I live in Seattle and regularly see needles on the street, and occasionally see paramedics tending to OD'ing addicts. This is a great development but should've happened years ago.
Definitely, as a Seattlite I'm all for it, less needles in parks, under I-5, and on the streets are good. Having users all in one place where they can be monitored, attended to and offered services much more effectively and at a lower cost to the taxpayer is also a huge win!
If you think this will bring LESS needles then you are gravely mistaken. Go take a stroll up to Vancouver to the safe-injection site they are modeling this after and you'll discover destitute conditions in a large radius.
Seattle's homeless problem is possibly one of the worst in the nation, likely due in part to the friendly & enabling atmosphere the city and it's citizens have provided. By denying these people hitting their bottoms, they will never have a chance at cleaning up and returning to society.
It's too bad this is being down-voted, because you're absolutely right. There will always be people who turn to substances, but the war on recreational drugs creates a black market that results in sketchy, dangerous product. Decriminalization and legalization of drugs will make everyone better off (except drug Cartels).
I know that is the popular meme. But is it really true? What country on earth can you buy any drug you want without a prescription in a pharmacy, and how does the culture look like?
Frankly some stuff is really bad and should be kept away from people.
No. Just because the war on drugs was started for a racist reason doesn't make banning drugs themselves a bad idea. I don't think people can make valid choices about the use or not use of highly addictive drugs. We as a society can do better than to help people be strung out.
> We as a society can do better than to help people be strung out.
Safe injecting facilities are not about helping people be strung out. They're about reducing harm, both to the addict and to the rest of society, coming from drug addiction.
Did you read the whole piece? There's strong evidence that drug abuse is bad, and that the best way to mitigate it is through harm reduction policies -- and that these policies ultimately reduce use of drugs. Which is what you want, right?
I'm pro-legalization, but there is a good argument to be made that legalization increases access and as a result you'd see a much higher rate of casual use (orders of magnitude higher). Any slight increase in healthcare costs or negative outcomes on a per-person basis multiplied across a large population is a factor worth considering.
But is there evidence that there would be a significant change? That hasn't been shown in California, Oregon, Washington, or Colorado, in the case of marijuana. Why would other drugs be different?
This is purely anecdotal, but I'm not so sure legalization would have a large effect on the rate of drug use.
I consider myself fairly well insulated from drug use. In my entire social group I know of only one person that has ever tried methamphetamine (which is rampant here in Australia), and none that have tried heroin. Despite that, if you set me to the task of aquiring heroin I'd be pretty confident in my ability to do so. I doubt I'd have to go through more than 3 levels of friends to find someone that could hook me up. And that's not even taking into account darknet markets (which I imagine would be fairly easy to learn how to use as a software engineer).
If I woke up tomorrow and decided to try heroin, there wouldn't be very much in the way of obstacles in my path.
So for me at least, there's not that much difference between the current situation and legalisation. Especially if said legalisation requires a prescription. Arguably convincing a doctor that I'm an addict and in need of heroin is more of a barrier to entry than finding someone that sells it now.
I don't know, I think there are a number of factors about illegal heroin that make it less attractive than legal heroin might be:
1. Buying it illegally funds criminal organizations
2. Quality is terrible, it's certainly adulterated
3. Association with low class and poor people
You can ingest or smoke opium products, too, if the needle is the off-putting part of heroin.
But yeah, another anecdotal perspective: I've had prescription opioid painkillers but don't have any particular interest in continuing to use them after the pain goes away. So if opioids were legal tomorrow, I don't think it would change my behavior at all either.
Yes, people don't realize that this "solution" doesn't work for any drug just because it makes sense for marijuana. For the people who disagree: In the limiting case thought experiment, imagine a drug which provides a complete DMT + MDMA experience with a single molecule, but has a 50% chance of killing you. Should this drug be easily available in a store? Run a simulation, let me know what the half life of your population ends up being...
Heroin isn't too different, really. It's very addictive, has a low LD50, and when it's easy to get, people effectively get a free ticket to a brothel on an accelerating rocket-fuel train with rarely stops. If a drug can have that much power over the body, people might think we could create microdoses, and sell those, and then it'd be safe. But then, the market for heroin/tar/etc. would still be there, and would continue underground.
It's not as simple as "selling it at CVS w/o prescription will lower overdoses and dissolve the underground H market"
I don't think it works with anything more addictive than say coffee and with reasonably negative health effects. I.e. today's engineered tobacco is likely on the wrong side of where I would personally draw the line.
I'm not aware of any country that's gone that far, but, Portugal decriminalized recreational-quantity possession in 2001 (across the board) and did a study on the societal effects in 2009: "Empirical data from that report indicate that decriminalization has had no adverse effect on drug usage rates. However, drug-related pathologies - such as sexually transmitted diseases and deaths due to drug usage - have decreased dramatically."[0]
There are places like Amsterdam that are perfectly functional with recreational drugs, although they still maintain a distinction for "hard drugs." Making such a distinction is fine -- it would be a huge step in right direction to at least recognize that recreational drug use is not inherently bad. But in reality, I don't think "dangerous" drugs are any less dangerous or prevalent because they are illegal, so I'm not convinced the distinction is necessary. The government-focused stigma against drugs was never so prevalent before the 20th century.
I literally cannot understand why this is being downvoted. Prescribed heroin would save thousands of lives and billions of dollars in ER OD cases and the acquisitive crime that this disorder causes. Shame on you HN.
There is a fallacy at work here where people automatically assume that outright banning a substance through legal action is always wise or even always effective. And if the people die as a result, our attitude is essentially stuck on 'screw em, they shouldn't have been breaking the law anyway'.
Meanwhile, with proper health care and psychiatric care, the same people who could have stayed within the system, could have greatly boosted research into all kinds of conditions that compel people to take hard drugs in the first place and we could have had this issue solved long ago.
Instead, the medical industry is hamstrung in helping them almost as much as the addicts themselves. But politicians from the left to the right get to look good on camera, and journalists can bravely declare more drugs will be off the streets as they show children walking to school, ensuring nobody will ever suspect they're setting those same children up for severe problems that will go untreated.
>Prescribed heroin would save thousands of lives and billions of dollars in ER OD cases and the acquisitive crime that this disorder causes.
If you get a prescription for heroin that would probably lead to addiction right? Now as an addict you want more, so you go back to the doctor but they won't prescribe anymore ostensibly to prevent overdose. So now you have an addict looking for a way to score more outside of a doctor prescription which would still open them up to every single risk that currently exists today. Seems like the end result is going to be the same either way unless doctors continually up the dosages prescribed, no?
If you get a prescription for heroin that would probably lead to addiction right?
Under what circumstances do you think doctors would be prescribing heroin? Because a person wants to give it a try? For recreational use? Doctors already prescribe (under heavy regulation) narcotics for pain relief. If they were to prescribe heroin, I can't imagine it would be cavalierly prescribed for anything, other to address existing addiction, not unlike methadone treatments today.
... and this is where most Heroin addicts start, actually, through prescription opiate use. Once a physical addiction is formed, heroin can be a cheaper or more accessible alternative to a prescription for say, Oxycontin.
The crackdown on "pill mills" meant that the cost of oxycodone shot up on the streets over the last 5 years. Demand remains the same, supply is lessened.
Why? Black market heroin can be produced without quality control standards, intellectual property licensing, in a country with cheap labor, and imported without paying tariffs. The distribution network is a little inefficient, sure, but you can pay a lot of mid-level dealers' markup for the cost of a 30 minute doctor's appointment.
I think you're using the incorrect mental model of addicts popularized by DARE, etc.
I mean first -
> If you get a prescription for heroin that would probably lead to addiction right?
Decently sure OP is suggesting replacing obtaining heroin from the street with obtaining it through a doctor. As such, only existing (and new) addicts are effected; you would not create addicts.
Alternatively, this story you have told is already the case with other prescription opiates.
> Now as an addict you want more
> continually up the dosages prescribed, no?
I mean, do alcoholics do this? Or gamblers? Adrenaline junkies? Yes and no.
Basically, most of what you know about drugs is inaccurate, and addiction (and escalation of addiction) is complicated. For instance, the rat park experiments indicate that addiction is a coping mechanism - rats in individual cages experience addiction; rats in group cages, not so much. Simply by obtaining the drugs from a sympathetic ear, you can reduce the dependence on the drugs.
You have a great comment, and I agree with much of it. However, Rat Park doesn't replicate and probably shouldn't be touted as a good example of addiction behavior.
Interesting. However, those are attempting to replicate the results, and not the experiment; from my level of education and based on the abstracts, that sounds more like "significant results" rather than "disproving results".
The first abstract actually describes a theory that cannot be correct given the Rat Park experiment as described on Wikipedia, due to group PC (no new rats were supplied to that group). Or, rather, a theory that does not explain group PC.
Not really, most heroin users reach a sort of stable dose, which can be very high.
The idea is you stabilize people's lives. Prescribe them heroin for say 3 months to start with. Their lives are no longer endless crime, prostitution, police cells etc. They can get housing and other things sorted without having to also find $1000s a month for a drug habit.
From that the community is already seeing a benefit (less crime and the market for black market heroin mostly vanishes), and then from that you can start helping people reduce their dose and get proper drug treatment while living a far more normal life.
There will probably be some black market dealing, but it will be much smaller scale and won't have anywhere near the scale.
> I literally cannot understand why this is being downvoted.
Because it's off topic?
You can't seriously think HN is not anti-prohibition?
To move forward we need to be practical.
One city in the entire US is getting an injection room.
Why start talking about the legalisation of heroin? If it works but it can't be implemented why discuss at this point when we are discussing something that does greatly help and is being implemented.
These are different approaches, not necessarily mutually exclusive but by changing the topic you devaluing the important discussion of injecting rooms.
This article is about injecting rooms not ending prohibition I think it is off-topic?
There are plenty of articles on decriminalisation and legalisation out there to have that discussion.
The guidelines state that "anything that gratifies one's intellectual curiosity" is on topic. At least one person thought so: the submitter. Others have contributed to the the discussion: likely they think it's appropriate for HN as well.
If you think it's inappropriate for HN, feel free to flag the submission and move on.
It will, ineffective, become so, though. Just like in Japan, near every pachinko parlor there is a window where you can trade your "prize" for cash, the underworld will set up shop right next door.
I am not convinced that that it will reduce overdose or trafficking. It depends on the drug's economics and pharmacodynamics, ease of production, addictiveness, LD50, etc. What's better? More people using high-grade heroin in a controlled, safe environment, or less people using low quality heroin in an uncontrolled, dangerous environment?
If the LD50 is very easy to arrive at in everyday usage, then I don't see this helping out very much. You could sell heroin in doses << LD50 for a high regulated price, but then you will end up with black markets which sell much larger doses at lower prices (if the substance is easy to produce in various quality levels). If the price to get "safe" heroin is not artificially increased, then it would be way too easy to accidentally have too much, especially if herion is highly addictive, which, it supposedly is.
People would just end up riding their doses up to dangerous levels, in which case they would now have a dependency on heroin. Would it bet better for everyone to have a safe, controlled dependency on heroin, or for 5% of people to have an unsafe, uncontrolled dependency on heroin?
> Would it bet better for everyone to have a safe, controlled dependency on heroin, or for 5% of people to have an unsafe, uncontrolled dependency on heroin?
For an answer, you can just look at alcohol, which is typically assessed as having roughly similar social harm to heroin (although it varies by source). Were things better during prohibition, or today?
I can't accept that heroin and alcohol are equal in that sense. I would be very skeptical about any sources claiming this equality. Ease of production, pharmacodynamics, etc.
Edit: Ideally, humans wouldn't be consuming poison? But, what is poison? It's a lot more complicated than "alcohol is bad" or "heroin is bad". Maybe you are right, letting down the flood gates will surely kill people who don't have control, and we'll be OK asymptotically. Making alcohol legal certainly killed people who wouldn't have died, and saved people who would have died. At some point, this is just a variation of the trolley problem. If heroin was made CVS-able without prescription, I would not guarantee that I wouldn't try it, and that scares me because I know how dangerous it is.
Honest question, do you have an alcohol problem or addictive personality that is driving this fear? If not, what keeps you from drinking yourself to sleep on the sidewalk every night?
When it comes down to it, not all drugs are equal. Heroin isn't "alcohol but worse". People who drink tend to get pretty nasty sometimes, and that's a social harm that someone who's nodding doesn't perpetrate. And in terms of physical harm, heroin is actually pretty low compared to alcohol. Lots of people destroy their livers with alcohol and die early, while there's an awful lot of rockstars who do piles of heroin and cocaine and live to their 70s and beyond (we need to start worrying about the kind of world we're going to leave for Keith Richards).
The harm comes from getting bathtub stuff of uncertain potency and purity, and from the things people need to do to afford their fix. If it's clean and affordable you tend to do fairly well on both the 'personal' and 'social' harm aspects.
Obviously that's not how DARE told you to feel, but the fact is that the current state of things is not the only one that is ever possible. You don't know what social use would look like in a society with legalized heroin usage.
If you eliminate the need to commit crime to obtain black-market drugs at obscene prices, a lot of the harms of heroin go away. Some people will still choose to do it, but we free up a whole bunch of police money that can be redirected to free treatment resources to help people quit when they realize they aren't going to find happiness in drugs.
If this were several years ago and I was still a college freshman, I bet I would have tried heroin if it was available for 5 bucks a pop next to the Benadryl at CVS. Things much more innocent than heroin get in the way of a freshman, so yeah, I would be concerned if heroin was on the shelf for anyone who is 18 right now.
I would've too, but I'm fairly confident it would have been a one-time-only thing. I had a roommate, smart lawyer kid, who talked casually about doing cocaine one day, which surprised me since back then I drew a line between "hard drugs" like cocaine, H, meth, and "soft drugs" like marijuana, LSD, and the like. And this guy seemed (and still is) like such a smart, successful person. He told me that drugs don't change who you are... if you're a cautious person who has self control, that doesn't change.
" People who drink tend to get pretty nasty sometimes, and that's a social harm that someone who's nodding doesn't perpetrate."
If everyone did heroin today - instead of drinking - the world would fall apart.
Can you imagine 50 000 people at a Football game, all doing smack? Sure, it would be a fun game. Within days, 10% of them would be full on addicts. Within weeks maybe 50% of them would. Those people would go through hell or high water to stay permanently high.
Giving them 'cheap and safe' smack at Walgreens is not going to help them - it would destroy them.
"If you eliminate the need to commit crime to obtain black-market drugs at obscene prices, a lot of the harms of heroin go away."
Have you actually ever met an addict - do you realize how insanely destroyed their lives become? Do you think that by making the drug cheaper and more accessible that this is going to 'make them better'? No - it's only helping to kill them.
I've met plenty of addicts, and they're perfectly fine people when they haven't been pushed to the brink by restricting their access. People can end up pretty nasty this way, the same way that people can end up career criminals - but they almost certainly didn't start that way.
Your perspective seems very out of touch with the reality of things, and I question whether you've actually really talked to any of them at all, and instead are simply arguing in respect to some caricature of one.
Yes, my roommate in college went pretty deep into opioids for a couple years and eventually quit. He's now a PhD student studying math, smart as ever. I think we know very different addicts.
> Can you imagine 50 000 people at a Football game, all doing smack? Sure, it would be a fun game. Within days, 10% of them would be full on addicts. Within weeks maybe 50% of them would. Those people would go through hell or high water to stay permanently high.
You sound like my middle school DARE teacher talking about how our brains would fry like scrambled eggs on MDMA. (ie those numbers are pulled out of your imagination)
That's still terribly high, and I think your ideas have an element of truth, but your approach to using unsubstantiated numbers and overall tone of self-assuredness is just kind of sad to see.
"Here's probably the most strict source on drugs saying that the addiction rate is 23%"
I get what you are saying, but I don't think you're applying the general context: everyone doing heroin as common as they drink - that would lead to massive addiction and total health crisis.
So it's not '1 game' of 50 000 users, it's every game.
Frat parties, bars, dinner parties, 'netflix and chill', I mean pervasive open used of opioids. This is 'where people drink alcohol' - so now replace alcohol with opioids.
23% addiction in narrow circumstances, but considerably higher across the board.
A 'University' that had widespread use of heroin - as widespread as alcohol - would crumble very quickly. Near 100% of the student body would be addicted.
Nicotine is addictive to 100% of people if they smoke enough packs - the chemicals just do their job, and that means pushing the body to 'demand more'. For some, it means more smoking than others, and many would chose not to smoke enough to get hooked - but it will get you 100% of the time, with enough cigarettes.
"d I think your ideas have an element of truth, but your approach to using unsubstantiated numbers and overall tone of self-assuredness is just kind of sad to see."
No. Absolutely not - and you proved it yourself: a 23% addiction rate over a small sample would lead to considerably more over time.
Can you imagine 23-70% of regular people addicted to heroin (because that's what would happen if they did heroin as much as people drank alcohol).
'23% of the population hooked on heroin' (and this would be a low, conservative number) would be totally devastating to civilization - that's not an 'extreme' or 'irrational' position.
It is 'extreme' and irrationally 'self assured' to posit that alcohol and heroin represent the same level of public health risk to society.
If I do heroin once and stop for whatever reason (because I didn't like it, because I was afraid of the addictive potential), why would I keep injecting myself over and over until the "chemicals did their job"? You're making a big assumption that people would keep going back to it instead of stay the hell away like you and I both do today (presumably). It's illegal but not hard to acquire.
For the record I've been prescribed opioid derived drugs and did not get hooked. Why? Because I know how addictive it can be, so I popped some to see what it was like and trashed it.
This world where everyone uses opioids pervasively won't happen because people would know or soon figure out how pointless and devastating it is. It's like asking why we don't have cultural customs where everyone murders a new family member each monday. Any culture dumb enough to try no longer exists.
His research was sufficiently well regarded, that when the British government sacked him from their advisory panel, all the other scientists resigned in protest
"alcohol, which is typically assessed as having roughly similar social harm to heroin"
This is absurd.
There is no place on earth where it is 'typical' to consider alcohol to be more dangerous than heroin.
The ridiculous 'research' on alcohol v. heroin make comparisons as to 'how many accidents are caused by each' etc. in society, which is obviously not a fair comparison considering once is widely used, the other very infrequently.
Opioids are extremely addictive, and destructive in almost all cases of use.
Demonstrably false. The vast majority of opioid users are recovering from surgery, taking Tylenol 3, etc. You're basically just talking out of your butt here.
Opioid use is not inherently dangerous (indeed, long-term pharmaceutical-grade opioid use is remarkably safe does not cause organ damage, unlike alcohol). There are several actual circumstances where opioid use gets dangerous to life and they are:
1) Dosage/concentration uncertainty
2) Contamination of a lower strength opioid (say, morphine or heroin) with a much higher strength one (fentanyl or fentanyl analogues)
3) Poly-drug use -- such as combining opioids with benzos to exploit synergistic effects
When it comes to pharmaceutical-grade opioids, the doses are known and measured and there's no risk of contamination with unknown amounts of fentanyl analogues. Indeed, the mechanisms of drug prohibition actually incentivize the use of extremely high potency/volume opioids such as fentanyl.
The third issue, poly-drug use, also is a consequence of prohibition -- the prices of opioids in the black market are artificially inflated (if you don't have the requisite permission slip for the drugs, you need to invest in all sorts of countermeasures to avoid being put in a cage and your product seized), so users need to economize, and this sadly happens by combining benzos with opioids, which can lead to fatal respiratory depression. This is also a symptom of prohibition and is not inherent to opioid use.
There are definitely real harms involved with / caused by opioid use today -- but most of those are caused by (or greatly worsened by) opioid prohibition.
Good points, but what about addiction and neurotransmitter equilibrium? If something is addictive enough, and highly available, do you think that it would become an unnecessary brain dependency?
I feel like someone functions better with their regular, stable dose of pharmaceutical-grade opioids in them -- I don't have any medical or moral issue with that at all. It's honestly...a lot like the hair dryer anecdote in http://slatestarcodex.com/2014/11/21/the-categories-were-mad....
As for the LD50 issue -- yes, opioid-naive (non-tolerant) users will have a low LD50 but they also won't need much a dose to get the effects. As people get opioid tolerant, the dose that will kill them also increases in step. It's not a case of "user needs higher and higher dose but needs to not cross a fixed LD50 threshold". Because opioids mostly just affect opioid receptors (unlike stuff like alcohol, which is hepatotoxic), tolerance means the LD50 increases in step with the effective dose.
The popular picture of the heroin addict who has to use higher and higher doses to get the desired "high" is a creation of prohibition -- there's no inherent need to do anything of the sort if one has proper medical access to the right dose of prescription opioids. Moderate and safe opioid use is difficult under prohibition if only because it's hard to moderate oneself without precise and pure measured doses.
There's plenty of people who engage in moderate long-term opioid use, between pain patients or "high functioning" heroin users. Those people tend not be the face of opioid use precisely because they have access to the drugs in ways that are stable, safe, not life-ruiningly expensive, and doesn't place them in regular contact with criminal organizations. They aren't exposed to the worst harms of prohibition and that's why they're able to keep using (without anyone knowing that they use) and have a stable career/family.
To be clear, none of this is to say that opioids are harmless or that should be handed out like candy -- they're serious drugs and should be used responsibly by people who are aware of the risks/contraindications.
These are all good points, in agreement with the general consensus here. I think most people here can agree that uncertain (i.e. impure, unpredictable) doses of pretty much anything is far worse than having predictable doses. You also mention the LD50 is a function of tolerance, which, of course makes sense. My main concern is the backlash of suddenly stopping opioid consumption after one has reached a significantly higher (compared to the naive values) personal LD50 and dosage.
They most certainly can - but the majority of the harms actually result from our treatment of the issue, not the issue itself. I think we simply have to accept that people are going to want to use these substances, and make it as safe as possible for them to do so. If the first step of a plan says something like "1) First, change fundamental human nature", the plan really needs a rethink.
"but the majority of the harms actually result from our treatment of the issue, not the issue itself."
Total nonsense.
Please tell me what 'harms' come from heroin treatments?
The primary 'treatment' for heroin addiction is to simply 'not do heroin'.
Stop doing it.
Ultimately, that's the only way out.
" I think we simply have to accept that people are going to want to use these substances, and make it as safe as possible for them to do so."
No - again false. Law of Supply and Demand: if we make it hard enough to get, and raise the barrier of supply, and also try to push back demand by teaching kids not to use it - then it becomes rare.
Enabling users lowers the 'difficulty of access', like lowering the cost curve - and creates more usage.
Anyhow who is caught in public, high on heroin, can be asked to go to a dry out clinic where they won't have access to it. They have to go through withdrawal.
> "the treatment for heroin addiction is to simply not do heroin... ...they have to go through withdrawal."
This is true for people who do not consume heroin a priori. For the others, suddenly stopping heroin use can be life threatening. Most people need assistance to wane off of things like that. Also, I think you are right that enabling will increase usage, but you must also consider the black markets which are enabled in response to disabling the regulated markets.
It seems like a majority viewpoint on this thread is that it's better for more people to be using real opioids safely than to have a smaller, effectively invisible/black-market population using "opioids" very, very dangerously.
The LD-50 of heroin is high relative to the recreational dose; it's widely regarded to be a relatively safe drug, when administered pure. Many governments have programs that administer heroin prescriptions to addicts, e.g. Switzerland [1].
Wikipedia gives the overdose level at 75-600mg[2], and Erowid reports the recreational dose at 5mg[3] (both for "opiate-naive" individuals, i.e. no tolerance). >10x is a high safety margin; alcohol is of the order of 10x for reference.
The piece you're missing here is that the primary risk of accidental overdose is greatly increased with illicit heroin where the purity is unknown, and can fluctuate wildly as it always cut to some extent, but seldom predictably so.
In the case of heroin, most of the harm from usage is directly caused by prohibition.
Impure drugs is certainly a big problem, and is the most compelling reason for legalization and healthcare instead of incarceration and war.
Only a single order of magnitude is not enough of a safety margin, depending on the substance, and how easy it is to administer the substance. Is alcohol's LD50/dose ratio an apt comparison? Does alcohol require a higher administration energy than heroin? It seems like it would be easier to "accidentally" consume half a gram of heroin in a small amount of time, as opposed to "accidentally" consuming 100 beers (or 2 handles).
Drug users experiment across this mere 10x range effortlessly, according to your source:
> As usage increases, however, the doses get much higher
Apparently, they get to 100x. Crazy!:
> The Swiss found that users offered unlimited quantities would, on average, max out at between 300 and 500 mg
This seems to support my view. I can't help but imagine a dystopian future (past?) where they start selling a soda called "HeroHera" which has trace amounts of heroin in it.
Anyways, it seems pretty dangerous for brains to depend on the naive-LD50 of heroin. Forgetting to consume it after one has an established a dependency must surely be an issue. How do we know that a potential widespread dependency on heroin and a requirement for widespread heroin sanctuaries won't actually cost more than the war on drugs?
They found using pharma grade heroin worked better than methadone in weening addicts off heroin but it is difficult to get from Europe, so they did another study to see if hydromorphone worked just as well and it did, effectively cutting costs for any prescribed opiate treatment program. They also found by prescribing it, the addicts no longer were getting arrested everyday or participating in the black market, and made long term goals like savings since they no longer needed to live day to day committing crimes to support the addiction.
As for injection sites I hope Seattle doesn't make the mistake of not making sure treatment is also available or else they'll end up like Vancouver with a growing number of injection sites because of the months long waiting list to get into treatment. These facilities are majority used by street addicts too so you still have a large amount of fentanyl overdoses since it's casual users dropping dead in their houses who don't frequent the clinics.
Another issue with these facilities is there's constantly a crowd of gangsters out front ready to sell you drugs on your way in or collect debts from addicts in the lineup so some addicts don't go to the injection sites.
> Drug treatment in the UK encompasses a range of available treatments and services including community (and primary-care) based prescribing, community one-to-one and group-based psychosocial interventions to support recovery, inpatient treatment, day programmes, and quasi and fully residential drug treatment and rehabilitation support. Prescribing (principally methadone) for drug dependence is provided for stabilisation, detoxification, maintenance and relapse prevention. The National Institute for Health and Care Excellence (NICE)107 also provides guidance on a number of drug-treatment related topics and these are reviewed and updated regularly based on the latest evidence. Treatment interventions in any given area are expected to include advice and information, care planning, psychosocial interventions, community prescribing, inpatient drug treatment and residential rehabilitation. In addition, drug misusers should be offered relapse-prevention and aftercare programmes; hepatitis B vaccinations; testing for hepatitis B and C and HIV; access to hepatitis and HIV treatment; and needle exchange. Oral opioid substitution treatment (OST) with methadone is the most common pharmacological treatment used in treating heroin addiction; buprenorphine is also prescribed and injectable opioids, such as injectable methadone and injectable diamorphine, are also available but are not commonly used. Naltrexone108 is recommended as a treatment option to prevent relapse in detoxified formerly opioid- dependent people who are highly motivated to remain in an abstinence-based programme
Unfortunately, in the US, it's illegal to prescribe a drug to maintain an addiction. If we can change that aspect of the law, then addicts can get legal access to narcotics until they voluntarily decide to quit.
Suboxone, methadone, buprenorphine, and several other non-narcotic medications are all available through an outpatient pharmacy with a prescription. They are regularly and widely in use with mixed results. You would be extremely hard pressed to gain support for adding pharmaceutical grade heroine to the mix without extremely compelling data.
Any pharmacy that administered or dispensed pharmaceutical grade heroine would suffer public backlash from their communities. They would be forced to specialize and essentially become a new flavor of methadone clinic.
Plus, there is the whole acting in good faith and professional judgement thing that seems like it would be a large hurdle to overcome.
Suboxone and buprenorphine are the same thing.
Yes, I know the manufacturer claims they're different, and the naloxone in Suboxone performs a function, but it really doesn't other than extending the patent lifetime. Buprenorphine itself is a partial agonist, and will cause precipitated withdrawal like they claim the naloxone is for just fine by itself, since it has a very strong affinity and low-medium intrinsic activity, thus ejecting lower affinity opioids like heroin from opioid receptors.
First put the drug cartels out of business by decriminalizing all recreational drugs including heroin. People will get drugs if they want them legal or illegal, tainted or not.
The next step is to provide safe injection and drug-exchange sites with immediately available drug counseling and detox. So an addict can trade 1g street-grade nasty drug for 1g medical-grade drug. Medical help needs to be available to swoop in right as they are coming down from the drug high. Hell, provide some free heroin to wean the drug addicts off of it on the condition that they participate in the detox programs.
This might sound like the unholy lovechild of libertarianism and nanny-state socialism, but I bet this ?pragmatic? approach will be cheaper in the long run, and centralize addiction/voluntary treatment in a location we [the people] can control. It would drastically cut down on ER visits from addicts, which is already a growing issue.
It's also worth noting that the only long term negative effect of heroin addiction is the addiction itself. It's not like meth or even smoking cigarettes where side effects will kill you.
The Midwest/East Coast really need this, since that is where all the powder, fentanyl-laced heroin goes. People are dropping like flies in those regions of the country, while I would imagine the West Coast, where black tar heroin is sold, hasn't seen as much of an increase in overdoses/deaths.
Black-tar is, as the name implies, a black (or very dark brown) compound, generally pretty sticky (though it can be dried into a powder). White powder heroin is, as the name implies, a white powder.
Fentanyl is a white or yellowish powder.
For a variety of reasons, it is far more common for white powder heroin to be laced with fentanyl (which is hundreds of times more potent).
"Powder" Heroin is most often light-ish brown/tan (the darker the better, generally -- with exceptions of course). It will still cook up to the familiar color of motor oil. White powder is almost unheard of these days. While generally considered to be of better quality, it's often referred to as "China White" -- I believe this stems from the heroin boom of the 1970's when most of it was imported from the Far East after the Vietnam War era.
In addition to what the others have said, black tar is essentially heroin that is made by skipping a few of the steps in the "standard" heroin synthesis process. Whichever cartel controls West Coast distribution decided that was good enough for them, and customers would buy it regardless. I'm actually curious as to why the other cartels bother producing powder heroin at all.
Presumably because it packs to a higher density and is purer, and since sentencing is done by weight irrespective of how much active drug it actually contains, it winds up being essentially a forcing function toward making the strongest substance you can. Such laws therefore are almost entirely responsible for why drugs have gotten stronger and stronger over the years, with the increased risk this brings.
On Facebook here in the middle to upper class suburbs of Baltimore I see friends of friends OD and dying once a month.
I don't understand why as growing up I dont recall such an epidemic, yet I do recall a ton of don't do drugs type of education. Has all those type PSAs & education in schools cease to exist and or not as well funded as back in the 80s and 90s?
Rise in overdoses can be attributed to dealers adding fentanyl (an extrememly strong synthetic opiate) to their product. If a particular salesman has a product which people have reportedly overdosed on will flock to them as they must be selling a stronger product. Another scenario is where the chemical isn't there in the first place and the dealer is simply mixing fentanyl with a filler, due to it's extreme potency (a dose being less than a milligram), making even a small mistake in the mixing can lead to many overdoses especially with tolerant users used to taking larger amounts.
Fentanyl is actually being synthesized by the Mexican cartels now and added to the heroin before it even makes it to the street dealers. It's getting really crazy.
So Trump isn't so crazy on this whole wall issue ....
I don't believe a wall is needed, but it should be used a hammer to get Mexico to clean up it's act for it's people. Canadians are not flooding into the US ... why are Mexicans then ... why isn't Mexico a place where it's citizens want to remain? Why are Mexicans as a whole not coming to the US high skilled like Indians are? Is their education system non-existent ... it's so corrupt your just struggling to live day to day? IF that's the case as Americans we shouldn't be angry about Mexico's lack of care for it's people due to those in power who are all about themselves/corrupt?
Immigrants are not flooding from Mexico to the US. The number of unauthorized immigrants from Mexico living in the US has been declining. These numbers are through 2014.
This comment should be removed. None of the seven+ questions posed are worth answering, and many of them are fragrantly offensive. Get on a soapbox somewhere else (or not at all)
> So Trump isn't so crazy on this whole wall issue ....
A wall can't stop fentanyl. A single gram of fentanyl is good enough for somewhere on the order of 10^5 doses. It is a trivial matter to smuggle a few grams of substance into a country, wall or no wall.
There are even stronger opioids making their appearance, such as carfentanil, which are 100 times stronger than even fentanyl. Only 19 grams of carfentanil a year are enough to satisfy current US medical demand for this substance.
Walls or Mexico cannot stop the war on drugs and the lopsided, perverse incentives it sets up, and the thousands of lives it ruins. That is entirely up to the American public and their representatives.
Walls don't keep drugs out. The corruption is largely due to the fact that the US keeps drugs illegal and in the hands of criminals while being the source of demand for drugs.
Umm please read I do not think building a wall is needed.
Also before you downvote I'd love to hear your thoughts as to why Mexicans come here illegally and in large quantities... why are they not staying in Mexico? Why is it not a country of wealth, opportunity and prosperity for its people like the US and Canada? Do you not think that's something worth questioning and trying to address/fix for all Mexicans?
You're essentially repeating yourself while not acknowledging the responses you've received to your previous comment. For one, the idea that Mexicans are immigrating to the US illegally in large numbers isn't supported by current stats.[0] If you have other statistics available, please share them.
Opioid prohibition ruthlessly selects for opioids that have the highest effectiveness per unit volume -- because traffickers want to make the most profit on uncut material for the same amount of risk.
"People are dropping like flies in those regions of the country, while I would imagine the West Coast, where black tar heroin is sold, hasn't seen as much of an increase in overdoses/deaths."
'Harm reduction' programs don't really do that much.
Since the 'Insite' facility in Vancouver opened - there has been basically no change in the number of users or ODs. The area around the clinic is still a zombie land - it's the only place in all of Canada that I'm afraid to walk down the street in the middle of the day.
There has been a massive spike of ODs in Vancouver lately, but it's mostly due to fentanyl and other purity issues.
I agree that 'doing heroin' should be treated more as a social health issue, and less as a criminal justice issue, but I'm entirely doubtful of the efficacy of shoot up clinics. They cost a lot, and the money just might be more effectively spent on other kinds of 'soft interventions'.
I think the real value of the clinics boils down to the fact that while there, users can be convinced to join 'get clean' programs, and that the health workers can have 'trusted and direct' access to the community.
And some 'harm reduction' efforts can be very destructive: in the Innes Road prison in Ottawa - if you go in with a heroin addiction - they give you three doses of "Diacetylmorphine" or whatever (similar to heroin) every day - and basically they keep their prisoners hooked. The users will go crazy in the time leading up to their 'dose time', screaming, banging on the door etc. etc..
'Reducing short term harm' by giving people doses of a drug, several times a day, for months or years - is utterly worse than what those people might have to do were they to have to spend a few days in 'hard withdrawal' and then a few weeks in less severe withdrawal.
Keeping prisoners hooked on extremely powerful opioids I think is a terrible form of 'cruel and unusual punishment'.
'Withdrawal' is not the end of the world, and usually it's not dangerous. It's inevitable. It's the 'first and most obvious step' of recovery. And the only path to recovery. And something and addict must eventually do - so 'going to prison' if anything, should be an opportunity to get them off of heroin. At least in a controlled environment they can be monitored during initial withdrawal, and have zero access afterwards for some time while in prison. (And yes, it's entirely possible to limit contraband drugs in prisons).
FYI - I'm not suggesting prison for users, but at least those who go to jail for other things, it's a chance to get clean.
Sadly, it seems there's just as much ideology and politicization of the 'harm reduction' approach as there is 'it's a crime/moral issue' approach.
We've had this in Australia for some time and I think it's abominable.
Western civilisation is founded on the rule of law. Obey the law and you do fine, break the law and you get punished. When you start saying to people "Hey guys, we know you're breaking the law, but go ahead and fucking do it in this room, we don't mind, you won't get arrested or punished"
Here's a better approach to drug users: catch them, sentence them to mandatory cold-turkey rehab, don't let them out until they're clean.
> What are you going to do when they start taking drugs again and die?
Shrug my shoulders. Those things are banned because they're dangerous, and if people die while using them it's not like we didn't give them enough fucking warning.
Actually, these days a lot of heroin users are getting started because their doctor prescribed them an analogue to heroin. Pain pills are being pushed out onto the market and people tend to keep buying once they get started.
And often drugs are banned not because they are harmful, but instead to punish a class of people. For example alcohol is more dangerous than weed, but weed is against the law in most places.
> Here's a better approach to drug users: catch them, sentence them to mandatory cold-turkey rehab, don't let them out until they're clean.
Treating drug use as a criminal justice problem rather than a public health problem is more expensive and gives worse results.
I think it's weird to ask tax payers to fund a very much more expensive programme (of police officers catching heroin users; of courts prosecuting them; of prisons holding them) especially when that programme has provably worse results (more harm to drug users; more harm to society; more cost to society) than treating drug use as a public health problem and providing harm reduction measures.
The point of the criminal justice approach isn't to save the lives of those who have already taken heroin, but to save the lives of those who might be considering taking heroin.
The harsher the punishment for heroin use, the more likely people are to get it into their heads not to fucking start taking heroin in the first place. On the other hand, if you make heroin addiction a free ticket to lots of health care and attention and "poor schnukkums" then you actually incentivise people who are already having a bad time to get on the heroin-addict train.
> The harsher the punishment for heroin use, the more likely people are to get it into their heads not to fucking start taking heroin in the first place.
Except it doesn't seem to work efficiently at that in the real world.
> On the other hand, if you make heroin addiction a free ticket to lots of health care and attention and "poor schnukkums" then you actually incentivise people who are already having a bad time to get on the heroin-addict train.
If it doesn't give any benefit beyond dealing with the harms of heroin addiction there is no actual incentive.
Anecdotal evidence suggest that cold-turkey rehab doesn't work (https://www.quora.com/What-happens-to-heroin-addicts-when-th...). I'm sure there is more information and possibly even research papers to back this up. Perhaps someone more knowledgable in the field can provide this.
However, from my POV, drug use is not just about a substance, but a life-style and emotional dependence. You can't just remove drugs and expect things to improve for a person, you need to provide holistic support - and let's face it, drug usage is an incredibly complex personal choice.
Or you know, fix the law so it is no longer attempting to lay claim over every individual's body. Perverting the "rule of law" with an attempt to dictate personal morality undermines the institution itself.
I feel it's important to mention that not all drug users are addicts. So where is the line between 'drug user' and 'problematic addict' being drawn here? ...Are you conflating the two?
There are so many situations in which someone might illegally use drugs.
For instance, I self-medicate with various substances. I've gotten great relief over the years with ketamine, lsd, and mdma. I learned how to administer drugs in a safe and cautious manner. I have never been arrested, nor had any major social conflict, while under the influence.
With your approach, I should be sought after and sentenced.
I used to work at a retail pharmacy and we would have addicts come in to buy needles all the time. On the one hand I felt bad about supplying these people with what they needed to feed their habit, on the other hand I felt good that they were coming to us instead of sharing needles with their buddies.
I'd not feel bad one bit, you are preventing Hep C, HIV and many other infections from spreading by selling needles. There are already 3 million Hep C infected people in the US, despite it being a curable disease now :(
I feel like harm reduction can go a long way toward helping these people. After all, something like 50% of alcoholics, and I assume other drug users, eventually quit on their own and remain abstinent.
Making it harder for "functional" drug users to accidentally ruin their lives could significantly reduce the number of addicts in the long term by increasing quit rates
I was not good at feeding my good old cat, so I had to give her insulin injections for a while. Much later, I found the used and unused syringes in a bottom cabinet where I put them after she died. I used to work in a hospital and know you need to dispose of this stuff properly. I brought them back to the neighborhood Walgreens where I'd purchased them. The people in the pharmacy were just like "yeah right, your cat", and pretty much treated me like I was a junkie.
Then again, this is San Francisco, and there are a lot of junkies, and Walgreens people have probably heard it all. But at ground-zero here, I'd guess not too many people are buying supplies at Walgreens.
Fuck those people. I had milk jugs full of used needles when I was a kid, since I had bad allergies and the doctors seemed to think that poking me every week with allergy antigens was a good idea...
Good point. I just copy-pasted the headline, but it's Seattle and King County that is responsible for the decision, even if it is the first safe injection facility in the U.S.
Yes, finally people are starting to see drugs addicts as the valuable people they are and not as disposable felons. Addiction is a sickness that affects people not a failure of morals that needs a jail sentence.
I know a high-functioning heroin addict who's a programmer by day. It's surprising to discover seemingly-normal people who have this monkey on their backs, given the popular perception of addicts.
Samuel Taylor Coleridge had an opium addiction too. We should legalize drugs and help people who get addicted, not just ban substances that some people use responsibly.
Yes, there is. Is it the norm? Not at all, but that doesn't change the fact that some people do use heroin in moderation and without it drastically impacting their lives.
This polarized look at heroin use further stigmatizes drug users and leads to those with problems (and casual users who are having trouble not letting it get out of hand) not getting the help they deserve.
Playing russian roulette isn't responsible just because you don't get shot. There are many people who use it in moderation... until they don't. Until they make one too many "bit more won't hurt" type decisions. Or they lose their job or a family member dies or they just have a shitty day.
"responsible heroin use" is probably the stupidest phrase I've heard all day, and I've been watching CNN.
EDIT: And, by the way, calling a spade a spade and naming heroin as the scourge it is is not stigmatizing users.
That's like asking, "Does that mean you don't believe in responsible knife juggling?" One is going to kill you a lot more surely and quickly than the other, but neither is a good idea.
To say heroin and alcohol/tobacco are equivalent would be stupid. To say an addition to heroin has no similarities to an addition to alcohol/tobacco would also be stupid.
No, because it's completely true. Repeated use of either tobacco or alcohol cause definite harm - cancer for tobacco (note, not nicotine...), brain and liver damage for alcohol. Heroin doesn't. Long term opioid use can cause hyperalgesia for _some_ people, but by no means all, and that's really if you take them every day at high doses (and heroin is actually not so bad for this - it differs from opioid to opioid), which is a little weird since morphine is quite the opposite - I suspect this is because the active metabolite responsible for the primary effects (heroin is really a prodrug) is morphine-6-glucoronide (M6G), not actually morphine as many would expect.
I thought most overdoses are the result of variable potency which is the result of the prohibition. Are you saying that accidental overdose would be a significant danger for addicts if they had a reliable supply of predictable potency? If that is what you're saying, do you have any evidence to support that?
I do agree that easy access to powerful opiates is a recipe for disaster for people at risk for suicide. And I concede that the danger of a negative feedback loop is obvious.
With heroin you should still legalize possession, just not sale. Instead do what they do in Switzerland and the Netherlands: Have safe injection sites where the government gives you free heroin. Those who are diagnosed with addiction can come once a day and get a dose of heroin under medical supervision. The clinics often help find jobs for the unemployed as well, further helping them with their addiction. Typically once someone gets their life back together they'll be able to quit.
Living in a community with heroin addicts that see every opportunity to rob someone for a fix, sorry addicts are criminals first. There is no excuse for their behavior.
Yes, every heroin addict robs people to feed their heinous, immoral addiction.
I’d love to hear your thoughts on crime in poverty stricken areas or those of one predominant race or another, I’m sure they’re just as well reasoned, tolerant, and coherent.
Behavior like yours is why many turn to other avenues of coping rather than feeling comfortable seeking help. Don’t think for a second I’m condoning what you perceive, but your definition of “addict” is likely one or two standard deviations away from reality, and to imply that all “addicts” are criminals or all criminals you see are addicted to heroin is more than a little amusing.
There's no excuse for robbing people for any reason, but the addicts who do that are broke and are faced with a choice of re-feeding their addiction (via theft or robbery) or immense suffering.
You do not see this issue in wealthy heroin addicts, I promise.
I was at a law enforcement armorer class with some police officers from various agencies in the Northeast recently.
The most impactful thing I heard "People who get narcanned multiple times should just be killed" -- maybe not his literal belief, but the problem seems to be out of control. He had stories of "frequent customers" who kept coming to hospitals/police stations/fire departments to shoot up in the bathrooms, knowing they'd get narcaned if they OD'd.
As a King County resident, though, I want this facility nowhere near me. As long as it stays in Seattle or near SeaTac, I'm ok with it. Yes, this is NIMBYism.
As a resident of Capitol Hill, I want this right near me. And I want to see another one in Belltown. And another near the waterfront. And another on Aurora. And then another twenty throughout the city.
There are junkies shooting up around me every day. They deserve safety and dignity, just like everyone else.
As an adult, you have to make tradeoffs. Given that the supply of money is finite (unless you're Bernie Sanders who believes that money grows on trees), you have to decide whether to spend the money on this, or on, perhaps, kindergartens, schools, public transportation, and the like. TBH, I'd rather the junkies got a different kind of help: forced rehab. Got caught with heroin in your blood? Off to rehab you go. That'd be a good way to spend this money. Facilitating their addiction and making their death spiral "dignified" is a weird take on "help" in my opinion.
I'm deeply curious about where you expect a city to find the money for "forced rehab" when you're belittling me about making "adult...tradeoffs."
Also, where do you think the money for emergency response to drug overdoses comes from, exactly? Do you expect that having a trained professional on hand to administer Naloxone in event of an OD would be more or less expensive than a 911 response?
The [safe injection] model has worked in Vancouver, B.C.
One study estimated the Insite facility in Vancouver’s
Downtown Eastside prevented 83 HIV infections, saving
the government at least $17 million. Others document a
reduction in overdoses.
Lastly, the people who use the site need to be given the chance to get into treatment if they want it. Forced rehab, as you describe it, doesn't seem to have the effect that you'd like it to. I found this study from UCLA which indicates that the evidence in favor of legally mandated rehab programs is murky at best: https://www.ncjrs.gov/ondcppubs/treat/consensus/anglin.pdf
Check out the Conclusions and Recommendations section for more. Here's a quote: "There is strong support for the role of internal motivation as a predictor of program retention and positive treatment outcomes."
I didn't say it'd necessarily be less expensive (although it might end up being that once you factor in the costs of crime needed to obtain expensive drugs in the first place). I said it'd be better for the addicts, which to me seems pretty certain. I know if I had something that was slowly killing me and I couldn't afford treatment, I'd want help at some point. And by help, I mean forced rehab, preferably without a felony charge which will make it impossible for me to find decent work afterwards.
I think safe injection sites are a short term solution. What you're proposing is a more long-term fix that addresses the root cause. I suspect (though I haven't spent much time thinking about this) that safe injection sites are cheaper to implement and test, before we go off and build rehab centers.
> As a King County resident, though, I want this facility nowhere near me. As long as it stays in Seattle or near SeaTac, I'm ok with it. Yes, this is NIMBYism.
At the risk of being flagged into oblivion, this is why I f-king hate the Eastside. I live and own property in Seattle (so I pay King County taxes just like the rest of you lot) and I'm sick and damn tired of Seattle being the dumping ground for whatever crappy problems Bellevue, Redmond, Shoreline, Kirkland, Sammamish, Issaquah, Duvall, and Fall City don't feel like dealing with.
This is on top of the city then getting a reputation as being "dirty" and "crime infested" so that those exact same cities in a "regional partnership" can troll bait in front of the people and businesses of Seattle to induce them to move out of the city, thus taking away the tax base to deal with those dumped problems.
I guarantee that there are heroin users near you and those people would greatly benefit from this kind of service. Oh, and there are also homeless, unemployed, and special needs people around you, too. Seattle--and SeaTac--isn't the receptacle for the entire region's problems, especially if we're going to get looked down by you lot from high atop your long noses for receiving them.
I don't think that's true at all. Seattle has a disproportionately large homeless population when compared to other cities. We have the 3rd highest homeless population but are only the 18th largest city. And we're far from the only city experiencing a housing crisis.
So it's a lot more complicated than "you're gonna pay for it one way or another".
Hard evidence? Nope. Maybe it's only 1%. Or maybe it's 20%. No one knows!
My #1 frustration with the homeless crisis in Seattle is that we have almost zero data. In fact almost all of our numbers on how many homeless are in the area come from the annual January one night count! It's absurd.
How long have the homeless been homeless? When was their last home? Where was that home? How many times have they bounced into and out of homelessness? When was their last job? What was their job? Why did they become homeless?
We honestly have no idea. Solving a problem is particularly different when you don't even know what they underlying source of the problem is!
Now gathering this data is actually pretty difficult. Many homeless don't have formal id. And many others have a justifiable distrust of the government and organizations which make them not want to use their real names.
In Seattle it gets even more complicated. Different groups don't like to share their numbers as to how many homeless they shelter or how many services they provide. Because if they all start sharing their numbers some of them are bound to start losing their funding. And we wouldn't dollars to be spent more efficiently by another organization now would we?
So why is Seattle's homeless population so wildly disproportionate to our city size? <shrug> No one knows and we're just guessing.
Yes -- getting better data and then creating policy based on that data makes a lot of sense. I think the safe injection site is actually supported by data from other cities as a way to reduce junkie fatalities, but it has a lot of other negative externalities.
(Fortunately for me, unincorporated King County is actually a completely illogical place to put such a center; no transit, no proximity to anything, etc. It will probably go in Pioneer Square.)
I know some junkies in Bellevue, unfortunately, but I can guarantee there are currently no homeless/unemployed/special needs/etc. within ~183' in any direction (and I don't believe my neighbors have suddenly become junkies, either). I agree things are different in higher population density areas. And yes, the Eastside gets a far better deal here.
Every day I commute through Seattle greenbelts absolutely littered with needles. You say 'nowhere near me', but it's occurring throughout the city, in the shadows.
I don't think some kid is going to get into heroin so they can hang out at the injection point, but if they do get hooked then I hope this buys them some time to escape.
See Vancouver's Insite program for proof it works. It's been a huge economic and social success, allowing timely intervention to help drug users get clean, reducing the rate of HIV and HepC amongst intravenous drug users and helping numerous people get a fresh start at life.
Serious question: what is the proof that Vancouver's program works? How is the program "falsifiable"? Meaning what condition(s) would need to be met for it to be considered a failure? And how much money was spent to reach the current levels of success?
"See Vancouver's Insite program for proof it works. It's been a huge economic and social success"
No - this is not true. OD's are at an all time high in the region [1]
It's a highly politicized issues and the entities behind it are strongly incented to make it seem as though it's working.
The only evidence of Insite 'working' is provided by them - and the data points they provide are selective, unscientific and definitely not objective.
There is no objective evidence to indicate that 'it's working'.
If it were a success - we should see number of users down, crime down, cleaner neighbourhood etc. - but no. None of that.
There has been no effect on the overall drug using population. There are no external metrics for success at all.
By 'success' Insite points to the 'number of ODs prevented' the number of 'addicts into programs' - but this assumes that those ODs would have resulted in death or would not have been dealt with otherwise, and that there are not other ways to get people into recovery programs.
Given the amount of $$$ being spent on the clinic, I'm very doubtful that we can claim any degree of success.
It boils down to a cleaner place to shoot up - that's about it.
I think it's worth keeping open as a 'point of experiment' so that we can try different methods of approach - but it's ripe to call it a 'success'.
When numbers of users is measurably down, crime is down, that area is safe to walk in during the day (it's not as of now) - then we can start claiming success.
That data has to be normalized for the surge in fentanyl use.
Sydney has had safe injecting for 15 years, initially the rate of overdose went down ~75% to around 1 per month but now in the past few years it has spiked back up again to record levels.
There are also other factors to safe injecting rooms - such as opening pathways to recovery, removing litter from the streets, preventing hepatitis and other diseases and removing the taboo from drug addiction.
I don't think anybody claims that safe injecting alone can prevent all opioid deaths, its part of (and usually the first step of) a multi-pronged approach.
"That data has to be normalized for the surge in fentanyl use"
I agree.
"I don't think anybody claims that safe injecting alone can prevent all opioid deaths,"
'Safe injecting' is not saving any lives and is not doing any 'harm reduction' is my point.
The only evidence provided that 'it's working' is the sites data where they say 'we prevented x number of ODs' - but this is not quite valid - just because they think they prevented an OD, does not mean they did. Someone who takes too much on the street can still get an ambulance and emergency services. Someone on the street who does 'way too much' is gong to die one way or another.
There's no evidence that the sites actually 'get more people into programs' than otherwise.
I believe that more directly interventionist programs might work: if you are caught, high on heroin in public - then you don't go to jail, but you go to a facility of sorts. This facility is basically a 'dry out hotel'. The only thing about this facility is you have zero access to heroin - you have to go through withdrawal and be clean for 30 day.
Withdrawal is the unavoidable 'first step' to getting off heroin. There is absolutely no other way, and it must be done.
New Zealand, where I live, also has a harm reduction program. Needles are cheap and easily available. It's been a huge success. MASSIVE drops in HIV/AIDS, Hep C, etc, as well as related things like infection and so on, in combination with reduced family harms like.
Also instituted were our opioid substitution programs, allowing people to choose from methadone or buprenorphine (aka Suboxone, Subutex) at the dose they want. This, too, resulted in massive drops in overdoses and crime.
There is literally no valid reason to oppose these programs supported by evidence. Not only are they the ethical thing to do... they also just work.
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[ 2.9 ms ] story [ 351 ms ] threadSeattle's homeless problem is possibly one of the worst in the nation, likely due in part to the friendly & enabling atmosphere the city and it's citizens have provided. By denying these people hitting their bottoms, they will never have a chance at cleaning up and returning to society.
> Go take a stroll up to Vancouver to the safe-injection site they are modeling this after and you'll discover destitute conditions in a large radius.
The site is located in the Downtown Eastside - aka "the poorest postal code in Canada" which had been like that long before the site opened.
Frankly some stuff is really bad and should be kept away from people.
Safe injecting facilities are not about helping people be strung out. They're about reducing harm, both to the addict and to the rest of society, coming from drug addiction.
I think it's maybe too early to tell what impact CO/WA/etc legalization has had on MJ use.
I consider myself fairly well insulated from drug use. In my entire social group I know of only one person that has ever tried methamphetamine (which is rampant here in Australia), and none that have tried heroin. Despite that, if you set me to the task of aquiring heroin I'd be pretty confident in my ability to do so. I doubt I'd have to go through more than 3 levels of friends to find someone that could hook me up. And that's not even taking into account darknet markets (which I imagine would be fairly easy to learn how to use as a software engineer).
If I woke up tomorrow and decided to try heroin, there wouldn't be very much in the way of obstacles in my path.
So for me at least, there's not that much difference between the current situation and legalisation. Especially if said legalisation requires a prescription. Arguably convincing a doctor that I'm an addict and in need of heroin is more of a barrier to entry than finding someone that sells it now.
1. Buying it illegally funds criminal organizations
2. Quality is terrible, it's certainly adulterated
3. Association with low class and poor people
You can ingest or smoke opium products, too, if the needle is the off-putting part of heroin.
But yeah, another anecdotal perspective: I've had prescription opioid painkillers but don't have any particular interest in continuing to use them after the pain goes away. So if opioids were legal tomorrow, I don't think it would change my behavior at all either.
Heroin isn't too different, really. It's very addictive, has a low LD50, and when it's easy to get, people effectively get a free ticket to a brothel on an accelerating rocket-fuel train with rarely stops. If a drug can have that much power over the body, people might think we could create microdoses, and sell those, and then it'd be safe. But then, the market for heroin/tar/etc. would still be there, and would continue underground.
It's not as simple as "selling it at CVS w/o prescription will lower overdoses and dissolve the underground H market"
[0] https://en.wikipedia.org/wiki/Drug_policy_of_Portugal
http://www.amsterdam.info/drugs/
Most of the poorer Asian countries have been like this in my experience.
Yeah shame on people for having a different opinion then yours.
Meanwhile, with proper health care and psychiatric care, the same people who could have stayed within the system, could have greatly boosted research into all kinds of conditions that compel people to take hard drugs in the first place and we could have had this issue solved long ago.
Instead, the medical industry is hamstrung in helping them almost as much as the addicts themselves. But politicians from the left to the right get to look good on camera, and journalists can bravely declare more drugs will be off the streets as they show children walking to school, ensuring nobody will ever suspect they're setting those same children up for severe problems that will go untreated.
Under what circumstances do you think doctors would be prescribing heroin? Because a person wants to give it a try? For recreational use? Doctors already prescribe (under heavy regulation) narcotics for pain relief. If they were to prescribe heroin, I can't imagine it would be cavalierly prescribed for anything, other to address existing addiction, not unlike methadone treatments today.
... and this is where most Heroin addicts start, actually, through prescription opiate use. Once a physical addiction is formed, heroin can be a cheaper or more accessible alternative to a prescription for say, Oxycontin.
I thought John Oliver had a good segment on it:
https://m.youtube.com/watch?v=5pdPrQFjo2o
Something is wrong with the system for prescribing Oxycontin if black market heroin is ever cheaper or more accessible.
I mean first -
> If you get a prescription for heroin that would probably lead to addiction right?
Decently sure OP is suggesting replacing obtaining heroin from the street with obtaining it through a doctor. As such, only existing (and new) addicts are effected; you would not create addicts.
Alternatively, this story you have told is already the case with other prescription opiates.
> Now as an addict you want more
> continually up the dosages prescribed, no?
I mean, do alcoholics do this? Or gamblers? Adrenaline junkies? Yes and no.
Basically, most of what you know about drugs is inaccurate, and addiction (and escalation of addiction) is complicated. For instance, the rat park experiments indicate that addiction is a coping mechanism - rats in individual cages experience addiction; rats in group cages, not so much. Simply by obtaining the drugs from a sympathetic ear, you can reduce the dependence on the drugs.
Here's a thing:
https://mic.com/articles/110344/14-years-after-portugal-decr...
https://www.ncbi.nlm.nih.gov/pubmed/11072395?dopt=Abstract
https://en.wikipedia.org/wiki/Rat_Park#Reaction_to_the_exper...
The first abstract actually describes a theory that cannot be correct given the Rat Park experiment as described on Wikipedia, due to group PC (no new rats were supplied to that group). Or, rather, a theory that does not explain group PC.
Apparently the results have been pretty good so far: http://sciencenordic.com/heroin-clinics-improve-addicts-live...
The idea is you stabilize people's lives. Prescribe them heroin for say 3 months to start with. Their lives are no longer endless crime, prostitution, police cells etc. They can get housing and other things sorted without having to also find $1000s a month for a drug habit.
From that the community is already seeing a benefit (less crime and the market for black market heroin mostly vanishes), and then from that you can start helping people reduce their dose and get proper drug treatment while living a far more normal life.
There will probably be some black market dealing, but it will be much smaller scale and won't have anywhere near the scale.
Because it's off topic?
You can't seriously think HN is not anti-prohibition?
To move forward we need to be practical.
One city in the entire US is getting an injection room.
Why start talking about the legalisation of heroin? If it works but it can't be implemented why discuss at this point when we are discussing something that does greatly help and is being implemented.
These are different approaches, not necessarily mutually exclusive but by changing the topic you devaluing the important discussion of injecting rooms.
This article is about injecting rooms not ending prohibition I think it is off-topic?
There are plenty of articles on decriminalisation and legalisation out there to have that discussion.
If you think it's inappropriate for HN, feel free to flag the submission and move on.
If the LD50 is very easy to arrive at in everyday usage, then I don't see this helping out very much. You could sell heroin in doses << LD50 for a high regulated price, but then you will end up with black markets which sell much larger doses at lower prices (if the substance is easy to produce in various quality levels). If the price to get "safe" heroin is not artificially increased, then it would be way too easy to accidentally have too much, especially if herion is highly addictive, which, it supposedly is.
People would just end up riding their doses up to dangerous levels, in which case they would now have a dependency on heroin. Would it bet better for everyone to have a safe, controlled dependency on heroin, or for 5% of people to have an unsafe, uncontrolled dependency on heroin?
For an answer, you can just look at alcohol, which is typically assessed as having roughly similar social harm to heroin (although it varies by source). Were things better during prohibition, or today?
Edit: Ideally, humans wouldn't be consuming poison? But, what is poison? It's a lot more complicated than "alcohol is bad" or "heroin is bad". Maybe you are right, letting down the flood gates will surely kill people who don't have control, and we'll be OK asymptotically. Making alcohol legal certainly killed people who wouldn't have died, and saved people who would have died. At some point, this is just a variation of the trolley problem. If heroin was made CVS-able without prescription, I would not guarantee that I wouldn't try it, and that scares me because I know how dangerous it is.
When it comes down to it, not all drugs are equal. Heroin isn't "alcohol but worse". People who drink tend to get pretty nasty sometimes, and that's a social harm that someone who's nodding doesn't perpetrate. And in terms of physical harm, heroin is actually pretty low compared to alcohol. Lots of people destroy their livers with alcohol and die early, while there's an awful lot of rockstars who do piles of heroin and cocaine and live to their 70s and beyond (we need to start worrying about the kind of world we're going to leave for Keith Richards).
The harm comes from getting bathtub stuff of uncertain potency and purity, and from the things people need to do to afford their fix. If it's clean and affordable you tend to do fairly well on both the 'personal' and 'social' harm aspects.
Obviously that's not how DARE told you to feel, but the fact is that the current state of things is not the only one that is ever possible. You don't know what social use would look like in a society with legalized heroin usage.
If you eliminate the need to commit crime to obtain black-market drugs at obscene prices, a lot of the harms of heroin go away. Some people will still choose to do it, but we free up a whole bunch of police money that can be redirected to free treatment resources to help people quit when they realize they aren't going to find happiness in drugs.
If everyone did heroin today - instead of drinking - the world would fall apart.
Can you imagine 50 000 people at a Football game, all doing smack? Sure, it would be a fun game. Within days, 10% of them would be full on addicts. Within weeks maybe 50% of them would. Those people would go through hell or high water to stay permanently high.
Giving them 'cheap and safe' smack at Walgreens is not going to help them - it would destroy them.
"If you eliminate the need to commit crime to obtain black-market drugs at obscene prices, a lot of the harms of heroin go away."
Have you actually ever met an addict - do you realize how insanely destroyed their lives become? Do you think that by making the drug cheaper and more accessible that this is going to 'make them better'? No - it's only helping to kill them.
Your perspective seems very out of touch with the reality of things, and I question whether you've actually really talked to any of them at all, and instead are simply arguing in respect to some caricature of one.
> Can you imagine 50 000 people at a Football game, all doing smack? Sure, it would be a fun game. Within days, 10% of them would be full on addicts. Within weeks maybe 50% of them would. Those people would go through hell or high water to stay permanently high.
You sound like my middle school DARE teacher talking about how our brains would fry like scrambled eggs on MDMA. (ie those numbers are pulled out of your imagination)
Here's probably the most strict source on drugs saying that the addiction rate is 23% https://www.drugabuse.gov/publications/drugfacts/heroin
That's still terribly high, and I think your ideas have an element of truth, but your approach to using unsubstantiated numbers and overall tone of self-assuredness is just kind of sad to see.
I get what you are saying, but I don't think you're applying the general context: everyone doing heroin as common as they drink - that would lead to massive addiction and total health crisis.
So it's not '1 game' of 50 000 users, it's every game.
Frat parties, bars, dinner parties, 'netflix and chill', I mean pervasive open used of opioids. This is 'where people drink alcohol' - so now replace alcohol with opioids.
23% addiction in narrow circumstances, but considerably higher across the board.
A 'University' that had widespread use of heroin - as widespread as alcohol - would crumble very quickly. Near 100% of the student body would be addicted.
Nicotine is addictive to 100% of people if they smoke enough packs - the chemicals just do their job, and that means pushing the body to 'demand more'. For some, it means more smoking than others, and many would chose not to smoke enough to get hooked - but it will get you 100% of the time, with enough cigarettes.
"d I think your ideas have an element of truth, but your approach to using unsubstantiated numbers and overall tone of self-assuredness is just kind of sad to see."
No. Absolutely not - and you proved it yourself: a 23% addiction rate over a small sample would lead to considerably more over time.
Can you imagine 23-70% of regular people addicted to heroin (because that's what would happen if they did heroin as much as people drank alcohol).
'23% of the population hooked on heroin' (and this would be a low, conservative number) would be totally devastating to civilization - that's not an 'extreme' or 'irrational' position.
It is 'extreme' and irrationally 'self assured' to posit that alcohol and heroin represent the same level of public health risk to society.
They are totally different substances.
For the record I've been prescribed opioid derived drugs and did not get hooked. Why? Because I know how addictive it can be, so I popped some to see what it was like and trashed it.
This world where everyone uses opioids pervasively won't happen because people would know or soon figure out how pointless and devastating it is. It's like asking why we don't have cultural customs where everyone murders a new family member each monday. Any culture dumb enough to try no longer exists.
In reality there is perhaps a good historical example of mass opium addiction you could tie your narrative to though: https://en.wikipedia.org/wiki/History_of_opium_in_China
http://www.economist.com/blogs/dailychart/2010/11/drugs_caus...
https://en.wikipedia.org/wiki/David_Nutt#Government_position...
This is absurd.
There is no place on earth where it is 'typical' to consider alcohol to be more dangerous than heroin.
The ridiculous 'research' on alcohol v. heroin make comparisons as to 'how many accidents are caused by each' etc. in society, which is obviously not a fair comparison considering once is widely used, the other very infrequently.
Opioids are extremely addictive, and destructive in almost all cases of use.
Demonstrably false. The vast majority of opioid users are recovering from surgery, taking Tylenol 3, etc. You're basically just talking out of your butt here.
1) Dosage/concentration uncertainty
2) Contamination of a lower strength opioid (say, morphine or heroin) with a much higher strength one (fentanyl or fentanyl analogues)
3) Poly-drug use -- such as combining opioids with benzos to exploit synergistic effects
When it comes to pharmaceutical-grade opioids, the doses are known and measured and there's no risk of contamination with unknown amounts of fentanyl analogues. Indeed, the mechanisms of drug prohibition actually incentivize the use of extremely high potency/volume opioids such as fentanyl.
The third issue, poly-drug use, also is a consequence of prohibition -- the prices of opioids in the black market are artificially inflated (if you don't have the requisite permission slip for the drugs, you need to invest in all sorts of countermeasures to avoid being put in a cage and your product seized), so users need to economize, and this sadly happens by combining benzos with opioids, which can lead to fatal respiratory depression. This is also a symptom of prohibition and is not inherent to opioid use.
There are definitely real harms involved with / caused by opioid use today -- but most of those are caused by (or greatly worsened by) opioid prohibition.
As for the LD50 issue -- yes, opioid-naive (non-tolerant) users will have a low LD50 but they also won't need much a dose to get the effects. As people get opioid tolerant, the dose that will kill them also increases in step. It's not a case of "user needs higher and higher dose but needs to not cross a fixed LD50 threshold". Because opioids mostly just affect opioid receptors (unlike stuff like alcohol, which is hepatotoxic), tolerance means the LD50 increases in step with the effective dose.
The popular picture of the heroin addict who has to use higher and higher doses to get the desired "high" is a creation of prohibition -- there's no inherent need to do anything of the sort if one has proper medical access to the right dose of prescription opioids. Moderate and safe opioid use is difficult under prohibition if only because it's hard to moderate oneself without precise and pure measured doses.
There's plenty of people who engage in moderate long-term opioid use, between pain patients or "high functioning" heroin users. Those people tend not be the face of opioid use precisely because they have access to the drugs in ways that are stable, safe, not life-ruiningly expensive, and doesn't place them in regular contact with criminal organizations. They aren't exposed to the worst harms of prohibition and that's why they're able to keep using (without anyone knowing that they use) and have a stable career/family.
To be clear, none of this is to say that opioids are harmless or that should be handed out like candy -- they're serious drugs and should be used responsibly by people who are aware of the risks/contraindications.
Yes, it is. It's extremely addictive, and is very well known to destroy lives.
Total nonsense.
Please tell me what 'harms' come from heroin treatments?
The primary 'treatment' for heroin addiction is to simply 'not do heroin'.
Stop doing it.
Ultimately, that's the only way out.
" I think we simply have to accept that people are going to want to use these substances, and make it as safe as possible for them to do so."
No - again false. Law of Supply and Demand: if we make it hard enough to get, and raise the barrier of supply, and also try to push back demand by teaching kids not to use it - then it becomes rare.
Enabling users lowers the 'difficulty of access', like lowering the cost curve - and creates more usage.
Anyhow who is caught in public, high on heroin, can be asked to go to a dry out clinic where they won't have access to it. They have to go through withdrawal.
This is true for people who do not consume heroin a priori. For the others, suddenly stopping heroin use can be life threatening. Most people need assistance to wane off of things like that. Also, I think you are right that enabling will increase usage, but you must also consider the black markets which are enabled in response to disabling the regulated markets.
It seems like a majority viewpoint on this thread is that it's better for more people to be using real opioids safely than to have a smaller, effectively invisible/black-market population using "opioids" very, very dangerously.
Wikipedia gives the overdose level at 75-600mg[2], and Erowid reports the recreational dose at 5mg[3] (both for "opiate-naive" individuals, i.e. no tolerance). >10x is a high safety margin; alcohol is of the order of 10x for reference.
The piece you're missing here is that the primary risk of accidental overdose is greatly increased with illicit heroin where the purity is unknown, and can fluctuate wildly as it always cut to some extent, but seldom predictably so.
In the case of heroin, most of the harm from usage is directly caused by prohibition.
[1]: https://www.ncbi.nlm.nih.gov/pubmed/11705488 [2]: https://en.wikipedia.org/wiki/Heroin#Overdose [3]: https://www.erowid.org/chemicals/heroin/heroin_dose1.shtml
Only a single order of magnitude is not enough of a safety margin, depending on the substance, and how easy it is to administer the substance. Is alcohol's LD50/dose ratio an apt comparison? Does alcohol require a higher administration energy than heroin? It seems like it would be easier to "accidentally" consume half a gram of heroin in a small amount of time, as opposed to "accidentally" consuming 100 beers (or 2 handles).
Drug users experiment across this mere 10x range effortlessly, according to your source:
> As usage increases, however, the doses get much higher
Apparently, they get to 100x. Crazy!:
> The Swiss found that users offered unlimited quantities would, on average, max out at between 300 and 500 mg
This seems to support my view. I can't help but imagine a dystopian future (past?) where they start selling a soda called "HeroHera" which has trace amounts of heroin in it.
Anyways, it seems pretty dangerous for brains to depend on the naive-LD50 of heroin. Forgetting to consume it after one has an established a dependency must surely be an issue. How do we know that a potential widespread dependency on heroin and a requirement for widespread heroin sanctuaries won't actually cost more than the war on drugs?
> Heroin assisted treatment is fully a part of the national health system in Switzerland, Germany, the Netherlands, Denmark and the United Kingdom.
https://en.wikipedia.org/wiki/Heroin-assisted_treatment
They found using pharma grade heroin worked better than methadone in weening addicts off heroin but it is difficult to get from Europe, so they did another study to see if hydromorphone worked just as well and it did, effectively cutting costs for any prescribed opiate treatment program. They also found by prescribing it, the addicts no longer were getting arrested everyday or participating in the black market, and made long term goals like savings since they no longer needed to live day to day committing crimes to support the addiction.
As for injection sites I hope Seattle doesn't make the mistake of not making sure treatment is also available or else they'll end up like Vancouver with a growing number of injection sites because of the months long waiting list to get into treatment. These facilities are majority used by street addicts too so you still have a large amount of fentanyl overdoses since it's casual users dropping dead in their houses who don't frequent the clinics.
Another issue with these facilities is there's constantly a crowd of gangsters out front ready to sell you drugs on your way in or collect debts from addicts in the lineup so some addicts don't go to the injection sites.
Patrick K Kroupa of LoD/Cult of Dead Cow managed to clean himself up with ibogaine doses and a lot of self discipline http://ibogaine.mindvox.com/articles/heroin-ibogaine-patrick...
There are only about 300 doctors with the correct licence to prescribe diamorphine to addicts.
http://www.nta.nhs.uk/uploads/uk-focal-point-report-2014.pdf
> Drug treatment in the UK encompasses a range of available treatments and services including community (and primary-care) based prescribing, community one-to-one and group-based psychosocial interventions to support recovery, inpatient treatment, day programmes, and quasi and fully residential drug treatment and rehabilitation support. Prescribing (principally methadone) for drug dependence is provided for stabilisation, detoxification, maintenance and relapse prevention. The National Institute for Health and Care Excellence (NICE)107 also provides guidance on a number of drug-treatment related topics and these are reviewed and updated regularly based on the latest evidence. Treatment interventions in any given area are expected to include advice and information, care planning, psychosocial interventions, community prescribing, inpatient drug treatment and residential rehabilitation. In addition, drug misusers should be offered relapse-prevention and aftercare programmes; hepatitis B vaccinations; testing for hepatitis B and C and HIV; access to hepatitis and HIV treatment; and needle exchange. Oral opioid substitution treatment (OST) with methadone is the most common pharmacological treatment used in treating heroin addiction; buprenorphine is also prescribed and injectable opioids, such as injectable methadone and injectable diamorphine, are also available but are not commonly used. Naltrexone108 is recommended as a treatment option to prevent relapse in detoxified formerly opioid- dependent people who are highly motivated to remain in an abstinence-based programme
There's some guidance available: https://www.evidence.nhs.uk/formulary/bnf/current/guidance-o...
Here's some statistics about numbers of people going into treatment. Frustratingly they don't appear to break it down by treatment type. https://www.ndtms.net/Publications/downloads/Adult%20Substan...
Any pharmacy that administered or dispensed pharmaceutical grade heroine would suffer public backlash from their communities. They would be forced to specialize and essentially become a new flavor of methadone clinic.
Plus, there is the whole acting in good faith and professional judgement thing that seems like it would be a large hurdle to overcome.
The next step is to provide safe injection and drug-exchange sites with immediately available drug counseling and detox. So an addict can trade 1g street-grade nasty drug for 1g medical-grade drug. Medical help needs to be available to swoop in right as they are coming down from the drug high. Hell, provide some free heroin to wean the drug addicts off of it on the condition that they participate in the detox programs.
This might sound like the unholy lovechild of libertarianism and nanny-state socialism, but I bet this ?pragmatic? approach will be cheaper in the long run, and centralize addiction/voluntary treatment in a location we [the people] can control. It would drastically cut down on ER visits from addicts, which is already a growing issue.
Fentanyl is a white or yellowish powder.
For a variety of reasons, it is far more common for white powder heroin to be laced with fentanyl (which is hundreds of times more potent).
I don't understand why as growing up I dont recall such an epidemic, yet I do recall a ton of don't do drugs type of education. Has all those type PSAs & education in schools cease to exist and or not as well funded as back in the 80s and 90s?
I don't believe a wall is needed, but it should be used a hammer to get Mexico to clean up it's act for it's people. Canadians are not flooding into the US ... why are Mexicans then ... why isn't Mexico a place where it's citizens want to remain? Why are Mexicans as a whole not coming to the US high skilled like Indians are? Is their education system non-existent ... it's so corrupt your just struggling to live day to day? IF that's the case as Americans we shouldn't be angry about Mexico's lack of care for it's people due to those in power who are all about themselves/corrupt?
http://www.pewresearch.org/fact-tank/2016/11/03/5-facts-abou...
If you are aware of other stats contrary to this, please share. I'm more than happy to be corrected.
A wall can't stop fentanyl. A single gram of fentanyl is good enough for somewhere on the order of 10^5 doses. It is a trivial matter to smuggle a few grams of substance into a country, wall or no wall.
There are even stronger opioids making their appearance, such as carfentanil, which are 100 times stronger than even fentanyl. Only 19 grams of carfentanil a year are enough to satisfy current US medical demand for this substance.
Walls or Mexico cannot stop the war on drugs and the lopsided, perverse incentives it sets up, and the thousands of lives it ruins. That is entirely up to the American public and their representatives.
Also before you downvote I'd love to hear your thoughts as to why Mexicans come here illegally and in large quantities... why are they not staying in Mexico? Why is it not a country of wealth, opportunity and prosperity for its people like the US and Canada? Do you not think that's something worth questioning and trying to address/fix for all Mexicans?
[0]: http://www.pewresearch.org/fact-tank/2016/11/03/5-facts-abou...
'Harm reduction' programs don't really do that much.
Since the 'Insite' facility in Vancouver opened - there has been basically no change in the number of users or ODs. The area around the clinic is still a zombie land - it's the only place in all of Canada that I'm afraid to walk down the street in the middle of the day.
There has been a massive spike of ODs in Vancouver lately, but it's mostly due to fentanyl and other purity issues.
I agree that 'doing heroin' should be treated more as a social health issue, and less as a criminal justice issue, but I'm entirely doubtful of the efficacy of shoot up clinics. They cost a lot, and the money just might be more effectively spent on other kinds of 'soft interventions'.
I think the real value of the clinics boils down to the fact that while there, users can be convinced to join 'get clean' programs, and that the health workers can have 'trusted and direct' access to the community.
And some 'harm reduction' efforts can be very destructive: in the Innes Road prison in Ottawa - if you go in with a heroin addiction - they give you three doses of "Diacetylmorphine" or whatever (similar to heroin) every day - and basically they keep their prisoners hooked. The users will go crazy in the time leading up to their 'dose time', screaming, banging on the door etc. etc..
'Reducing short term harm' by giving people doses of a drug, several times a day, for months or years - is utterly worse than what those people might have to do were they to have to spend a few days in 'hard withdrawal' and then a few weeks in less severe withdrawal.
Keeping prisoners hooked on extremely powerful opioids I think is a terrible form of 'cruel and unusual punishment'.
'Withdrawal' is not the end of the world, and usually it's not dangerous. It's inevitable. It's the 'first and most obvious step' of recovery. And the only path to recovery. And something and addict must eventually do - so 'going to prison' if anything, should be an opportunity to get them off of heroin. At least in a controlled environment they can be monitored during initial withdrawal, and have zero access afterwards for some time while in prison. (And yes, it's entirely possible to limit contraband drugs in prisons).
FYI - I'm not suggesting prison for users, but at least those who go to jail for other things, it's a chance to get clean.
Sadly, it seems there's just as much ideology and politicization of the 'harm reduction' approach as there is 'it's a crime/moral issue' approach.
Western civilisation is founded on the rule of law. Obey the law and you do fine, break the law and you get punished. When you start saying to people "Hey guys, we know you're breaking the law, but go ahead and fucking do it in this room, we don't mind, you won't get arrested or punished"
Here's a better approach to drug users: catch them, sentence them to mandatory cold-turkey rehab, don't let them out until they're clean.
Shrug my shoulders. Those things are banned because they're dangerous, and if people die while using them it's not like we didn't give them enough fucking warning.
Who is "we"?
And do you actually think that "warning" is the main contributor in avoiding addiction and dependance on drugs?
Your comment reads as if your opinion is common knowledge. Can you elaborate?
And often drugs are banned not because they are harmful, but instead to punish a class of people. For example alcohol is more dangerous than weed, but weed is against the law in most places.
Treating drug use as a criminal justice problem rather than a public health problem is more expensive and gives worse results.
I think it's weird to ask tax payers to fund a very much more expensive programme (of police officers catching heroin users; of courts prosecuting them; of prisons holding them) especially when that programme has provably worse results (more harm to drug users; more harm to society; more cost to society) than treating drug use as a public health problem and providing harm reduction measures.
The harsher the punishment for heroin use, the more likely people are to get it into their heads not to fucking start taking heroin in the first place. On the other hand, if you make heroin addiction a free ticket to lots of health care and attention and "poor schnukkums" then you actually incentivise people who are already having a bad time to get on the heroin-addict train.
Except it doesn't seem to work efficiently at that in the real world.
> On the other hand, if you make heroin addiction a free ticket to lots of health care and attention and "poor schnukkums" then you actually incentivise people who are already having a bad time to get on the heroin-addict train.
If it doesn't give any benefit beyond dealing with the harms of heroin addiction there is no actual incentive.
However, from my POV, drug use is not just about a substance, but a life-style and emotional dependence. You can't just remove drugs and expect things to improve for a person, you need to provide holistic support - and let's face it, drug usage is an incredibly complex personal choice.
If that's the way it's going to be, why not let them simply die when they OD?
There are so many situations in which someone might illegally use drugs.
For instance, I self-medicate with various substances. I've gotten great relief over the years with ketamine, lsd, and mdma. I learned how to administer drugs in a safe and cautious manner. I have never been arrested, nor had any major social conflict, while under the influence.
With your approach, I should be sought after and sentenced.
Interesting
Making it harder for "functional" drug users to accidentally ruin their lives could significantly reduce the number of addicts in the long term by increasing quit rates
Then again, this is San Francisco, and there are a lot of junkies, and Walgreens people have probably heard it all. But at ground-zero here, I'd guess not too many people are buying supplies at Walgreens.
This polarized look at heroin use further stigmatizes drug users and leads to those with problems (and casual users who are having trouble not letting it get out of hand) not getting the help they deserve.
"responsible heroin use" is probably the stupidest phrase I've heard all day, and I've been watching CNN.
EDIT: And, by the way, calling a spade a spade and naming heroin as the scourge it is is not stigmatizing users.
To say heroin and alcohol/tobacco are equivalent would be stupid. To say an addition to heroin has no similarities to an addition to alcohol/tobacco would also be stupid.
Indeed, with proper dosage long term recreational use of heroin is far less likely to cause lasting damage than alcohol or tobacco.
Deaths per year from Heroin: 13,000
Deaths per year from Alcohol: 88,000
Deaths per year from Tobacco: 440,000
Hmm...
It doesn't sound like you have any experience with drugs or medicine outside of what you learned in D.A.R.E.
I do agree that easy access to powerful opiates is a recipe for disaster for people at risk for suicide. And I concede that the danger of a negative feedback loop is obvious.
Do you think it's possible to go off this drug without substitutes.. say by forcing small sever periods etc etc ?
Suboxone is a miracle drug, more people need access to it.
I’d love to hear your thoughts on crime in poverty stricken areas or those of one predominant race or another, I’m sure they’re just as well reasoned, tolerant, and coherent.
Behavior like yours is why many turn to other avenues of coping rather than feeling comfortable seeking help. Don’t think for a second I’m condoning what you perceive, but your definition of “addict” is likely one or two standard deviations away from reality, and to imply that all “addicts” are criminals or all criminals you see are addicted to heroin is more than a little amusing.
You do not see this issue in wealthy heroin addicts, I promise.
The most impactful thing I heard "People who get narcanned multiple times should just be killed" -- maybe not his literal belief, but the problem seems to be out of control. He had stories of "frequent customers" who kept coming to hospitals/police stations/fire departments to shoot up in the bathrooms, knowing they'd get narcaned if they OD'd.
As a King County resident, though, I want this facility nowhere near me. As long as it stays in Seattle or near SeaTac, I'm ok with it. Yes, this is NIMBYism.
There are junkies shooting up around me every day. They deserve safety and dignity, just like everyone else.
Also, where do you think the money for emergency response to drug overdoses comes from, exactly? Do you expect that having a trained professional on hand to administer Naloxone in event of an OD would be more or less expensive than a 911 response?
Here's a great editorial from the Seattle Times's op-ed page, which isn't exactly known for being liberal: http://www.seattletimes.com/opinion/editorials/bring-heroin-...
And a great quote:
Lastly, the people who use the site need to be given the chance to get into treatment if they want it. Forced rehab, as you describe it, doesn't seem to have the effect that you'd like it to. I found this study from UCLA which indicates that the evidence in favor of legally mandated rehab programs is murky at best: https://www.ncjrs.gov/ondcppubs/treat/consensus/anglin.pdfCheck out the Conclusions and Recommendations section for more. Here's a quote: "There is strong support for the role of internal motivation as a predictor of program retention and positive treatment outcomes."
At the risk of being flagged into oblivion, this is why I f-king hate the Eastside. I live and own property in Seattle (so I pay King County taxes just like the rest of you lot) and I'm sick and damn tired of Seattle being the dumping ground for whatever crappy problems Bellevue, Redmond, Shoreline, Kirkland, Sammamish, Issaquah, Duvall, and Fall City don't feel like dealing with.
This is on top of the city then getting a reputation as being "dirty" and "crime infested" so that those exact same cities in a "regional partnership" can troll bait in front of the people and businesses of Seattle to induce them to move out of the city, thus taking away the tax base to deal with those dumped problems.
I guarantee that there are heroin users near you and those people would greatly benefit from this kind of service. Oh, and there are also homeless, unemployed, and special needs people around you, too. Seattle--and SeaTac--isn't the receptacle for the entire region's problems, especially if we're going to get looked down by you lot from high atop your long noses for receiving them.
Source: Resident of the city of Seattle
So it's a lot more complicated than "you're gonna pay for it one way or another".
My #1 frustration with the homeless crisis in Seattle is that we have almost zero data. In fact almost all of our numbers on how many homeless are in the area come from the annual January one night count! It's absurd.
How long have the homeless been homeless? When was their last home? Where was that home? How many times have they bounced into and out of homelessness? When was their last job? What was their job? Why did they become homeless?
We honestly have no idea. Solving a problem is particularly different when you don't even know what they underlying source of the problem is!
Now gathering this data is actually pretty difficult. Many homeless don't have formal id. And many others have a justifiable distrust of the government and organizations which make them not want to use their real names.
In Seattle it gets even more complicated. Different groups don't like to share their numbers as to how many homeless they shelter or how many services they provide. Because if they all start sharing their numbers some of them are bound to start losing their funding. And we wouldn't dollars to be spent more efficiently by another organization now would we?
So why is Seattle's homeless population so wildly disproportionate to our city size? <shrug> No one knows and we're just guessing.
(Fortunately for me, unincorporated King County is actually a completely illogical place to put such a center; no transit, no proximity to anything, etc. It will probably go in Pioneer Square.)
I don't think some kid is going to get into heroin so they can hang out at the injection point, but if they do get hooked then I hope this buys them some time to escape.
No - this is not true. OD's are at an all time high in the region [1]
It's a highly politicized issues and the entities behind it are strongly incented to make it seem as though it's working.
The only evidence of Insite 'working' is provided by them - and the data points they provide are selective, unscientific and definitely not objective.
There is no objective evidence to indicate that 'it's working'.
If it were a success - we should see number of users down, crime down, cleaner neighbourhood etc. - but no. None of that.
There has been no effect on the overall drug using population. There are no external metrics for success at all.
By 'success' Insite points to the 'number of ODs prevented' the number of 'addicts into programs' - but this assumes that those ODs would have resulted in death or would not have been dealt with otherwise, and that there are not other ways to get people into recovery programs.
Given the amount of $$$ being spent on the clinic, I'm very doubtful that we can claim any degree of success.
It boils down to a cleaner place to shoot up - that's about it.
I think it's worth keeping open as a 'point of experiment' so that we can try different methods of approach - but it's ripe to call it a 'success'.
When numbers of users is measurably down, crime is down, that area is safe to walk in during the day (it's not as of now) - then we can start claiming success.
[1] http://www.cbc.ca/news/canada/british-columbia/drug-overdose...
Sydney has had safe injecting for 15 years, initially the rate of overdose went down ~75% to around 1 per month but now in the past few years it has spiked back up again to record levels.
There are also other factors to safe injecting rooms - such as opening pathways to recovery, removing litter from the streets, preventing hepatitis and other diseases and removing the taboo from drug addiction.
I don't think anybody claims that safe injecting alone can prevent all opioid deaths, its part of (and usually the first step of) a multi-pronged approach.
I agree.
"I don't think anybody claims that safe injecting alone can prevent all opioid deaths,"
'Safe injecting' is not saving any lives and is not doing any 'harm reduction' is my point.
The only evidence provided that 'it's working' is the sites data where they say 'we prevented x number of ODs' - but this is not quite valid - just because they think they prevented an OD, does not mean they did. Someone who takes too much on the street can still get an ambulance and emergency services. Someone on the street who does 'way too much' is gong to die one way or another.
There's no evidence that the sites actually 'get more people into programs' than otherwise.
I believe that more directly interventionist programs might work: if you are caught, high on heroin in public - then you don't go to jail, but you go to a facility of sorts. This facility is basically a 'dry out hotel'. The only thing about this facility is you have zero access to heroin - you have to go through withdrawal and be clean for 30 day.
Withdrawal is the unavoidable 'first step' to getting off heroin. There is absolutely no other way, and it must be done.
Then programs to help people stay off of it.
Also instituted were our opioid substitution programs, allowing people to choose from methadone or buprenorphine (aka Suboxone, Subutex) at the dose they want. This, too, resulted in massive drops in overdoses and crime.
There is literally no valid reason to oppose these programs supported by evidence. Not only are they the ethical thing to do... they also just work.