with boredom and stress might help with things like boredom, which is what actually got me to start around 18).
And just to state things: I don't know how it is with heroin addiction, but not all addicts for other drugs are alike. Not everyone is an addict for life. Some folks can be alcoholics but then be completely able to drink casually like everyone else, without re-developing a problem. Others cannot, and I think we do a great disservice to people when we lump them together like this.
Legalize everything, and offer the appropriate counter-medication at a discounted cost. Heroine costs someone $20 per use? Methadone is $10.
You'll never keep drugs out of the hands of people who want them, all you're doing is creating artificial scarcity driving up prices and giving people like Mexican drug cartels huge financial incentives to run drugs into the country. Even if only 1/10th of their drugs make it into the US, as long as there's an demand, that supply will be exponentially worth more, and cause more harm than pharmaceutical grade heroine sold just like alcohol, tobacco, marijuana, etc...
Heh, heroin does cost about that much, same for methadone, at least in the UK. I can get 100ml of 1mg/ml methadone for GBP 10 which will keep me stable for a day or two; a GBP 10 (i.e. 'tenner bag' or 0.2g) of heroin is enough for a single IV shot for many users. Of course, depending on your tolerance, that may well not be enough, but my point is that 'legal' heroin would probably be much cheaper than current 'street' prices. I'm not sure how cannabis prices have varied in places where it's legal in the US, though - do taxes bring the price back to parity with the old 'street' level? I'm guessing it's going to be complicated by the fact that it's still illegal in other states?
So, turn the Mexican drug cartels over to america drug cartels? Until we fix the cartel problem in the US legalization will do nothing but bring down prices. Look at how it took 30-50 years for "education" in tobacco products. Yes there are examples of countries that have legalized drugs, but without a much better healthcare system in the US it would turn into a huge money grab.
Would have loved for this to work, but there might be a few problems.
1. Some people might pass the test and sell it to others who didn't.
2. I'm not sure how education helps here. Everyone who takes heroin/cocaine knows how bad it is. I think people actually think it's much worse than it is.
After taking a "health" class in high school, my friends and I said "wow, I thought drugs are much worse". For example, they showed a recording of a lady taking MDMA and enjoying it in her room. From what I was taught before that, I assumed she must die or commit suicide immediately or must start craving another dose a day later. Same thing with marijuana.
"It's bad, but we can't tell you why except some potential side effects that may or may not occur"
>2. I'm not sure how education helps here. Everyone who takes heroin/cocaine knows how bad it is. I think people actually think it's much worse than it is.
Respectfully, you are wrong. Nothing wrong at all going to the pub, having a few beers with friends and sharing a gram of coke.
Heroin itself isn't bad, is actually quite useful medically.
Just like drinking a bottle of whiskey is not good for you, but has a tiny relation to have a beer after work, the same for coke / heroin.
> After taking a "health" class in high school, my friends and I said "wow, I thought drugs are much worse". For example, they showed a recording of a lady taking MDMA and enjoying it in her room.
That is 99% the experience people have with MDMA. They have fun and no problems. So if the result of truthful information is people go out and have fun safely with zero problems, then what is the problem?
Legalise all drugs without discrimination. Provide true information and have access to health, mentalhealth workers at the place of purchase. Most opiate addicts do not want the life they have, but when 100% of your waking day is spent searching for the money to get your drugs / using drugs / feeling the effects of the drugs you have next to no time to seek help for the root cause of your issues. Provide these people with free medical grade drugs and other a support system for helping them become a part of society with the honest admission some people will never get clean, but if can be funded their drug can leave (relatively) normal lives as a functioning member of society
1. So, it'd be like alcohol and tobacco, then? At least the product they are selling will have standards of purity and things like that.
2. Education that doesn't involve scare tactics provides things like proper expectations, safety on dosage, and things like that. MOst drug education in the US has scare tactics - like your reference to cocaine. Most healthy folks can do a little bit every once in a while and have few to no side effects. Same for MDMA, but folks should know that taking it too frequently can mess you and that you'll not be sober for a while. Folks get morphine and medical-grade heroin for pain without becoming instant addicts, so obviously it is safe in some situations. We can teach folks what to expect from pot edibles, mushrooms, and LSD. We can teach folks how to keep safe while doing a drug - how long before you should consider yourself no longer impaired, for example. Warning signs to seek medical attention are important to learn. Legalisation means folks aren't as likely to lie about it to cops and doctors.
There is a solution to the drug problem that is clear, simple, and wrong. As you put it, there is no magic bullet. However I hope we can all agree that the current war on drugs isn't working. We've been fighting it since (before) 1971, and prohibition isn't working. People are dying, and have been for decades.
Just like we admit that 100% uptime is impossible, and admit that there's no solution that will make that possible, we instead work to minimize 500s to an often respectable number of nine's. Similarly, there is just no solution to the evils of addiction.
What we can practice, however, is harm reduction, and injection sites have been one method that has been in use in Europe for decades.
Can we agree that the drug war is a failure, and work on supporting harm reduction techniques?
How about supplying heroin under strict conditions and medical supervision?
Switzerland went this route 20 years ago and I dare say it's pretty successful.
The cost to health insurance (yep, they pay for it) is pretty much negligable. Especially when compared to the cost to the addicts and society to keep that shit completely underground.
There will always be people that push the envelope because they are suicidal. But funny enough buying pure fentanyl is one of the only ways to get a powerful opiate with a known potency.
You cant trust street dope because of the fentanyl, but if you order a pure fentanyl analog from China, and you are smart about dosing using volumetric dilution, you can be very aware exactly how much you are taking. Whereas with street dope, you will never know.
But by definition, a supply of known potency will never cause a "hot shot" as long as you are being smart and responsible.
The problem is some people don't "feel" high until they are pushing the limits of respiratory depression, so you will have people overdosing no matter what.
I've known people that overdosed, were revived at the hospital, only to go home and shoot up again and die. Its very sad.
A major factor in the escalation of deaths in the modern era is the contamination of the street pharmacy's heroin supply with more potent synthetic opioids (fentanyl, etc).
Overdoses happen when street drugs are more potent than the user expects, or when the user's tolerance has changed. Two factors in my girlfriend's OD were having been sober for 5 months and having been made addicted to clonazepam (a benzodiazepine that increases the potency of opiates - she'd only wanted this 'as needed', but the professionals at the hospitalization preceeding her OD thought she needed to take the full dose every day). That batch of heroin could also have been contaminated...
A clean supply of heroin would be quite helpful in preventing people from killing themselves while self-medicating. Until the politicians find courage to acknowledge that it was a mistake to trust organized crime to control the supply of addictive substances, at least 'safe injection sites' is an intervention that can actually prevent people from causing their own premature expiration.