> One of the major reasons people can’t overcome it is because we’re not very good at treating addiction in this country.
I am often wondering about how addiction "feels". I don't consider myself being addicted to anything, and always wonder how an addiction actually manifests itself. Is it a pain? Is it comparable to being extremely hungry or thirsty?
Slightly related: a few years ago, I overheard a conversation between a fairly large woman and a child. The child said that it was hungry. The woman said: "Oh yes, that hurts". That struck me as odd, because even after eating nothing for 1-2 days, I never actually felt pain when I was hungry. It was surprising to me that some people seem to do, and it would have certainly explained why the woman was so heavy: I, too, would of course eat much more if being hungry was painful.
I've done this several times, I have a headache for 24-48 hours then pretty much back to normal. Tolerance takes longer to reset obviously and I'm sure I get more energetic in subtle ways I'm unaware of in there... but I don't think it's remotely comparable to a serious addiction, from what I've read tobacco is probably the most widely accepted thing able to cause that level of addiction.
The worst is over after a couple of days off cigarettes too, but there's a thick trail for a couple of weeks and a long thin tail for a couple of years.
There's got to be more to this because even though I consume prolific amounts of caffeine I do not experience any pain on cessation. Yet, many of my coworkers do feel this pain.
Good way of putting it. It’s in the chest for sure. I’ve always thought of it as something missing in your chest - a type of emptiness. “Thirst” is a good metaphor.
for heroin it's ... hard to describe? one thing about heroin though is it is motivating as hell, at least in terms of motivation to _obtain heroin_ and you're going to do stuff that ranges from ill advised to ... very ill advised? anyway, thing i discovered is that if you stop taking the stuff, it takes a long time to find a replacement motivation. e.g. found myself waking up, discovering i didn't have an immediate need for heroin, and then, well that's it. nothing important to do here. it was ... annoying? fucking terrible? still is, so there's that.
Addiction is rooted in truama. It's almost impossible to become an addicted if you didn't have to endure (childhood) trauma. So addiction is often an attempt of escaping, or soothing that pain.
I'm not sure, I agree it sounds like pop psych crap and you'll develop physical dependence of course, but I suspect there's a big difference between people who can pick up smoking weed on a weekly or monthly basis recreationally and people who find a need to be high every waking minute of their day. People who take to drinking a bottle of vodka for breakfast and those who keep it to the odd occasion. I don't see why we wouldn't see similar for other, even more physically addictive drugs.
>but I suspect there's a big difference between people who can pick up smoking weed on a weekly or monthly basis recreationally and people who find a need to be high every waking minute of their day.
Maybe, but why would it be due to childhood trauma alone?
I can imagine someone with a happy childhood and a big 20-something or 30-something trauma (loss, divorce, various other issues) falling for drugs/alcohol addiction for the first time just the same.
Veterans who are given an opioid for pain, rarely got addicted if they had a warm and loving childhood, and lived a life with community and friends.
Veterans who had many Adverse Childhood Experiences (A high ACE score), such as coming from a broken home, or faced neglect and isolation growing up, were much more likely to become addicted to the opioids they were given to treat pain.
>Veterans who had many Adverse Childhood Experiences (A high ACE score), such as coming from a broken home, or faced neglect and isolation growing up, were much more likely to become addicted to the opioids they were given to treat pain.
Veterans at that stage are also usually young, so if they came from a broken home, or had isolation growing up, they'd still return to something like that.
What about veterans that have build a succesful family and working life in between (aside from having had childhood trauma)?
there could be some underlying pain or trauma or anxiety, and when you find a chemical that obfuscates it, your brain goes "oh I like this new feeling", and you start using that chemical as a way to mute the negative, often without realizing it OR realizing those underlying issues even exist.
then, the press secretary in your brain (the thing between your subconscious & conscious mind) goes into hyper-rationalization (denial) mode and you start to defend the amount and type of chemicals you use, even when they are literally killing you and those around you
If you're asking about what physical or psychological withdrawal from a drug feels like, it depends on the person, the chemical, and other variables. The worst opiates (Suboxone / Methadone) have 6 month+ withdrawal symptoms, and the faster ones are ~7 days. Hellish times. However, while abstinence frees you from withdrawal symptoms, unless the underlying mental issues are addressed it's likely you'll go back to the very same substance that got you here.
Ever read a good book, or played a video game, and known that you have to stop now but thought "I'll just read another chapter / play one more turn"?
I would say that's basically how addiction manifests itself: even if you know that you're dealing with substance abuse, come on, one more time won't matter, will it?
And then there's also the comfort aspect: you're getting back from a hard day's work, you're feeling tired and cranky, you do deserve something nice, don't you?
N.B.: I'm not saying that not being able to drop the book or stop playing that game IS addiction, just that substance addiction might feel the same way.
N.B. 2:And I'm not talking here about the medical aspects of withdrawal, because that's not the thing an addict would usually experience (withdrawal would only happen because you're trying to stop or cannot get access to the substance you need).
Addiction to smoking is like a mixture of itch and thirst, to a certain extent. You can get other psychological symptoms, like irritability and anxiety, or physical ones, like headache, but mainly it's this continuous need of absorbing the substance, that never goes away. A bit like when you're itching and you can't scratch, or you're thirsty and you can't drink.
It depends on the addiction. Opiate addiction comes along with flu like symptoms, insomnia, restless legs/arms AKA crazy legs, and an ever present anxiety that you really really want some that will make you do some weird shit just to get it. Other addictions are more subtle, some worse, but all of them I've experienced have the same feeling of stress/anxiety that can only be cured by the vice they are caused by. Many are all in your head, or, can be overcome by willpower, but definitely not opiates
> Opiate addiction comes along with flu like symptoms, insomnia, restless legs/arms AKA crazy legs, and an ever present anxiety that you really really want some that will make you do some weird shit just to get it. ... Many are all in your head, or, can be overcome by willpower, but definitely not opiates
Sure, but one can be dependent on e.g. SSRIs or SNRIs. But they aren't addictive!
Dependence + addiction is a special problem with opiates, I think you can die from withdrawals?
You can't die from opioid withdrawal. It's unpleasant and many people need help. But it's not like alcohol dependence which can kill people if they stop suddenly.
SSRI/SNRIs can be problematic. The difference is that SSRIs tend not to have the other features of dependence:
Seeking the meds when you run low; preoccupation with the meds; continuing to take the meds even though you know they're doing harm.
I'd say that cigarette addiction doesn't really feel like anything. Mostly it's just like a feeling that you forgot something. Or a feeling that you didn't complete your to-do list. Then you get satisfaction when you're able to complete it.
Former smoker. You also get increasingly annoyed at anyone and everyone until you get to check off that box. Nothing feels complete, none of life's little victories or big disasters, until you've had a smoke to commemorate it.
To me, it always felt like there was something like a little pebble be stuck in my brain and there was only one way to get it out. Not physically, but in terms of how it affected me mentally.
> I am often wondering about how addiction "feels"
It highly depends on the "thing" (it must not really be a thing). I would say "its the desire to plug a hole".
Do you drink tea? Why dont you drink tea without sugar? There are lots of answers to this question. It can be "it tastes better". Thats what your mind is telling you. It probably would be more healthier to drink tea without sugar but you still add sugar to it.
Thats addiction. And there are tons of other examples and its hard to determine it for every case. Addictions are deeply implemented in our brains. Eating, the urge to be close to people, getting complemented for things you do, all this is kind of an addictional behaivour.
Drugs can basically fill this already existing but empty receptors more efficient. Then your brain tells you to do it again. It will find reasons.
That was harder to explain than i thought. I hope it makes sense.
But certainly it is much harder for an alcoholic to stop drinking, than for me to stop putting sugar in coffee or tea? I actually did that 15 years ago because I was too lazy to buy sugar. It tasted strange for 4-5 cups, then I was accustomed.
Alcohol is very addictive. Its one of the few drugs that can actually kill you on cold turkey. Your body will sign that it wants it and it feels very bad.
I generally tried to explain what addiction is and what it feels like. It really depends on the matter.
A guy I knew in college told me not smoking for him was like not eating. Not physically in the stomach, but those same urges and feelings that you'd better do something about it soon because it's important. It becomes the main thing you're thinking about until it's resolved and anything or anyone that gets in the way annoys you.
Hunger never hurt me, but I used to give into it quickly because it distracted me a lot and I enjoyed cooking and eating. The first time I dieted intensively it took about 5 days but I mostly stopped feeling it. It was more of a notice "probably a good time to eat" than a strong urge anymore. It was easy to reframe in my mind as a positive - this is the feeling of fat evaporating! Getting to that point can be tough though.
It happens to me with CocaCola. I have stopped drinking it, but when I waz i the process, the cravings it gave me were crazy. I NEEDED to have a coke.
Btw, in relation to the article, there was a Reddit user who ar some point wanted to "just try" this heroin thing and his message history depicts very amazingly hiw he spiraled to addiction.
I'm currently a Coca Cola addict. It's not unbearable, but I really have strong cravings regularly. It's not thirst -- I don't want water, I specifically want Coca Cola.
This beverage has no redeeming qualities, and I want to kick off this habit.
The beverage is fine, if you have it every few weeks, during heavy exercise or when trying to stay a awake on a long car journey. It's not a drink you should be drinking all day, every day unless you'd be happy taking caffeine tablets and having several spoons of sugar on top of what you're eating. I love coke and will have about 1 can a month on average. In America (and fast food places in general) it seems to be the norm to have sugary soft drinks with everything, which seems pretty weird to me.
Agreed, in moderation it's probably mostly harmless... but still, it's a disgusting sludge when you look at it objectively: a syrupy dark thing with excess sweetener/sugar.
However, it triggers some addiction mechanism in my brain, and I must drink it every day. No moderation for me -- it really is an addiction. I don't go to McDonald's: I drink it at home. Diet Coke, so no excess sugar, but I'm pretty sure Diet Coke is unhealthy as well, and I'm not sure those sweeteners are good for you anyway.
Addiction controls what you want, regardless of whether you like the thing you are addicted to. That's what makes it hard to beat by just white-knuckling it; whatever strength or will you have gets redirected against you.
> Is it comparable to being extremely hungry or thirsty
Not for me. I used to be a smoker and alcoholic.
For smoking, I just felt uneasy without it, like idk when you're anxiously waiting for something important.
That's the physical dependence and was only the first two weeks and relatively easy to overcome. I got dizzy and other withdrawal symptoms but you can fight through that for a couple of weeks. The other part is the ritual to it. E.g. like most people probably brush their teeth once a day, smoking after eating is just something you do, give in once and you're back to physical dependence.
Alcohol was different for me. Self medication. Once i solved the issues i was medicating (insomnia and stress) i... just stopped drinking and never missed it. The biggest adjustment here was getting used to not being drunk and figuring out what to do with all the time i had now.
> Hart presents himself as a model drug user. “I am now entering my fifth year as a regular heroin user,” he writes. “I do not have a drug-use problem. Never have. Each day, I meet my parental, personal, and professional responsibilities. I pay my taxes, serve as a volunteer in my community on a regular basis, and contribute to the global community as an informed and engaged citizen. I am better for my drug use.”
Anyone who has plumbed the depths of addiction either with a family member or personally has spoken this exact paragraph, potentially word for word. It's a rationalization for addiction, and honestly the most common and basic one.
Good luck to him as he descends through addiction. He's extremely educated and very assured of his self-perception so for him to hit Step 1: Realize you have a Problem, is going to be a lot harder than the average person.
Death comes from _mis_use, which usually stems from _mis_information ("drugs are bad, let's not talk about them").
People die when they over-dose (which more often than not happens because they don't know exactly what they're getting, or the purity of it) or mix with other substances that they shouldn't.
That's not a side effect of heroin, that's a side effect of overdosing. Death is also a side effect of overdosing on acetaminophen, and alcohol. Imagine if when I went to my local wine shop they made a mistake and sold me something that was 80% abv rather than 12-14% and I drank the bottle. Or my pharmacy gave me 5g acetaminophen tablets instead of 500mg, and I took 2 of them every four hours for a few days. Or my finely ground table salt was cut with some form of rodent poison. I'd be pretty dead in those cases most likely. Most illegal substances you have absolutely no idea what you're buying or how much you're buying unless you test it yourself. Yes, word gets around but that's no use to you if you accidentally take 10x a dose, or something that is just not what you were told it was.
Legal substances also have lots of information readily available around them - if I go to my pharmacy and ask for ibuprofen, they will tell me the dosages in advance. If I go to my doctor and they put me on oxycodone, they will give me a dose that they think is safe, (and in theory, a plan to reduce my dependence on them) without judgement. If you develop an opiod addiction, your support options are much more limited.
Switzerland started a program in 1995 where they give medical grade heroin to people suffering from addiction. From the people taking part in this program, none have died from heroin overdoses or due to toxic contamination in the drug.
So heroin is actually pretty safe if used correctly.
Indeed. If one reads the adverse effects of heroin (e.g. in Wikipedia) and ignores the ones caused by dirty injection, lacing and overdose, you are left with no long term effects other than a blurry "brain impairment to make decissions". On the short term, respiratory depression. That's it.
Not many legal drugs has such short list of side effects.
Thing is, good heroin/morphine is almost free of side effects. Paracetamol, for example, is a lot more dangerous than heroin.
Also, Joplin took heroin AND massive quantities of alcohol on the day of her death. It will be close to saying that when someone dies in a car crash while DUI, driving is the real and unique problem here.
But the drug-war irrationality is better exposed by taking a look at weed and MDMA. Two quite safe substances (certainly more safe than alcohol), with clear medical applications, and forbidden just because some ignorant decided to put them in Schedule I. MDMA at the time of its prohibition was being used in psychotherapy with success in tens of thousands of patients [1]. Today, no medical use is recognized, and being in Schedule I (making it un-researchable), none will be. I wouldn't be too surprised that some country discover that it could be used as a treatment for depression or PTSD.
Black market incentivises dealers doing things like mixing fentanyl into heroin in order to make it vastly more profitable (fentanyl is cheap and incredibly potent), with the side effect of increasing its deadliness massively.
Users often mix heroin with benzos and/or alcohol which increases the level of risk enormously. The vast majority of overdoses are caused by mixing CNS depressants in with heroin, not by heroin use alone.
If you can't get a steady supply then withdrawals are vicious and can cause a host of other problems (crime in order to get money for more heroin being a commonly cited one).
One of the ways that heroin itself can cause overdose deaths is relapses - users may take a dose that they were previously tolerant to. I believe this is still far less of a danger than combining with other substances.
That's kinda the point. Most drugs are not bad/evil in themselves. They can be used irresponsibly.
Many classic drugs (as opposed to research chemicals which introduce small molecular changes to circumvent banns on another substance) are pretty safe or at least have a well known safety profile.
What would you characterize as a benefit? Medical, certainly. Recreationally, certainly (it feels good). Socially, I imagine so for some people and some doses.
"Repeated heroin use changes the physical structure and physiology of the brain, creating long-term imbalances in neuronal and hormonal systems that are not easily reversed. Studies have shown some deterioration of the brain’s white matter due to heroin use, which may affect decision-making abilities, the ability to regulate behavior, and responses to stressful situations."
I expected something more damning. Unfortunately, I feel that we don't have enough studies (incl. long-term ones) when it comes to recreational drugs.
Worse: heroin destroys hippocampus function over time. If the hippocampus is damaged by disease or injury, it can influence a person's memories as well as their ability to form new memories. Hippocampus damage can particularly affect spatial memory, or the ability to remember directions, locations, and orientations.
Yeah, and he's putting out his experience as an example for others to point to and say, "If that guy could do it, so can I!"
Personally, I've always felt I had a personality that is prone to addiction, so I've stayed away from even alcohol on a regular basis. (Though at one point I was having my favorite alcoholic drink every night... I stopped when I realized what I was doing.)
Even breaking away from caffeine (again) is tough for me. Soda was also tough, and I ended up on soda water instead and still drink way too many of those.
I've also spent too much money on mobile gacha games, but because I know my personality, I managed to keep it from spiraling out of control. (Some people would even say the amount I spent wasn't a big deal, but it was far more than a single game is worth, so it's a sign that I was going wrong.)
Someone else asked how addiction feels, and I almost answered there, but didn't because I'm sure they meant hard addiction that you need help to correct, and I haven't been there. But as far as I've been, it's an almost-uncontrollable desire and subsequent rationalization and then capitulation. Each time. Fighting the feeling is depressing, even if everything else is going great. I only ever escape when I make myself feel worse about doing the thing than I feel from not doing it.
Man, I read this as someone who tried to use opioids and I just couldn't chip. It spiraled into full blown physical dependence. I guess i'm the type with an underlying psychiatric illness which drove my usage and denial.
That there exists people like this person who can chip (controlled use of opiates) always intrigues me -- as this drug was the ultimate pathway to euphoria and thus I became the mouse hitting the button for more more more. If you're on the chipping path I hope you can find peace just for today.
I am pro-legalization of all drugs with some FDA oversight on quality.
Opioids are insanely and ~~instantly~~ quickly addictive. I accidentally became addicted after knee surgery.
When the pain subsided, I stopped taking them, and within a day I found myself curled up in a ball and wanting to rip my own skin off. It's really true when addicts describe it as "being uncomfortable in your own skin".
The moment I realized I was experiencing withdrawal, I flushed the meds down the toilet and just suffered through it for a couple days.
Never ever touch heroin. Stay away from prescription opioids unless it's really really needed, and make sure it's short term only.
This is the kind of FUD that TFA is specifically addressing. Namely, that this is not always a true statement.
Of course, for many people, it is, which is why people make such sweeping (and incorrect) statements. Your warning is valid, your claimed facts are not.
I think you're trying to argue GP's point, but you've only confirmed it, because you're misrepresenting both the facts and the traditional advice.
"Treat every gun as if it were loaded" is the traditional advice, and is a wonderful attitude to have about firearms. But if it's not loaded, it's not loaded, those are the facts.
Perhaps the same with opiods: treat them as if they are highly addictive, in a rapid manner. But if (for you) they aren't, they aren't.
So even if it's not true for everyone that's a practically useless observation because how are you going to find out it's not true for you without risking becoming instantly addicted?
I don't have the reference at hand, but the rates of problematic use in the population seem to mirror alcohol. A small single digit percent of people will absolutely have a horrible problem, 8-10% will engage in disordered use, ~10% will over use in some way, and 80% will never develop a problem at all.
Here's one showing only 5% of people filling opioid scripts go on to long term use.[1]
Another older study citing 2% of US adults regularly using opioids, while a further 29% use them infrequently. Other more recent studies I seen hold this pretty constant. [2]
Here [3] only 13% of elective surgery patients fill opioid scripts beyond 90 days, and "mental health disorders, and tobacco dependence or abuse were associated with prolonged opioid use". It's well known that people with one substance abuse issue tend to be at higher risk for developing others.
You could go on and on finding studies that show that relatively few people with high risk medical/mental health history go on to develop opioid addiction after using these substances. There doesn't seem to be any support for the idea that the average person can take these drugs once and become "hooked".
All that said, they are dangerous and have strong addictive potential so caution is warranted.
That you cannot imagine an approach doesn't mean an approach doesn't exist. It may be possible to form a generalized understanding of an individuals predisposition based on testing with other substances, just as one example.
You’re still taking a substantial risk when forming that generalized understanding, and then another substantial risk when you start making conclusions from that general understanding.
Ok, so basically, since we haven’t proven the opposite, we can’t be sure, regardless of how the situation appears. I think that’s a weak argument in a general sense, but point taken.
No, I'm not arguing that proof is necessary for certainty. I'm pointing out that the implied reasoning is akin to argument from ignorance. We don't have to take a position on a topic if we are ignorant, but we often do so when doing so can be used to justify existing biases.
The assertions that the are made in the article seem like something that should be backed up with studies and not anecdotal evidence from one person (even if he is well respected).
It is an incredibly slippery slope for people to walk out on. It would be incredibly hard for someone to say whether or not they will spiral out of control if they try it and the consequences of becoming heavily addicted are life destroying. It seems like playing Russian roulette and I'm not sure it's a good thing to raise the idea that one can potentially manage it. Also, the person being interviewed could be one of the people that can't control it and will spiral out of control or him saying he manages it well and it's possible to do so could be a facade and he could be trying to do whatever possible to keep his habit alive, but we just don't know. Many people manage it fine for years without anyone knowing until they start their sharp decline towards bottom.
>The assertions that the are made in the article seem like something that should be backed up with studies and not anecdotal evidence from one person (even if he is well respected).
Wherw do you think he got these assertions? There have already been studies about how often heroin users are addicts or what the addiction rate of prescription opioids are.
From the interview, it sounds a lot like he got them from his personal experience. He mentions percentages, but I see no references to any sources. It matters what those sources are (e.g. if they are from Purdue pharma or the sacklers, it's probably BS).
He could mention an institution and professors that ran the studies like other people I've seen interviewed. It is an incredibly dangerous assertion he is making, it seems like the readers shouldn't be the ones that need to investigate and you certainly shouldn't need to buy his book to investigate it. Denial is an incredibly huge problem with addiction, stuff like this could be used by those with bad addictions to stay in denial and maintain their addiction.
One thing I am curious about with this research is how they would get reliable numbers for high functioning opiate addicts. Addiction is really a spectrum from "no dependence on the drug and no negative life consequences" to "high dependence on the drug and many negative life consequences". I'm sure that many people fall in the middle where they continue to responsibly live their lives while still being dependent on a drug that they may wish to quit, but can't because the withdrawal is too much. I also would not be surprised if many of these people did not seek out help and tried to hide their problem from others due to the major stigma associated with being addicted to opiates, not to mention those who are dependent on opiates but in denial about their dependence.
So the article states that Carl Hart makes a claim that 70% of drug users don't meet the criteria for being a drug addict. I'm wondering how you could even get a reliable number for this for a drug like heroin, given the stigma attached to this drug and the fact that users themselves may be in denial that they are dependent on the drug. Someone can be meeting all their obligations in life and still be struggling with a drug addiction. If asked, I would imagine a lot of high functioning addicts would say they can stop whenever they want to, they just don't want to. Anyway, I may just have to give his book a read, it sounds interesting.
An easy way to improve that accuracy is to survey people based on their past use as well. There's less reason to be in denial about something you've already dealt with.
Yea, I would be very interested in the methodology they used to come up with that 70% and I am wondering if that is a snapshot in time or is that over someone's entire life. Addiction almost always starts out in a more controlled manner until its not. So if 50% of those 70% of drug users become full blown addicts, then its a BS number. I'm also really curious how they found those high functioning drug users, because I can't imagine anyone that is successfully hiding their use from the world would divulge it to anyone they don't know or trust ("hey, are you a high functioning drug user?" sounds like something a cop might say).
> Opioids are insanely and instantly addictive. I accidentally became addicted after knee surgery.
Is that true generally, or just for a subset of people who have some predisposition to addiction?
While it could just be Purdue Pharma propaganda, I vaguely recall hearing that the "instant addiction" was a myth. However, people like you have experiences like yours, so there must be some truth to the "instant addiction" idea.
Edit for downvoters: I think it totally makes sense for everyone treat opioids like a loaded gun, like another poster said, if some people are vulnerable to an instant addiction effect. I just want to clarify what the actual situation is (for me and all the other people who were told it was a myth).
Yeah it’s a total myth. Not sure why you’re being downvoted. My wife and I kept a bottle of oxy in our bathroom for a few years, taking it only occasionally. No one got addicted because neither of us wanted to keep taking it.
A prerequisite for addiction is that one must believe the drug makes them feel “normal” or functional in some way. “I can’t live with this pain - I need it.”
If instead you as a user go into the drug experience with the mindset that you are entering a temporary state, one that is reserved for special occasions, you’re far less likely to become addicted.
It is not myth. Some people get instantly addicted to heroin, others can continue using casually for years. We dont really know what exactly is different, but it cant be psychological only. The withdrawal symptoms are physical, not just how you feel emotionally.
Yes, it’s a myth that they are “instantly” addicting. I don’t deny the drug is powerful, but you have to want it.
If it were true that it was instantly physically addictive, then literally every human being that has ever had any kind of surgery or been to the ER for trauma would be a rabid opioid zombie. But they aren’t.
My cousin is a social worker, dealing with addicts. I've done heroin myself. I know heroin addicts, though not as many as he does.
We both agree: almost all addicts have a backdrop of broken families, poverty, unemployment, some kind of trauma or just a general lack of opportunities in life. Heroin makes all that go away... for a while. How could they NOT become addicted?
The myth is about shifting blame from social inequality onto a drug. The addiction is but a symptom of a societal disease.
That is not mutually exclusive. Every single person living in 2020 knows dangers of heroin addiction. It is not starter drug happy person will try these days. You have to be seld destructive to even try.
> Every single person living in 2020 knows dangers of heroin addiction.
LOL no. Some people here, most of them highly educated, are spewing myths like it's "instantly addictive", lies laid out to try to curb the epidemic from the 80s.
It takes relatively long daily use for one to become dependent, and basically you only do that if you don't have a job or anything you value waiting for you after the high, really. Sure, there are exceptions, but that's the norm. The fact that drug abuse heavily correlates with economic recessions and unemployment increases should give everyone a hint. [0]
In 2020, we know roughly 80% of the users never become dependent. [1] In the same ballpark as alcohol, unsurprisingly.
And it's normal. Because it's bliss, but then it's pretty shitty. For a few hours of high you have a few hours of nausea and general discomfort.
> You have to be seld destructive to even try.
No, you just have to be curious and know how to evaluate risks and benefits. It's not a "starter happy drug", but it's not the devil. In 2020, the people doing heroin know a good deal more what they're doing than the ones from the 80s.
Harm prevention and reduction has moved on a lot too. There are high precision scales for very cheap. There are testing kits, too. In the 80s pharmacies in most countries were told not to sell syringes to addicts, again to curb the epidemic, causing them to share needles with all the associated problems (HIV expansion, needles leaving more bruises, sepsis...). Now most countries with a sane drug policies provide free needles to addicts, when not straight up supplying heroin to them [2]. Unsurprisingly such countries have lower problematic drug use than the US, where the problem is policed rather than treated.
I've been prescribed oxycontin several times over the years, and never completed a single bottle. Couldn't wait to stop as the pain subsided due to the brain fog. I think at most I completed one third of one.
Some people are definitely more prone or vulnerable to becoming addicted to it. Im lucky, I guess.
I can't confirm your experience at all. I've had a serious car accident after which they kept me on opium in the hospital for three days. After they replaced it with weaker pain treatment compounds I didn't have any desire to go back, despite how I was feeling when taking opium. I wouldn't say they're instantly addictive.
I can confirm his experience via my brother's nearly identical experience. He asked for a non-addictive painkiller, as he knows he has an addictive personality. He was prescribed an opiod anyway, I don't recall which, for a serious abscessed tooth.
After a couple of days he was experiencing identical symptoms as the GP.
I'm not trying to chime in on how strictly we're interpreting "instantly," but for me I will definitely do my best to avoid opiods. Taking the prescribed amount for 2-3 days, and literally not taking the rest of the pills (both GP and my brother), and having serious physical withdrawals--that's fast enough that I would rather avoid it.
Someone I know had a basic nose surgery (bone deviation) and then she experienced withdrawal symptoms after the surgery because of the anesthetics, which required intervention by professionals and she was unable to work for a month.
Edit: Just to clarify, she was not prescribed any opioids/drugs to be taken post surgery, it was purely the anesthetics.
An anesthetic would typically consist of something like a small dose of a short-acting benzo before surgery for anxiety, propofol (very short acting) for induction, an opioid for pain management, an anesthetic gas like sevoflurane to maintain anesthesia, pressors to bring up blood pressure if necessary, and a few other drugs that probably don't merit mention.
Of these drugs, the only ones that might cause withdrawal symptoms would be the benzo or the opioid. The benzo, if it's even given at all, is going to be tiny. Even if we were to hypothesize that a single unusually large dose of an opioid could induce dependency, a surgery where the patient isn't even given opioids to take home wouldn't warrant such a dose in the OR.
In short, your second-hand account makes no sense.
To be honest, a lot of people, including the doctors themselves, doubted her as well.
I am fuzzy on the details, because the person was just an acquaintance. There was a huge investigation on her history, looking for substance abuse. They found nothing.
They aren't instantly addictive, though: As in, I've had opioids prescribed, took as needed, and still have some in the cabinet that are probably expired.
I've smoked opium a handful of times. It smells wonderfully.
And yet, if I take any drug regularly, I'm using something with THC in it (hash or pot, in general). I currently do not, however, and tend to have a few drinks and get high on the weekends. Not a big deal if I don't, though.
I've had medical grade heroin in the hospital (morphine didn't take care of the pain). No withdrawal, though I was wonderfully high. Haven't gone to a morphine habit.
The prudent thing to do is not to say, "opioids are instantly addictive", but to give folks safe ways to detox from them and give folks information on signs of addiction - because not everyone has such experiences.
You're an outlier. The vast majority of people who smoke opium or experience euphoria from taking medical grade heroin will obtain the urge to do it more.
See, this is saying something else entirely. Also, do you have a source for this?
Would I do opium again? Sure. It was fun. Would I do medical grade heroin or morphine again, under controlled circumstances with a nursing staff dosing me? Yeah. It was fun. Did I have some weird urge to go out and do it frequently? Nope. But to be fair, lots of folks drink on more than one occasion as well. They get high more than once. They might even have more than one drink or hit in one day. Simply wanting to do something again doesn't mean anything. I've done acid more times than I can count, and I wouldn't call it a habit. The only drug that I'd probably do more often if it were not dangerous to do too often is MDMA because it feels spectacular (better than opioids, to me anyway), but I'd not even call it a strong urge.
This isn't addiction, nor is it anything uncontrollable in general.
Unless you are implying that folks get uncontrollable urges, and in that case, please back that up with facts. Though I've met my share of addicts, most things just aren't instantly addictive. Even heroin isn't that way - especially if you actually improve an addicts like (hence, troops addicted to heroin in wars came home to be non-addicts).
>> This isn't addiction, nor is it anything uncontrollable in general.
With as much respect as I can offer I think you should consider the following notion, which in my personal experience is an actual fact:
"Until and unless you have been an addict you truly cannot understand the experience. And subsequently you are not able to point out what is and is not addiction."
Asking for opinion: can one transfer experiences with non-drug addictions (videogames, promiscuity, social nets, etc) to the substance-abuse kind? How similar are these?
I believe the most-essential factor is this: loss-of-control over the behavior in question.
IOW, when the behavior takes places in spite of the individual wishing to stop, or committing to stopping -- then it is almost certainly "an addiction". It is the behavior that is most important, not 'substances' particularly.
The trouble is that it is very, very difficult for someone to recognize AND admit that they are unable to control some aspect of their behavior.
Most of us will create elaborate explanations to avoid admitting (to ourselves mostly) that sometimes we window up in a situations where we are completely powerless to control our behavior.
No, the 'vast majority' do not. I've supervised medical grade opioid administration to more than a few people, both acutely and chronically, and *folks without a pre-existing substance use problem* do not often develop one, especially if it's over the short term. The idea that "I give you an opioid and then BAM I want more!" is highly divergent from my clinical experience.
As a physician, you should know that using opioids to experience euphoria and pleasure is drastically different from using appropriate doses to combat the effects of pain. It's the euphoria and pleasure that triggers operant conditioning and the accumulation of ΔFosB that occurs in the vast majority of addictions[1]. Only after receptor downregulation does withdrawal avoidance become a factor, but once that occurs, it doubles the strength of the operant conditioning.
Use != Misuse, but use for pleasure is a direct precursor of misuse.
From what I've read, this varies hugely among the population. Some people seem to not be affected by them at all. Some people are able to use them short-term for pain relief and stop with no drama when the pain subsides. And some people get dangerously addicted even with a legitimately prescribed short-term dose for actual crippling pain. It seems it's often hard to determine which one a person is ahead of time.
FWIW, good on you for recognizing that you're one of the third group and getting off of it entirely before the addiction gets even worse.
I've only ever tried opioids after being a surgery. I was prescribed off oxy to take every 4h. Was supposed to take it for two weeks. Every dose knocked me out and made me feel so uselessly drowsy… I quickly dropped it to one a day and by day 3 I just stopped taking it altogether. Couldn't stand it… the pain was better than the feeling of being high. I ended up using barely 5% of the prescribed amount. Random acquaintances came out of the woodwork to ask to buy my pills. I just tossed them all… that shit was nasty and I didn't want it nor did I want to enable anyone.
And I say this as someone who's plenty happy with drugs legalization, who likes the occasional MDMA, and who drinks plenty of alcohol. I guess I'm lucky I never run the risk of opiates addiction, because despite all that I have no desire to every touch the stuff again.
"Opioids are insanely and ~~instantly~~ quickly addictive."
Do you have a source for this assertion? I'm just a physician with a particular specialty in medically managed (as opposed to procedurally managed) pain, and I've never seen a "I took it once and was instantly addicted." I don't mean to undercut your subjective experience, but I've seen a few folks on pain killers, and if what you described was more common than "very rare", I would have by now.
> Opioids are insanely and ~~instantly~~ quickly addictive. I accidentally became addicted after knee surgery.
They may be instantly addictive for you, but they are not for everyone.
After I had a pleurodesis, the nurse sat me down in the chair next to the hospital bed and gave me a little controller I could use to release morphine into my saline solution if the pain became unbearable (and it did). It was the strangest sensation—I could 'feel' the pain, in a sense, but it was like I was on a different plane, and it didn't quite bother me.
But to say it was instantly addictive—nope. Not at all. Have had no desire to try anything like that again outside of a hospital setting. Maybe some people are just not prone to it.
That's a very blanket statement without any backing. I've been on opioids several times for pain management and haven't experienced any withdrawal symptoms.
Caffeine, or coffee? They are very different substances: one is a pure alkaloid with well-defined effects, the other is a concoction of hundreds, possibly thousands of active ingredients.
Most relevantly, coffee contains a relatively large amount of Harmala alkaloids, which are a family of beta-carboline monoamine oxidase inhibitors commonly found in Ayahuasca brews (and named after one of its ingredients, Penganum harmala).
I've been given opioid prescriptions a few times in my life, and I've never found myself wanting to take them for their own sake or suffering from withdrawal afterward.
It's probably some variable physiological response - hopefully one day we'll have a good way of profiling a priori which people may have difficulty with using opioids in a controlled fashion so people don't have to suffer to find out they're among the unlucky ones. (Or maybe we'll come up with either a new class of drugs to replace opioids entirely, or a cocktail to block the adverse effects...)
I got prescribed Percocet back when they casually gave them away to teenagers who had their wisdom teeth removed, and did not like it. Not only was I constipated but it made me feel really lazy and itchy. Not a fan.
Because it’s not the ultimate pathway to euphoria for everyone.
Some of us don’t like the “sinking into oblivion” feeling of that class of drugs. I don’t want to feel like my IQ has been sliced in half. Really hate it actually.
The dragon to chase is of the functional businessman’s variety- cocaine. I’d rather take something that enhances my life experience, turns conversation in liquid gold oozing from mouth. Opiates and barbiturates temporarily hide your problems under a blanket of haze, confusion, and constipation. No thanks.
Yeah, I've done heroin, morphine, oxycodone, opium, and a few others in the past and never felt any pull to do them.
But I love cocaine, psychedelics, and weed though, and I have been somewhat addicted to all three at different times in my life. I specifically wouldn't ever get drunk if I didn't have weed to go with it, as that's the only way to make alcohol any fun for me.
As a teen I made opium from poppies around the neighbourhood. After smoking it once I threw the rest out. The intensity of how perfect it felt was alarming. I remember within minutes thinking I'll become addicted to it if I don't get rid of it. Despite that being a scary prospect, I kept feeling great the entire time. It really beats any bad feeling out of you. Incredibly creepy.
I was a dumb teenager (I'm still not very smart) but I'm grateful I had the intuition to realize how dangerous it was. The only way I can describe it was that I felt the pleasure overwhelming my ability to reason, and that felt very disabling.
Perhaps Tasmania? Tasmania has legalized opium production and you'll see fields of opium poppies everywhere since it's the source of the majority of medical opiates. The reasons for Tasmania being the center of the western worlds poppy production are obvious. It's easy to ensure the exports to the rest of the world are done via controlled channels.
This does lead to the weird situation where an entire population has easy access to opium should they want to raid nearby fields; the fields are lightly fenced with warning signs stating that it's bad for your health. Perhaps surprisingly to many Tasmania doesn't really have any issues from this. This may lend some credence to the above article - it takes more than just access to lead to issues for people.
Not full of them, but I’ve always been especially fond of plants, and poppies in particular because my mom grew some spectacular varieties. Through boredom and interest I discovered a home nearby was growing a variety of poppy which could be processed into opium. I took some seed heads at the correct growth stage on an evening walk, then processed them later.
The process is very crude but works well for experimentation. I think if you were a serious opiate user it would probably be too inefficient and inconvenient to warrant over simply buying opium.
Yes, I still see them while walking around here in Victoria, BC. I have some seeds from a friend as well. They circulate and people grow them out of curiosity as well I guess. You’ve maybe seen them without realizing it.
When I was 17 I had a bad cough and my mom gave me what turned out to be too much codeine cough syrup. An hour later I realized my cough was gone but I had spent all that time staring at my Windows ME desktop, in some sort of euphoric daze, repeatedly selecting and deselecting all the icons. For an hour! It was really, really creepy and deeply unsettling. And this was codeine, a "mild" opiate! Have aggressively stayed away from opioids ever since then.
Ah, yeah - this is very much like my experience as well. I sat on my bed and just cycled through the same thoughts for a shockingly long time. Nevertheless it felt great. Very creepy.
Ever taken codeine again? You may have a genetic variant of CYP2d6 that makes codeine, in particular, hit you hard. It's not an effect common across opioids.
Nope never, or any other opioid either, fortunately. But thanks that’s really interesting. Neither of my parents seem particularly affected. But who knows.
My wife can have a cigarette once and a while when she drinks and it's no big deal, last time I did that (6 months after I had quit) it took me 6 or 7 years to quit again.
I remember the early days of the Silk Road market. The members posted thoughtful reviews of their orders, sometimes containing lab-tests results of the drugs they'd ordered.
It was a small community whose members looked more like the Hacker News crowds than the meth heads you'd see in the news.
yeah that was amazing. it felt like a lot of people on there were also fans of Erowid, which I now realize probably had a lot of the same people submitting experiences
Drug addiction is a continuum not a binary state of being (addict or not an addict). Addiction can run from someone who uses every night after work because that’s how they relax (and they feel like something is missing if they don’t) to a person who compulsively uses to the exclusion of sleep and eating. And it can vary over an addicts life time.
The one drug that has interestingly been demonized is meth. It’s used as a prescription drug and was commonly used recreationally in the 70’s. Now it’s viewed as a one way road to destitution and death.
Drugs are illegal so the media covers the train wrecks. The users who aren’t train wrecks don’t make the news.
Can you imagine if alcohol was illegal and the only stories you heard about users were the people who drank themselves to death? You’d assume nobody could use alcohol in moderation, which isn’t true.
Do insulin users have a drug problem? I think at the core of the issue is that our society generally regards psychological ailments as a personal flaw, rather than a health issue. (I’m talking generally, not about the professor from the article)
Even worse, I think it's treated as a modern version of demonic possession, where the cure killing the patient isn't considered enough of a reason not to deliver the cure.
Unfortunately, insulin users in the United States are sometimes forced to turn to more nefarious means of getting money to support their body from dying. I've known 2 people who died that were unisured and broke who died from not being able to support their dependency on it. Universal Healthcare should cover those dependent on Insulin and Heroin
Drugs have a pleasure effect on the brain. Food does too. So do experiences or playing sports. Winning a sports game feels exactly the same as doing cocaine. Issue with drugs is the risk. Risk of damage to your body or your mind. But the other activities have associated risk. For example, I ski and including back country. I risk avalanches and injury. I've broken a rib and have countless other injuries. I have friends with permanent injuries and have seen deaths on the ski slope. No one says skiing is a national problem.
I wish I’d see more discussion and analysis like this over the recreational use of anabolic steroids (read: not for professional sports or contests, but rather for physical appearance).
You want to talk about some shit that gets demonized for no reason? Testosterone replacement therapy is legal, but if you decide that you want to use an extra 100mg, suddenly it’s a criminal offense and you are a bad person. For what? Wanting to have bigger biceps or train harder in the gym? What is the alternative? Drink alcohol which has a measurable death rate per year, or smoke some legal cigarettes and second hand smoke poison countless people?
This'll get downvoted, but it strikes me how hypocritical it is that you can say you don't feel comfortable in your body they'll put you on test blockers and estrogen replacement to help you look like how you identify, but saying you think you need to look like Adonis is illegal.
Controlled use of anabolic steroids is demonstrably safe and effective.
There's a good book on this called Better Than Well that discusses the use of medicine for life improvement rather than treating disease. One of the most interesting chapters was on amputees by choice, people who want to cut off a limb to become handicapped. Doctors were left with the painful decision of helping these people achieve this or having them do it on their own in a much more dangerous way. While most would agree the behavior of amputees by choice is in some way pathological, it presents an interesting question about whether people have the right to do to their own bodies what they want and the role of medicine in helping them achieve those aims.
You can go to a doctor and get them to prescribe the same hormones to change you from a girl to a boy. Tell them it's for gender re-assignment and they will send you home with a lifetime supply
Is there a testimony of someone who went through such surgery? What's the mindset of a person who really needs his/her limbs removed because of such urges?
I saw an interview years ago on TV and someone was saying it felt like that appendage was not part of their body, it belonged to someone else. It was so mentally uncomfortable they'd rather remove it.
For what I'd suggest is 90% or more of their use case, which is using them to improve muscle mass, strength, or appearance, for your typical gym goer or fitness enthusiast.
When you use the term "recreationally", my assumption is that you are asking about how to use these drugs in contrast to using them in an "addicted" state. Since I am very interested in fitness and physical culture, my .02 is that recreational use is anything where you are not endangering your short term health, endangering anyone else's health or well being, you can afford and understand everything you are using and what side effects and ancillaries you would need to take, and you are taking an amount of drugs that are "way less" than what would be necessary to compete at the Mr.Olympia.
> Hart reports that more than 70 percent of drug users—whether they use alcohol, cocaine, prescription medications, or heroin—do not meet the health criteria for drug addiction.
I don't think it's about health criteria. It's about whether you want to add yet another item to things you depend on just to feel normal.
Also, the need is a symptom of a real issue that needs to be addressed instead of just numbed and berried i.e., unhappy at a job or a situation etc that needs to be addressed.
> Hart strives to “present a more realistic image of the typical drug user: a responsible professional who happens to use drugs in his pursuit of happiness.”
I think this is likely wrong. I guess it partly depends on the definition of a "drug user" (like, does it include alcohol drinkers) but I would be very surprised if most heroin users are responsible professionals - how can you do anything when you're high on heroin? I'd go so far as to say that saying people that are addicted are "typically responsible professionals" is a little disrespectful and downplays the reality of those that are actually afflicted with addiction, as it feels like it's just pushing the "burden" onto the drug user, which reinforces negative stereotypes and makes it harder to get people on the side of treating addiction as a health issue and not a moral failing.
> how can you do anything when you're high on heroin?
It is a straw-man to assume that drug users are high during work. There are plenty of hours in the day. Erowid puts the duration of a heroin high at 2-4 hours.
From my reading, alcohol drinkers are absolutely included in his definition of a "drug user" and the exact same objection would apply - how can you do anything when you're drunk on alcohol?
> how can you do anything when you're drunk on alcohol?
The statistics for alcohol consumption in the Nordic countries in the 19th century are staggering, adult males were basically drinking hard liquor all day every day as they went about their work. Alcohol definitely has its effects on the body and is a huge safety risk, but apparently men were still able regardless to run their farms, build the buildings they needed, chop wood, etc.
I've actually often used booze to power beyond sense and get extra work done at the end of a day, however there is a HUGE proviso - it has to be design work, or stuff that I know inside out and could do blind-folded anyway. Anything to do with programming or logic and I became a useless head-scratching moron, going around in ever tighter circles of stupidity.
Design work though? There was many a time I awoke the next morning and had a dread-chill panic thinking I'd need to get some project done, only to find I'd not only done it the night before, but I'd actually not hate it. Which, as a designer at the time, was high praise. Sure, there might be some rough edges or stupid typos, but the overall work would be Great, by my standards at least, so after a quick review, would be ready to go. I used to refer to it as 'free work'.
I guess letting go is more of a useful trait in design.
I'd not recommend it for doing work in critically-important fields, obviously!
Same. I tried coding tipsy, especially after colleague farewell meals, and I never did anything good. At most I gave funny code reviews to people.
For most of my life I also cooked sober. But when I started cooking tipsy, I began preparing meals I could have never believed I made myself. My current lasagna recipe is an absolute bomb and it's been perfected over a dozen drunken cooking sessions. Even Italians asked me for the recipe.
Main problem there is replicability. My partner often gets annoyed at me when she asks if I can cook some nice thing I'd recently made, only for me to umm and aaah because I didn't write down the exact ingredients... .
I've never taken heroin, but I've heard that it is quite possible to work while high on it. Partly because the high isn't quite like other drugs that give you a high. Which is apparently one of the reasons why it's so easy to become addicted: at first you can feel pretty normal and competent while on it.
I used drugs recreationally until I had children. During this time I knew many colleagues that used drugs every week. Some used amphetamines and mdma at parties. Some used morphine substitutes day time during the weekends, and on a few occasions some were high during work hours (the last few hours on friday). They were very productive. Just because you use a hard drug does not mean that you have to take a large dose. I would argue that most people will be more productive with a low dose of amphetamines. On the other hand, I think no one codes better with alcohol. It all depends on the drug.
For several years I made a living playing poker, and I played a lot better with morphine in my system. It made me more patient and focused. I even tracked my results in different databases (with pokertracker) to compare my results while high. I made almost 10% more while high, and this is over hundreds of hours played.
Does that mean the substances are to blame? IMHO, people who would create a responsibility for themselves (child) and then ignore that responsibility have problems above and beyond how they recreate. Their indulgence is a symptom, not a cause.
Friend of mine is from Pakistan. He says that the guys who drive heavy trucks through the mountains always take heroin first.
Helps them keep calm when navigating a road which has sections only marginally wider than the truck, with a 500m drop on one side.
I'm not promoting DUI (lost too many friends that way, mostly from OTHER people DUI'ing and hitting them), just saying that there are professions where the people engaged think that dulling the fear/panic response is worth the reduced reaction times.
The Guns N' Roses song "Mr. Brownstone" is essentially about this (brownstone being slang for heroin). It seems it worked for some time, but eventually...
I get up around seven
Get out of bed around nine
...
I used to do a little but a little wouldn't do it
So the little got more and more
I just keep tryin' to get a little better
Said a little better than before
...
Now I get up around whenever
I used to get up on time
It did not take a while to understand all drug experiences are deeply fake comparing to living full life. And if they enrich you, you life is probably fake.
Like in Russian group Splin lyrics:
"Я наяву вижу то, что многим даже не снилось, Hе являлось под кайфом".
Rough translation: "I see the things in reality, others don't even when dreaming, when getting high"
I used to smoke weed every day. At the end of the day after work, I would vape until I was fairly intoxicated. Almost everything was better on weed--sex, food, television, etc. I would be out with friends and look forward to getting home and smoking weed. In essence, it made being bored fun. But I started to question who I really was when I smoked weed. I was in a different state mentally, a state that in many ways was disconnected to my sober state. Almost as if I were a different person.
I eventually completely quit because it seemed like a black hole in my day and in my life, where the sober me just lost valuable time and focus. It also dampened my motivation. Part of it may have been physiological, I would be less focused the next day. But part of it was also that compared to being on weed, life was just not as enjoyable when I was sober. I did not like that contrast.
Isn't it ironic that you provide a quote from Vasilyev, who's not exactly known for being straight edge? Moreover, this is a line from a song about love from first sight, which itself is a specific kind of an altered state of mind.
I am Coca Cola and coffee user. I am not addicted. That is, until I try to leave it for a while and then even if I succeed it still takes a lot of willpower.
Addiction is a force that counteracts your will power. You may not have drug problem but you are an addict if you feel compulsion to use the drug.
Today you may have enough willpower to counteract that force to consume more alcohol or drugs. But the next day may be worse, you may find some family or work problem and your will power may decrease enough that you will run into drug problem and have really hard time getting rid of it if at all.
I'm not entirely sure if I follow the narrative here, perhaps you can clarify what you mean. Occasionally I have a beer, either socially or to try out a new beer — does this make me an addict? I would argue no, this alone is not a good definition. I don't have a better definition myself, and surely this is a subject many people have put a lot of effort into figuring out, but I don't think this approach has merit.
It is up to you. People have different levels of willpower regarding different things.
Don't dismiss power of addiction just because you "don't have a problem now". Our willpower levels change so what isn't a problem now may become another day.
You may loose your job and have hard time finding new one and try to use something that has been giving you comfort to lighten your day. And because your "bigger" worries you may not be paying attention to it or you may need that extra comfort so much you will just say "yeah, it will not hurt if I do this for a while". This is frequently how these things start. It doesn't happen that you are completely normal one day and die hard alcoholic or drug user the next.
Now, I wouldn't call what you described even remotely close to a problem. I also consume alcohol socially and even privately. I pay attention to whether I "crave" alcohol and when this happened I cut it instantly.
I have a test for this. Even if you don't drink alcohol, are you constantly thinking about it?
If you are not using but constantly thinking about it it means there exists a force (addiction) that you are currently able to overcome.
>When you’re at a wedding reception, alcohol serves as a social lubricant. People are more gregarious. They talk, they interact. The same is true with cocaine at parties, heroin among friends, or opium among friends, NDMA among lovers. It enhances empathy, openness, and forgiveness, all of these pro-social attributes.
Please, don't take this horrible advice. Drugs are harmful and can do fatal damage to you and those around you. I mean, is this guy advocating drug use? It sounds like he wants to justify his dependency.
Do you drink alcohol? If so you're a drug user... We've just decided for myriad, commercial, political and historical reasons to legitimise some and make others illegal. Note I never used the word "scientific" in that sentence.
I don't drink alcohol. The best advocates of drug use are drug users. They're quite passionate about it. Where I come from, they make fun of you if you don't drink and sing a song about how you're "too weak to drink." Every occasion calls for a drink: childbirth, Friday, getting married, getting divorced. It is so common that you're the weird one for not drinking.
It doesn't look like an advice but a simple, neutral observation of the pluses. Of course there are also minuses but this quote doesn't seem it rejects those.
While slinging a cat has always been a disturbing analogy to me, in this case I think it’s appropriate; you can’t sling a cat without it hitting a popular rockstar that did heroin or similar at small or varying doses, was convinced they had it under control, and their careers slowly and then quickly tanked. I also have friends and acquaintances whose lives were ruined by it or they died early because of it.
I’m glad this made it front page news given that the northwest coast of US now gets hard drugs, so maybe one of them will think twice about being a full-on grade A dumbass.
Also remember: with legality especially in a rich entrepreneurial country comes business which lobbies, funds studies, etc. Pot strived for many years for legitimacy, and once they got it, it exploded all over the US.
Since you called it out specifically I figure you might be interested to know the idiom is actually "swing a cat. Definitely a disturbing mental image, I agree.
I agree. I consider the ability caring for children to be integral to life. I consider things that interfere with that (getting drunk, high, unresponsive for periods of time) bad.
If you don't have or want kids, you're missing what made you and was given to you.
We need a more nuanced discussion of “drugs”. The word drug is about as useful as “chemical”. The biggest evidence that we’ve been lied to and manipulated by the media and the government is that “drug use” is even a term.
Addiction, as the article says is more complicated than any drug and is factor of a person’s life situation in general. Look at the work of Gabor Mate for a better understanding of addiction.
How is that you can totally talk about social media/sugar/porn/whatever addiction but when there are drugs there is always someone screaming "OH MY GOD LOOK THIS GUY IS TALKING BAD THINGS CALL THE COPS!"?
Coffee, chocolate, and sugar are drugs. If a drug is a substance that affects how your mind functions, then water is a drug too. There is no definition of "drug" that cleanly separates the (currently) illegal substances from those that are legal.
The world is full of chemicals that affect us, some more than others. People self-medicate all the time (alcohol, coffee, chocolate, sugar); I see no problem with (after learning and carefully experimenting) broadening one's set of "self-medication" tools.
All the luck to him. I have seen enough of heroin use second hand to know that this is how it starts and is rationalized for many. Some people spiral immediately, others after a few years, others after a decade. Eventually, if you keep using, it will catch up to you and you risk losing everything.
Even this comment section alone demonstrates that this is a very loaded topic and that's one of the main reasons purely logical argumentation won't help drive the discussion far. If someone has a person close to them that's had (or has) issues with drug abuse, it won't be easy to have a neutral discussion on the matter. What I find contrasting though, is that this doesn't seem to be the case with alcohol abuse. This probably stems from a number of reasons, normalization of alcohol being one of the largest, but I would also argue that lack of education is probably one of the highest contributing factors. Without delving into the subject of whether regular heroin use is or isn't healthy, as I simply don't know enough about the matter, I think it's good to educate people on the topic. Educated people make better choices, regardless of what they choose to do in the end.
This is interesting personal testimony. For anyone curious about a more scientific view of this issue I would recommend the book High Price by Dr. Carl Hart. While it is common for people to believe strongly that drugs are bad and addictive, actual scientific observation of drug users finds in many cases there is little evidence of harm and instead of forming an enduring habit they follow a progression which is more like a hobby.
There are plenty of comparisons that might be made, but driving seems an apt comparison. Driving is extremely dangerous, magnifies even small mistakes, and kills or maims very large numbers of people on a regular basis. And yet even with similar evidence of harm and habit formation people do not treat driving with the same fear but instead face driving with irrational positivity and optimism.
Scientists using rigorous observations and mathematical analysis do not see drug use and driving as having risk profiles that are completely different.
I'm assuming that's the same Dr. Carl Hart from this interview?
Driving was my go-to analogy too (I've got a longer post where I go into it) Surely there's the concept of legal drugs though too? You're allowed to have wine, but not drive at 120 miles per hour past school gates.
My feeling is that there's a difference between "safe" and "worth the risk". And as far as lawmakers are concerned, for most drugs there's not case where it's worth the risks.
This guy's whole viewpoint seems to be pinned on "it's not addiction if it's not negatively affecting the rest of your life" (yes, I know this is a major criteria for a lot of medical diagnosis, addiction included).
The problem is that what it takes "negatively affect the rest of your life" depends a lot on what role you have in society.
Short of pornography producer, fantasy fiction author, songwriter and other professions where copious drug use fit one's "brand image" or potentially enhance one's work, a tenured college professor gets about about as much leeway from the rest of society as a white collar professional can get. He can be "eccentric" and nobody blinks twice. But for other professions the standards of behavior are different (and generally get more permissive as you go down the economic ladder).
Defining the difference between acceptable use and addiction, and by proxy who's problems are bad enough to be considered problems and therefore in need of solving in a way that is relative to one's place in society is very dangerous. If you're blind in one eye you're still blind in one eye even if it doesn't negatively affect you. Addiction (and a multitude of other conditions) are the same.
A better way to say that is that if the tenured professor accidentally takes 5mg more, or has an off day, he doesn't kill somebody while driving a truck, or someone who programs a circuit wrong and causes a dump of chemical into a water supply.
> This guy's whole viewpoint seems to be pinned on "it's not addiction if it's not negatively affecting the rest of your life" (yes, I know this is a major criteria for a lot of medical diagnosis, addiction included).
That's what distinguishes dependency from addiction.
I think he's glossing over the fact that some drugs can be addictive, which is a thing on its own, aside from promoting happiness.
> Despite the current false narrative, the addiction rate among people prescribed opioids for pain in the United States, for example, ranges from less than 1 percent to 8 percent.
What's the threshold where it's a problem? 1% of prescription drug users getting addicted sounds like a terrible situation to me. Let alone 8%. Especially if they're already in a situation where finding a way to escape is tempting.
If heroin were cheap and accessible to addicts, there would be no need to escape until the user were ready. It's so bizarre how laws against heroin get to be the Gallant against the Goofus of anti-pot laws when virtually all societal problems springing from heroin spring from the drug war.
There would be few to no deaths, suffering, or crime associated with heroin if it were cheap and accessible, and if addicts were under the care of a doctor or social worker. It would be a mild burden to public health services tasked with helping people quit, but far cheaper than tobacco smoking or alcoholism.
Heroin is already relatively cheap and accessible to addicts. The bigger issue right now is the latter part, helping people get off the drug and contamination, ex. fentanyl. I agree with everything else though.
It's cheap, accessible, and totally fucking unpredictable. You never know what dosage you're going to get, and, as you mentioned, whether it's laced with something else much stronger.
I think legalizing it to the point where an addict had access to predictable dosage would save countless lives.
Whilst I'm sure there are many functional `users` of heroin, there are many more who think they are functional and yet they are not and just don't see it themselves. I've lived near many heroin `users` and I will say that the biggest issue is that if they can lie about their habits to themselves, then others are a given. Equally, whilst they may not see their usage of as a problem, they neglect to see the impact upon others - be that antisocial noise, keeping odd hours so again, noise or shady dealer meetings in the streets that scare the parents across the road to not allow their kids to play out in the park near there. That's just the good part of the spectrum. Then you have those who buy on-line and feel like their not supporting criminal activities, well until heroin comes with a fair trade logo, or you know the farmer, producer and workers personally - it's easy to say you don't have a problem and yet create problems for others when you look at the bigger picture.
As for knowing any functional, well I've seen many have functional phases would be the best I could attest to that from experience and out of about 30 heroin addicts I've endured in the past 2 decades, I'd say only 2 would be close to being classed as functional.
Really gets down to if somebody who is using drugs can just stop and take a break every now and then, then in that clean period - still hold the same mentalities towards their usage and if they can come to the same conclusion - bravo as that is what I would call somebody with their head working well for them.
What really is the issue for many drug users is the point in which the drugs use them - that's the turning point of addiction I'd say.
Yet all that said, you can't help but accept that the brain is driven by chemical stimulus and there lays the hard barrier of having the will power to quite.
I've personally never done heroin, no desire too as like a fine wine, I might like it and it is easier to miss what you never had and one step I've become very mindful never to take having learned from others, many who's lifestyle choices I had thrust upon me and I will say, not best neibours to have from my numerous experiences.
not really a hot take, this is more or less the mainstream opinion. it's also unfalsifiable. you can take anyone who chimes in to say they use heroin responsibly as more evidence for your claim.
personally I lean more in the direction that heroin and friends are significantly more addictive than most other drugs. but I have to say, if there were a sizable group of recreational users, they would probably know better than to ever say anything about it in public.
> personally I lean more in the direction that heroin and friends are significantly more addictive than most other drugs. but I have to say, if there were a sizeable group of recreational users, they would probably know better than to ever say anything about it in public.
Without a doubt, how else do they get introduced/exposed to such temptations otherwise.
Pattern that usually follows is, cocaine, then onto doing crack as suddenly in their mind it's cheaper better high or other mental juggling to avoid having a break and carry on chasing that next level of high, building tolerance all the time. Then the comedowns, well whilst the highs may not seem as good and cost more to reach that level the downsides are less easier to adjust tolerance wise. So you find that chasing a line of heroin solves all that nasty crack come down and once in a while, you won't get hooked, after all you are able to do all that crack and your mentally strong and other decisions made whilst completely out of it on crack cocaine. So you make that leap, the odd bit becomes more and year on and your addicted. Coz prices and that, not long before your after that next level, so injecting for many becomes a hurdle that gets lower and more appealing and justified in crossing. You will just do it the once, case of only way to solve your needs as not enough to chase and sort the cramps. I've seen all this play out many times, heck even audio surveillance from chasing to shooting up to introducing new recruits into junkie club, via crack and then heroin. After all, opportunity to sort somebody out and charge them extra for sorting it, kickback from dealer and chance to share a hit - addiction makes people greedy and that greed plays out in doing what's best for them, if others freely bit that apple, they will certainly not stop them that hard. After all, how they themselves started doing drugs. Seen it play out just too many times and from start to coffin too many times and shocking how much goes on, ignored as society as a whole class the addicts as the victims and the dealers as the baddies in a clear cut way when I can attest that the lines are very blurred indeed.
> Hiya kids. Here is an important message from your Uncle Bill. Don't buy drugs. Become a pop star, and they give you them for free.
... except in this case the message is don't do drugs kids, but "grown ups" should (as defined as a state of maturity where you know how the drugs behave, know your limits and can balance your experimentation with fulfilling your societal obligations)
I see this as a bit like speeding. The government sets fairly arbitrary speed limits for different types of road. They do it based on what they think the majority of people can cope with, versus the likelihood of risks, vs the need to get from A to B in a reasonable amount of time. The government hasn't been amazingly scientific about the speed limits, and don't take into account time of day, traffic, weather conditions etc. A healthy, fully-alert person can probably go at 150% of the speed limit on an ambient clear day on an empty road - and do so perfectly safely. But that isn't the message they give people, because it would be impossible to assess person-by-person, minute-by-minute.
And yet, some would consider the above information to be recklessly given, because some people will on read "go at 150% of the speed limit... perfectly safely" and take that as my advice.
So the question is, should it be legal to travel at any speed, provided you feel like you're doing a good job of it? In both cases, misjudgement can be disastrous for yourself and the people around you (and innocent bystanders too)
And when you are talking about something that can alter your perceptions, you would surely need a non-drug-taking associate with you at all times who could give you an honest blow-by-blow assessment of where you are dropping the ball as a "normal" human being, and where your drug-fuelled failings are happening?
When the potential downsides so vastly outweigh the benefits, I can understand why laws take the side they do. That said, I absolutely do think that there are massive downsides to making drugs illegal when taken responsibly. Countries should be realistic about what they can and can't do. If they can't eradicate drug use - and most countries can't - they need to put effort into safeguarding above incarceration.
But I think that's the consensus anyway on most social issues. And it seems to be a lesson that governments globally are very slow to learn.
Because one person thinks he has it under control at this time, I don't see how advocating for wider acceptance of drug classes that have killed and destroyed the lives of millions every year is even a story that deserves a platform.
It is interesting to me how ready we sometimes are to dismiss others' self-reports. This is akin to doctors in early 1900's (and even now) simply ignoring women's self reports of pain.
When a person reports something about their own life and internal state, you need to have overwhelming evidence before you can dismiss what they are saying. On what grounds do you dismiss the author's claims about their life? He clearly has his life well-enough-together to get an essay published in a reputable science magazine.
I'm not dismissing his account, so you should read my comment closer.
I don't think I would use getting published as evidence that somebody "has their life together". Again, I don't care if he does have his life together. It may entirely fake, it can be temporary, and it can be one account.
Look, I'm wholly for the idea of not shaming people who use drugs. I am also wholly against treating drugs which have established track records of destroying lives as recreational or not a problem when used regularly, especially to avoid personal problems. So I'm strongly against publishing essays which tell a soft story to play down the millions of other stories, which this absolutely does.
Why doesn't he talk about how this impairs his motor or thinking? Is he somehow magic, isn't the entire point to alter his conciousness? No, it's all positive about drugs. Ridiculous. Why doesn't he point to the side effects? Using alcohol as an example of how "harmless" drugs are is obscene. Alcohol destroys millions of lives every year as well.
If he wants to sell tolerance of people's choices in the name of the freedom to ruin your own life, then so be it. Don't soft peddle me bullshit.
Could we have a story about all the men and women who had their entire lives destroyed by drugs as a counter example?
We do hear (literally) hundreds of stories about how drugs destroy lives. Growing up in the US, there would be nearly a yearly assembly where we were told about (exaggerated) dangers of drugs. One story was "a mother put her child in the oven" and other horrors.
Hearing an opposing point of view is a breath of fresh air for people who are fed up with the one sidedness and hysteria.
Stories distort reality. They oversimplify and hide details.
Think about a parallel: pizza. People in the US are notoriously (unhealthily) overweight. Should we be hysterical about someone who says "I can eat pizza without going overboard"?
Ugh. Come on. Be part of the solution, not the problem. We should be promoting safe use and harm reduction education, not these bullshit blanket statements such as 'do not mess with opioids'/'say no to drugs', and stop using them quick.
Otherwise the people who inevitably will/do use, only hear and have only heard, 'don't do it to start' or get ostracized instead of getting the help they need or the education they need to know when they are overdoing it or not in control any more.
We also need more clinics and support for safely quitting or managing drugs and tools for it similar to what we have for tobacco.
Shamefully, here in Canada, some of these clinics in Vancouver are getting shut down, rather than more of them popping up, during the worst opioid crisis this country has ever seen.
These closures are a direct result of a 'don't ever do/touch drugs' policy and the stigma and ostracization that come with it.
Speaking from experience...education is better than 'don't'. I have had friends who have died from using drugs, and I have many, many friends who are regular users but not abusers - pull an insane variety of different full-time jobs. (And well!)
The huge difference between these two groups of people for me is education (for instance, preexisting mental health conditions that would be made worse by a particular substance and the knowledge to avoid it), and having a support system, etc..
It is fascinating and inspiring that someone has chosen to put themselves in the very vulnerable position of coming out about their personal use, and I believe the intention is to help remove the stigma around drug use, so education can be bettered. :)
Edit: Maybe better to say 'Drugs can be extremely harmful and addictive. If you choose to use them, please be sure you are educated, safe, and have someone nearby.'
In fact, that doesn't seem dissimilar to the surgeon general warnings on cigarette packs, anyway.
What kind of warning labels will we see on cocaine, heroin, etc - in countries where its sale will inevitably be legalized? These are the kinds of statements we should be making rather than 'just stay away from opioids.'
> We should be promoting safe use and harm reduction education
for existing users. We should not tempt people who would have otherwise never used them with false fantasies that they will be able to dabble and remain in control without getting addicted
This is dose-dependent. You're comparing alcohol abuse to heroine use. That's not a fair comparison.
You should also examine the proportion of heroin "users" who become abusers. You should then do the same comparison for alcohol use.
I'm willing to entertain the notion that the risks of heroin are overblown. I'm even willing to believe it. What seems entirely unsupported by evidence is the notion that alcohol and heroin are in remotely the same league.
Look at the data on those who have chronic pain: they are prescribed opiates at high dosages daily (equivalent to extreme abuse), and doctors think this is acceptable. Heroin is essentially just an opiate. They do not show effects as bad as life-long alcohol users, nor obviously abusers. A lot of socially acceptable alcohol use would be called abuse if society was fair about it.
>they are prescribed opiates at high dosages daily (equivalent to extreme abuse), and doctors think this is acceptable
That's an orthogonal concern. That being said, I don't understand your reasoning.
Firstly, this is opioid abuse. Granted, the responsibility for this abuse falls on the prescriber rather than the user, but it is nevertheless a pathological pattern of use.
Secondly, you've substituted "heroin" for "pharmaceutical-grade opiates" in your argument. The irony is that this supports my position more than yours because it demonstrates that the slope is particularly slippery, even with medical-grade opioids. This point bears repeating: the addictive and toxicological potential of opioid medicine is greater than alcohol. The trend is even less in your favor when we return to the topic at hand: heroin.
I share your concern about opioid-based medication, but this argues against your point.
You didnt say anything at all in this comment about physical consequences, so I am lost in the discussion.
Doctors are rationally ok with such prescriptions because the effects are not as bad as alcohol.
Simply put: opiate abusers and users don't need liver transplants or get such severe brain damage; alcohol is more damaging in a myriad of ways for both uses and abusers. There is plenty of data supporting this, and it is valid to use data regarding medical grade opiates.
The risks of heroin are almost entirely side-effects of the war on drugs rather than the drug itself.
It's not nearly as addictive. It's not nearly as deadly. It's much easier to control dosage. It has modes of consumption that are non-pathological.
This is typical of the distorted anglo-saxon view of alcohol as a tool for getting flat-out drunk. This is not how most of the world relates to alcohol, nor is it a healthy relationship with it.
Honestly, this says more about you than about booze.
Strangely I know more ex-heroin addicts than ex-alcoholics, and there are way more alcoholics out there, but that's just anecdotal data I guess :)
> It's not nearly as deadly.
Maybe if you leave out all of the DUI and accidents where alcohol played a role, you'd be right, but overall alcohol causes way more damage than heroin. While David Nutt ranked heroin as more addictive than alcohol, overall he found alcohol more harmful.[0] Precisely because even though it doesn't harm one as much as heroin, it's way more likely that you harm others with alcohol.
> It's much easier to control dosage.
Actually no. Lots of things affect gastrointestinal absorption of alcohol. Just compare a few shots on empty stomach vs after a meal. Also don't get me started with the absurdly long and not always obvious list of drug interactions that alcohol has.
Heroin, assuming known purity, will work roughly the same, either snorted, smoked or injected. If you make a point about its purity, that's a consequence of its legal status. Most, if not all of the interactions are self-evident (other CNS depressants).
> It has modes of consumption that are non-pathological.
I guess you have preconceptions about what heroin use implies. How is unwinding after work a pathological use of heroin vs whiskey?
> Honestly, this says more about you than about booze.
>Strangely I know more ex-heroin addicts than ex-alcoholics, and there are way more alcoholics out there, but that's just anecdotal data I guess :)
Indeed it is! You conveniently ignore all alcohol consumers except the ones with dependency problems.
>Actually no.
Actually, yes! You're arguing that there is variance in absorbtion, and you are right. That is different, however, from e.g. the LD50 or the ability of people to measure dosage accurately.
>I guess you have preconceptions about what heroin use implies.
You're conveniently ignoring that non-pathological use of heroin is extremely small. It's a rounding error when compared to alcohol usage. You are cherry-picking.
> Strangely I know more ex-heroin addicts than ex-alcoholics, and there are way more alcoholics out there, but that's just anecdotal data I guess :)
Good thing this has been formally studied
>Maybe if you leave out all of the DUI and accidents where alcohol played a role, you'd be right [...]
Yes, and people with pools in their back-yards experience more drowning. Color me surprised.
You're also leaving out all the incidental damage from heroin use in your analysis. Shall we factor in drug-related murders? How about secondary complications like pneumonia?
Again, cherry-picking.
>Ah, ad hominem to finish, a classic.
An observation, actually. I've rarely seen this level of bad-faith argumentation.
> Indeed it is! You conveniently ignore all alcohol consumers except the ones with dependency problems.
Actually a significant part of alcohol users have dependency problems, roughly 10% as someone already mentioned.
> Actually, yes! You're arguing that there is variance in absorbtion, and you are right. That is different, however, from e.g. the LD50 or the ability of people to measure dosage accurately.
So... no? Unless you ignore all that I said, that is. Active to LD50 ratio for alcohol it's 0.1, for heroin it's 0.17, in the same ballpark. When you factor in the variability of oral administration, alcohol is way more dangerous. Most overdoses in heroin are due to fentanyl or changes in purity; in case of alcohol it's due to wanting to get drunk fast, and doing it too fast (plus interactions).
> You're also leaving out all the incidental damage from heroin use in your analysis.
There is a lot of it, it's just that alcohol is bigger. People on heroin don't usually go driving or picking up fights, they're usually just lying on the couch.
> Shall we factor in drug-related murders?
I wouldn't factor anything external to the use/abuse of the substance, like its legal status. It'd be interesting to compare them with roughly 25% of vehicle deaths that can be attributed to alcohol.
> How about secondary complications like pneumonia?
Which was already accounted for in Nutt's analysis.
> An observation, actually. I've rarely seen this level of bad-faith argumentation.
I could say the same, it feels like you have a horse in this race, pun intended.
This is legitimately dangerous reporting. Heroin is ranked in the top 3 of addictive chemicals and all this article reports about is this anecdotal nonsense. I've too many friends to Heroin to know the reality of the drug.
I think you're missing the point of the article a bit. Everyone knows Heroin is dangerous and it's iterated on in the article as well. Only responsible and healthy individuals should self-use drugs, generally speaking.
Then you can also argue that you might not have lost your friends only because of Heroin the substance, but also how people with heroin addiction is "treated" and frowned upon in society.
I think what the article is trying to say is that harm reduction is a much more human and possibly effective approach to fighting real addition. Compared to other ways, which some of them include "there is no such thing as responsible drug use, it's all addiction" and treating people as such.
That coupled with the fact of how heroin is treated in society makes it worse. On top of that, add that not everyone that uses it is healthy and responsible, makes it even worse providing some bad validation. And then, not everyone is capable of making the distinction between fun or addiction early on when an addiction is starting.
The article is an interview with a Heroin user. It's as dangerous as an interview with a sex-worker. The interviewer even seems to bring up some interesting counter-points to the interviewee.
In the end, the interview is just providing a voice for the person getting interviewed. Are you saying that interviewing people who might do harm to world is dangerous?
Well, after all, interviewing a sex worker is dangerous too. People might have a bunch of sex and catch some nasty diseases.
I think that's the logic, anyway. It's ironic that most people here are in the camp of "decriminalize drugs! Oh wait, no, not these drugs, just some drugs."
Fair point. But, if something isn't criminal, then it should be fine to read about people doing that thing –– which is all that this article is. Railing against it like it's somehow an affront to post it seems neither productive nor fair.
Portugal has a much more comprehensive set of programs to get people off hard drugs than any of the US jurisdictions that have decriminalized (or stopped enforcing through executive action) hard drugs.
I'm not sure we can take the results of a single experiment in an incredibly homogenous tiny country in Europe to mean an outcome is replicable across the world.
Indeed. The "experiment" in Portugal is not proving it works everywhere, but shows it can work, which indicates we should study it further and possibly deploy it in more countries across the world, to see if it works elsewhere and if we could possibly make it even more effective.
While Portugal is probably the most famous example of decriminalizing working in humans favor, it's not the only example, it has been employed in other states too. Netherlands has de-facto decriminalized all drugs (in practice, not in law), Czech Republic has decriminalized all (most?) drugs as well.
We can, however, easily take the opposite conclusion: drug criminalization has been an unmitigated disaster in almost every country it’s been tried short of a few incredibly homogenous countries like Japan and countries for which no real data is available like North Korea.
It's a disaster in Japan and North Korea too, albeit in different ways. In North Korea the state manufactures some very nasty narcotics and distributes them as a way to gain foreign currency with the "nice" side effect of destabilising those places they export to. Japan has a plainly crazy attitute to cannabis, with people losing their careers and being socially ostracised over the most passing association with the drug.
> That coupled with the fact of how heroin is treated in society makes it worse.
So this is sort of a problem with treating the thing "Heroin" as bad, versus treating the Heroin Addict as bad. Society makes it worse, mainly, by tossing addicts in jail and I'm generally against drug laws as they stand[0]. But making "everything legal" doesn't reduce the impact of the law on drug users as much as you'd expect. At least, anecdotally, every addict that I've known personally has had run-ins with law enforcement because of their drug use but having nothing to do with the drugs, themselves. In one case, a friend ended up with an "impeding traffic" charge when he fell asleep in the left-turn lane at an intersection.
The story, as it was told to me, was that he chased a few Vicodin with a single beer, which resulted in him registering a 0.03, but he fell asleep in an intersection with his foot on the brake pedal. Despite this, he passed the field sobriety test, but the officer judged him to be intoxicated, and he was arrested. Apparently he was supposed to get a blood test; he was taken in early on Saturday and held until Monday, but they didn't do the test until he was "on his way out". It turned up nothing and he got out with a lawyer bill.
[0] I'm convinced that things are so bad/ineffective right now, that I'm pretty close to support of all-out decriminalization (of possession), simply because it reduces the impact of addiction on the addicted.
They all work by increasing dopamine. But 'Addictive potential' does vary by drug, and by the person [1].
'All substances of abuse self-administered by humans that can result in addiction are believed to exert their reinforcing effects by increasing DA in the nucleus accumbens (NAc)'
Who decides that someone is a responsible and healthy adult? Do we have any data on how many responsible and healthy adults try heroin?
Anecdata and broad brush strokes of course - In my experience anyway, the actually responsible and heathy adults I know haven’t felt the need to use heroin. The people who somehow are able to delude themselves into thinking they are responsible and healthy while obviously in crippling mental and/or physical pain, have - and it’s been devastating to them.
I’ve had prescription opioids before (hydrocodone, codeine, morphine) during medical emergencies. The feeling of peace and calm is amazing - which is exactly why it attracts people in pain and suffering, destructively so in many cases. It is difficult to know if that feeling is going to be magnetic or repulsive to you until you try it. It happens to be repulsive in my case (I know it’s a trap), thankfully.
It’s a complicated story of course, and bad outcomes tend to get the press. Better treatment (including in many cases mental health treatment) is definitely needed.
It is not the only substance like this - alcohol, tobacco, amphetamines, and others have track records of similar problems.
Pretending that anyone and everyone could self evaluate and go for it without a decent percent of them having major problems for them and those around them is unfortunately just not a good idea.
> Who decides that someone is a responsible and healthy adult?
You do. It's not up to someone to decide, you're responsible for your own body and your own decisions to improve/harm it.
I don't think they are saying advising governments to setup some sort of screening process for this. It's more for the people who are interested in the drugs themselves. When I first started getting interested in drugs, many pushed the idea that I should be psychologically healthy first (mostly because my first interest was psychedelics and I have good and well-meaning friends). I think that's what the article is trying to signal here.
The problem with that attitude is when the body count gets high enough, there is incredible pressure to 'do something' - because enough people are terrible at judging this (or don't have the right friend group, or whatever) that we end up with huge crime problems, destroyed lives, and other social ills.
The libertarian 'you can do what you want and it's your own responsibility' is great until the people who obviously made the wrong decision stop quietly owning the results of their decisions and start murdering random people for money to fund their habit.
An argument can be made that the answer is free heroin and mental health treatment of course, and maybe it is the right answer. It seems hard for societies to accept however, outside of some very niche locations (Netherlands) though.
Oxycodone is legal [albeit controlled]. There are plenty of pill doctors that will prescribe oxycodone to anyone that doesn't look like too big of a mess. A cousin of mine stole oxycodone from my grandmother when she couldn't afford the ever increasing costs of her spiraling out of control oxycodone habit. People have murdered and gone bankrupt acquiring oxycodone, and continue to do so. [https://www.pharmacytimes.com/news/pharmacist-killed-after-r...]
If you're saying 'I meant it should be legal to buy over the counter for cheap and/or given away for free', then that might decrease the number of people being robbed for it - but doesn't seem to decrease the number of overdose deaths, area crime rate, or urban decay by as huge an amount (or maybe it just concentrates it?), at least based on the experiment in Vancouver, BC, Canada's lower east side. The Netherlands is also problematic, and not a solved problem. [https://www.areavibes.com/vancouver-bc/downtown+eastside/cri..., and overdose deaths have continued to skyrocket in Vancouver [http://www.vch.ca/Documents/CMHO-report.pdf] despite harm reduction, decriminalization, and other means.
Areas like San Francisco with de-facto decriminalization also have major problems with people, for lack of a better word, rotting of neglect on the street - something that I've also seen first hand in Vancouver. I also have friends who have seen this first hand in Seattle. Resident complaints around muggings, being assaulted unpredictably by unstable mentally ill people (on drugs or not is hard to say, but there is a high correlation with this and these areas in my personal experience) are hard to ignore.
This isn't a solved problem, and I'm not advocating for 'lock them up' policies - but pretending this will all be cool if everyone can walk down to the corner store and buy heroin if they think they're up for it isn't helping anyone either.
Oxycodone was the #1 recent example of patients and even doctors being lied to about the addictivene potential of the drug. For well over a decade, pharmaceutical marketers (from Purdue Pharma especially) straight up falsely claimed that habitual use of Oxycontin would not lead to opioid dependency.
Which is a very near mirror to Heroin, which was created as a less addictive/problematic alternative to Opium.
Also, correct me if I’m wrong, but that doesn’t seem to address my core point?
Legality can reduce some negative effects, but it isn’t a cure-all. There are also a lot of people that should just not use opiates or bad things will happen, and we can’t predict who those people will be reliably until it is too late.
So please don’t use opiates unless you really really need to, and be aware of the dangers.
It’s easy to predict who will have problems with opiates, very few go from 0 to 100 without skipping steps. Just license the users.
Commit any infraction, drive or work heavy machinery while under the influence, your license is suspended until you complete rehab. Do it too many times and it’s suspended permanently. Use while unlicensed, it’s jail time.
This way there is a progression. We don’t have to waste police resources on those who can handle it. The minority who can’t are directed into rehab to deal with their issues first, and only the minority of that group who fail to shake up get jail time.
Meanwhile crime is down because drugs are affordable. New addicts are down because kids aren’t getting laced drugs. Deaths and overdoses are down for same reason.
And it all costs society less, less police, less crime, less hospitalization and less death means less taxes.
People rob and murder people for all sorts of reasons. But drug addicts have to commit fewer crimes if their drugs are cheap and easy to get.
And legal drugs have known potencies, and aren’t mixed with other more addictive drugs.
Don’t compare decriminalization to legalization, they are entire different things. Decriminalization still suffers from higher addiction and death rates because selling the drugs is still illegal.
Interestingly enough - all crime (including in the US with it's war on drugs) has dropped dramatically since the 80's. Lots of theories about leaded gasoline phase-outs, etc. but it's a complex multi-variate problem. Merely having the issues about use widely known (and the initial round of people super susceptible to it) can also cause many people to shy away, with significant decreases in abuse.
IID/BAIIDs that gets installed in vehicles are often installed to protect other peoples life, not your own.
I was thinking in the context of "Should I be able to use drugs", which we normally leave up to the individual to decide, except for _those_ drugs that we don't leave up to the individual to peruse on their own.
> IID/BAIIDs that gets installed in vehicles are often installed to protect other peoples life, not your own.
Yeah, but that's just an example. If you were about to make a suicide attempt, you could be involuntarily committed, and the only person's life being protected would be your own.
The point that I was trying to get at was that black and white individualist statements like:
>>> You do. It's not up to someone to decide, you're responsible for your own body and your own decisions to improve/harm it.
...paper over some important complexities of real life. There are many, many cases where people have responsibility for others (and I'm not just talking about legal responsibility, even though my examples all intersected with the law in some way).
Anybody who thinks this harm reduction strategy works should go visit cities that have employed it for years like Vancouver, Canada where there are legal shooting galleries everywhere, no arrests for personal amounts, and prescribed heroin that thousands of drug addicts have been on for 10 years now and the problem gets worse everyday. There used to just be a contained area of people passed out all over the street now it extends to the rest of the city. There is even a drug takers union that demanded treatment options be removed from drug taking clinics as 'it shamed drug users'.
So if you create an accomodating and encouraging area for taking heroin you will find it surges in population when heroin is freely available and detox discouraged. Everybody points to the European model but they must have done something different than just harm reduction, like proactive policing breaking up open air drug markets and shutting down slums teeming with addicts forcing them into detox.
Heroin is still illegal in Vancouver. Only a handful of addicts get free heroin.
And because it’s illegal most addicts have to pay high prices for heroin of unknown potency, and frequent laced with Fentanyl. That directly leads to overdoses and hundreds of deaths, along with street crime to fund expensive habits.
> The Vancouver motion however for the moment has no force in law.
A municipality doesn't have the authority to decriminalize drugs. They're just requesting the Federal government to act. It's not official, though it could eventually be.
Decriminalization isn’t legalization. Not only is it still a federal crime to buy and use, but it’s also illegal to sell. And illegal heroin is still cut with a variety of substances leading to more overdoses and deaths.
I live in Europe where drugs are legalized. Definetly it doesn't mean anti social behavior is "legalized" what often at least seems the case with Nort American progressive cities. People are treated as adults and are expected to act like ones.
What is the success rate of folks who use heroin with some effort to not be addicted ... and what is the cost of getting them out of the cycle of addition? and what is even the success rate of getting them out of that cycle?
The impact of failure to somehow prevent yourself from being addicted can be catastrophic ... even if you are successful in getting them out of the cycle of addition. And that impact can extend WAY beyond the individual.
I'm open to the possibility that some drugs really can't be used responsibly by enough people that they absolutely should not be legal.
> Only responsible and healthy individuals should self-use drugs, generally speaking.
This not a very helpful observation, as we all know that this is far from what happens and is not going to become the norm.
Furthermore, quite a lot of people became addicted to opiates through acting seemingly responsibly (at least initially taking the drugs under the supervision of a doctor whom they could reasonably assume was looking out for their best interests) and in the persuit of better health.
I should add that Hart himself punted on this issue when the interviewer touched on it. In the interview, he does this a lot - for example, when the interviewer raised the question of physical addiction, Hart merely discussed the physiological basis, without touching the obvious issues it raises for the concept of responsible use. It may be telling that, in his description of himself as a responsible user, he avoided saying anything about this particular issue.
> Then you can also argue that you might not have lost your friends only because of Heroin the substance, but also how people with heroin addiction is "treated" and frowned upon in society.
This is also rather beside the point, as, while the way addiction is treated is also a problem, it is not an issue except where there is already a problem with addiction.
That aside, there is such a thing as responsible addictive-drug use (including, but not necessarily limited to, people with chronic pain that only responds to such drugs) and the way we respond to addiction today is in many ways ineffective and in some ways very harmful. One cannot make a very good argument for reform, however, on the basis that some people can use some of these drugs responsibly.
Exactly. I always thought of myself as responsible and healthy (and I basically was). I never overused alcohol, never binge-drank etc. I absolutely had no understanding how people could not regulate drug use because I had no problem with it.
A few years ago I had a lot of stress and started drinking to help me sleep. After only a few months I felt kind of agitated without a nightcap. I immediately stopped and now I just don't drink when I'm stressed.
So maybe in one sense I was right about being responsible, but on the other hand it could have very easily become a habit and now I understand how people slowly slide into addiction. It's arrogant to assume anyone knows how they'll respond to a drug as habit forming as heroin.
> Only responsible and healthy individuals should self-use drugs, generally speaking.
The funny thing I've been reading the article and the tone of it reminded me of heroin addicts who was not hit by their addiction heavily yet. I mean, Carl Hart thinks he is a responsible user, that he have an ability to decide for himself. It doesn't seem so for me. It is hard to tell, having as a data only one interview with him. But... you know, I'm an addict also, a nicotine one. I know how it is. First ten years of my addiction I though that there is nothing wrong with that, it costs some money and gives an urge to smoke sometimes, but it brings some benefits too. A few years ago I stopped smoking, after a month of abstinence I saw no benefits in smoking at all. My abstinence lasted for a couple of years, now I'm smoking again. Seeing no benefits at all.
I know what I'm speaking about, I know the signs, I see the signs, and I see Carl Hart as a fellow addict, though with a different substance.
I drink alcohol sometimes, and I know that I'm not an addict. Even despite the fact that sometimes I want to drink. A wish to drink is a warning sign of course, but I see no other signs. Like a despair coming with the thought that now it is not the good time to drink for some reasons. I have no ideas about benefits of being drunk: it is a funny state of mind, but mostly annoying, I'm really stupid when drunk, I see my stupidity and can do nothing to it. An addiction is a special state of mind, I believe one (i.e. me) could feel it as distinct from other states. Though it takes some learning, one needs to become an addict and to stop using an addictive substance of his choice. If Carl Hart wanted to prove that he is not an addict, he should stop using heroin for a couple of years, and then try to state his freedom from an addiction with a straight face. While he is using heroin for just five years and didn't tried to stop, I'd never believe his words that he is not an addict. When it would be 10-15 years or 5 years of abstinence, I'll probably believe his word on it.
> The funny thing I've been reading the article and the tone of it reminded me of heroin addicts who was not hit by their addiction heavily yet.
Having known someone who was a responsible, highly educated adult with a fantastic career who died of a heroin overdose, this whole article sounded eerily familiar.
Do you know whether this person's overdose was due to an escalating addiction or due to mixing with other substances or impurities? That's the distinction the article is trying to make
> I drink alcohol sometimes, and I know that I'm not an addict.
> If Carl Hart wanted to prove that he is not an addict, he should stop using heroin for a couple of years, and then try to state his freedom from an addiction with a straight face.
So by that logic... we should only believe that you're not an alcohol addict after you stop using alcohol for a couple of years?
Why do I think it's a gotcha? Because there seems to be a double standard: ordu is allowed to innately know that they are not an alcohol addict, but the author of the article is not extended the same courtesy.
I don't know if ordu has thought of that, but they don't appear to have from their comment.
I find the idea that the only way to know if you're not an addict is to give up for a period of years to be very problematic. Most definitions of addict suggest they are unable to control their compulsion, but I couldn't see any indication of that from the article. If the author of the article can sustain occasional use while maintaining a high profile job (science professor), their use doesn't appear to be out of control.
> ordu is allowed to innately know that they are not an alcohol addict, but the author of the article is not extended the same courtesy.
Yeah, something like this. I'm not entirely sure that alcoholic addiction would be just like a nicotine one, but I believe it would be similar enough for me to detect it. If I'm right I might hope that my experience with nicotine could be generalized to alcohol.
Maybe unrelated to a discussion of "is a period of abstinence is revealing", but I rarely drink alcohol, and a year or two without a drop of alcohol is a normal to me.
> Most definitions of addict suggest they are unable to control their compulsion, but I couldn't see any indication of that from the article.
I see no indication that he is able to control it. He is like "I want to take heroin, so I'm taking it". It is a very popular stance for addicts. When I tried to control my nicotine addiction it mostly ended with "I do not want to control". Even now I do not want to control, though I now see the difference between "I do not want to control" and "I want to smoke". I do not want to smoke and do not want to control my addiction.
When plane uncontrollable falling to a ground due to a failure, a pilot could state that it is his intention, and therefore the fall is a controlled one. People often do something like this, but for an addict it is a symptom by itself.
Carl is a white collar professor. The worst thing that can happen if his drug indulgence becomes a problem is he knocks over the water cooler or loses his job.
I work a blue collar job servicing heavy diesel engines. Casual hard drug users are aggravatingly cavalier to work alongside. They forget important things constantly. They show up late and lose things often. You'll spend all day repeating things they'll never retain and at the end of the month they will lose a finger or toe or suffer a massive back injury and get fired. The back injury usually turns the casual heroin into constant endless heroin.
Drug tests exist in my field for a really valid reason and it has nothing to do with having a problem but becoming one.
The issues is "drug decriminalization" people treating addictions like it's not a real problem for many people.
Many of these folks want it to get to a point where you can quite easily buy heroin and suffer no legal consequences.
I'm not saying our drug laws are just or can't be reformed but the fact that heroin is illegal prevents a LOT of people from using it. How many people will then use, aided by these pronouncements that "Heroin isn't actually that addictive!" and ruin their lives?
We already have an opioid epidemic in this country that has destroyed communities.
There's a middle ground between our terrible war on drugs and the naive "make it all legal and experiment with heroin!"
> I'm not saying our drug laws are just or can't be reformed but the fact that heroin is illegal prevents a LOT of people from using it. How many people will then use, aided by these pronouncements that "Heroin isn't actually that addictive!" and ruin their lives?
Do you know a lot of people who have expressed to you that they would use heroin recreationally if only it were legal? My gut is that the number isn’t large.
My impression of the evidence from places that have tried decriminalization (eg Portugal) is that the number of people who use and then are able to get their lives back on the rails is higher than the extra people who use because it’s decriminalized.
You genuinely believe that there is no large group of people curious about trying a drug that supposedly offers the most euphoric feeling imaginable "better than sex" as many have claimed?
What if people tell them it's not addictive? And now it's not illegal?
Illegal drugs increase addiction rates because drugs are often cut with different drugs. How many heroin addicts were created by lacing lesser drugs with more addictive ones?
Tobacco is legal, and also illegal to tell people it's not addictive, at least in any sort of marketing sense.
Also, my understanding of most drug legalization is that the intent is to legalize usage/possession, not distribution. This is done with the intent to make it easier/safer to gain treatment and decrease addiction.
Decriminalized isn't the same thing as legalized. Legalized means that you will have multinational companies promoting heroin nonstop through massive advertising campaigns. That would completely change peoples' usage patterns. Like how many people would smoke if tobacco was legal? Answer: many.
That is not necessarily true. Alcohol and tobacco are legal and there are massive restrictions on how they are aloud to be advertised. The point being made here is that not many people would by more of it if they felt that purchasing it was not going to put them in legal trouble. For example, how many people do you know that do whippets?
The decriminalization folks recognize for the most part that addiction is real. The difference is that they want to use taxes on legal drug sales to fund rehab clinics and treatment programs. The people who want to maintain the status quo want to throw users in jail and forget about them. We already know for certain that throwing people in jail does not solve addiction. So why wouldn't we at least try the alternative?
The central point of the article is actually not “let’s decriminalize drugs”. It is “drug addiction is not brain disease”, which seems like a reasonable argument to me.
I don’t know if you read it, but it also talks about how many deaths are from bad education (not understanding drug interactions, i.e. between two depressants), and bad drugs (i.e. lacing heroin with fentanyl) with no easy way for users to test their drugs.
It further goes on to discuss that addiction treatment in the US is terrible precisely because it focuses on the drugs as a pathology and does not consider the holistic person or helping the person solve their underlying problems.
Progressive drug policy isn’t “legalize it all”, it is “prevent needless deaths and treat addiction properly”. It has been for some time. Here are garden variety articles I found about these policies being implemented in the wild:
> There's a middle ground between our terrible war on drugs and the naive "make it all legal and experiment with heroin!"
I wholeheartedly agree. a couple google searches showed buying alcohol for a minor was a $1000 fine, but heroin possession for personal use is $20000 and a year in jail.
I think there's room to scale back the penalties and still be a deterrent. I think there's room to scale up addiction recovery.
Hell, keep the horrible penalties, but waive them if the accused, with counseling and whatever other support makes sense, can stay clean for a year.
So much of the system is about papering over problems rather than fixing the root cause.
Dunno about you, but I have never bought drugs from a junkie, but, of course, through dealers, who - in my experience, more often than not - do not actually use many of the substances they sell.
I haven’t actually bought or even used any illegal drugs at all, my point was just that I don’t think a lot of people will be inspired by an article like this to try heroin, unless they were already considering it.
Most people that fall into heavy addiction are probably driven there more by chaotic circumstances than intellectual considerations.
Several years ago, I read about the significant nootropic effects of nicotine and spent time on forums that downplayed the potential negative impacts. I ended up trying it and became addicted for years.
Social contagion can have significant effects on social issues like this.
By that logic, we need to ban cooking shows - the habit reinforcing qualities of food are well known and obesity is a leading cause of health issues. It looks like you got off easy since your "drug" of choice nicotine has entirely negligible negative effects on an organism of the size of a human - it's a neurotoxin that in the quantities we use it for recreationally can't even harm insects (much like caffeine!).
> It looks like you got off easy since your "drug" of choice nicotine has entirely negligible negative effects on an organism of the size of a human
You are right. I ended up with easily maintained hypertension and the urge to smoke that probably will never go away.(While on it, I also had significantly worse anxiety, decreased sleep quality, and bubbly urine. I definitely don't recommend trying it)
But the social dynamics between it and heroin are the same. If we normalize its use and downplay its risks, more people will use it. And the physical and social harms from heroin use are far worse than nicotine.
I've experimented with nicotine (in the form of gum) myself, but haven't really observed much in the way of benefits. Did you see benefits? What form(s) were you using? How did you end up quitting?
(I was turned onto this after listening to an interview with Dr. Peter Attia [haven't yet made up my mind on whether he is a huckster])
I personally didn't experience benefits, just side effects. I started with vaping, then moved to smoking.
To quit, I switched to vaping for a few weeks, then tapered the nicotine concentration to zero over the course of a month or two. Cigarettes have MAOIs which make it more addictive which is why I switched.
I was irritable for weeks and still get the urge to smoke sometimes(it's been over 5 years since I quit). I don't recommend starting.
> Dr. Peter Attia [haven't yet made up my mind on whether he is a huckster])
I've listened to him off and on, and think he's ok. He tests on himself pretty relentlessly, and still sees patients (though it's a boutique practice). He also appears open to new ideas as new research presents itself. And while crazy people can come from anywhere, he also has all the proper credentials.
Finally, if you haven't already, you should find the podcast episode where he talks about Theranos. Pretty wild that he was asked to join and turned Holmes down.
I tried the gum and the patch for nootropic purposes. I even had to cut up the patch into smaller pieces to get the proper dosage. It was hard to get the dosage down enough, and I just mostly ended up feeling really twitchy. It didn't seem worth it and I didn't notice any real boost in the mental realm that a good nap wouldn't give me.
I vaped. I've also taken adderall and enjoyed it, so our neurochemistries are probably different.
That's something important to consider when reading about experiences on the internet. There are people who are relatively resistant to addiction. When they talk about their experiences, they make it sound like it's no big deal, and it's not to them. But that's not how it is for everyone.
Heh, same happened to me. I managed to get hooked on Nicotine gums after reading about the nootropic effects. After a while I moved on to snus (Swedish smokeless tobacco) due to expense/hassle of getting the gums.
Nowadays I have a pretty big nicotine consumption and probably extremely marginal nootropic effects.
At least you don’t need to worry about dementia, alzheimer’s and parkinson’s, as well as many other degenerative diseases. It’s pretty well documented that specifically Swedish snus prevents them effectively.
How many people are flat-earthers, anti-vaccine? Somebody will take this article, make it viral by picking out one sentence. Bam! Heroine and meth become legal.
You can't just lie to people and tell them that everything is deadly or they're gonna question everything else you've said. That's basically what DARE was.
I know a chainsaw is dangerous. But listening to every Youtuber lecture me about how I have lock out tag out to change a lightbulb my own home and every Redditor jump at the opportunity to engage in a monologue about how I should wear safety classes when I use a screwdriver sure lends a lot of legitimacy to the people who say their dad never wore PPE and retired with all his limbs so it must be fine.
Not defending drug use at work, but if you're to be fired it should be for the performance related issues you mentioned caused by the drug, not because of the drug itself.
Edit for more context:
Depending on the drug, substances consumed outside of working hours would still show up in a drug test. Firing someone for something they do outside of work shouldn't be acceptable.
If you can prove they consumed drugs that would impair their ability to perform their job during working hours, that'd be a valid cause for dismissal. Drug tests don't measure that precisely enough though.
Not to mention, drug tests are not infallible. They can come back positive for morphine if you eat a poppy seed bagel in the morning [1].
Sure, but op is talking about someone who uses controlled substances outside of work. If they’re not under the influence of a substance at work, then it’s not the same situation you are talking about.
Airline pilots, I believe, have a no-drink-within-X-hours rule. I'm not sure whether X is 12, 24, or more. So even one drink the night before a morning flight would be prohibited, even though logically a single drink with dinner the night before should be a non-issue.
The effects can last a lifetime but saying any narcotic will last for at least 72 hours doesn't take into consideration dose, weight, history isn't even closely true.
Did you know eating a poppyseed bagel will cause a positive for heroin for upto 60 hours afterwards while doing a small amount of heroin will not show up on that same test.
I can see where you are going with this, and I am aware of the problems with drug tests and largely agree they are over-applied. But I don't know of an alternative to these imprecise tests in many cases.
In many places there are safety issues to deal with. You have to be proactive to avoid an incident.
Here's a non-drug related one. In many places road construction companies will disallow workers from wearing headphones. This is because of the heavy machinery and you need to hear the beeps of a machine backing up. Drivers of those do not have good sight around the machinery and large trailers. Headphones on can mean not hearing a warning sound and being struck and possibly killed.
Are wearing headphones a problem? Do you want to fire someone until an accident happens?
Part of the proactive nature to this is insurance companies. If there aren't strict safety policies that are enforced than insurance companies won't cover companies. When accidents occur they have to pay out and want to avoid that.
Drug use has been proven to cause certain issues depending on the drug that can have safety impacts at work sights. This can costs lives and money.
This is why it becomes a big deal in certain fields.
In this case, the grounds for dismissal are for wearing headphones during working hours. Drug test results can be positive for things done outside of working hours.
Drugs still affect people during working hours even if used off-duty.
I had to mummify a guy's hand because it was sliced open by glass, once. They were airlifted to the hospital because the bleeding couldn't be controlled.
Another guy was doing something unsafe with his forklift, probably because he was in a hurry, right before Christmas, it rolled over on him and he died.
That's why we couldn't keep people who were careless for any reason around. People could, and did, die for a moment of carelessness.
I have a solution to prevent this, which doesn't prejudice Mike for having a bit of weed 2 weeks ago camping. Also it will filter out those unfit to work from legal medication, or tiredness.
Make workers do a 30 second ability test before going on shift. Design the test to measure reaction speed, short term memory, etc.
[follow up thought] - Test must be immune to practice/muscle memory. Don't want a drunk passing the test through familiarity, then performing shit on the job.
Serious question: Can we design a test for “getthereitis”? Most often, people would pass the test, but then misjudge and, in the case of Christmas, hurry up to “get there” (hence the name) and underestimate a risk. Ability is 10/10 but judgement is 2/10, and it is hard to verify that their mindset is calm.
Sounds difficult to test for. Thinking about a Pilot I think there would be data points you could measure on the job that predict likelihood of making a bad judgement. For example heart rate variability, cortisol levels, skin moisture.
I think the better solution is to abstract out the judgement into a formula that the pilot must follow, so not courting "gethereitis"
If you're comparing factories to pilots, be aware that factories have a much lower standard of execution for grand ideas.
At least pilots mostly actually do their paperwork and checklists, even if they sometimes fall prey to things like neglecting to land their helicopter when they end up in IFR conditions while, say, transporting Kobe to a game.
A) when getting hired
B) if you show up to work intoxicated
C) after any serious accident
So other than at hiring, which the person can anticipate the timing of, the drug tests are effectively only done after failing such a test to begin with. The average factory doesn't care about hiring people with a record, either, so long as it's not too serious or likely to impact work.
Your test is one of those things that sounds like a good idea until you realize that the people who are needed for some big customer's order are too tired, but still able to work and you don't have anyone to replace them. Rolling the dice on that kind of stuff enough times until a failure happens is what gets factory floors in trouble.
That poor guy just wanted to get home to see his family for Christmas and busted ass to get one more dumpster of trash dumped even if it meant messing with the dumpster while the forklift was on too much of an incline. I don't truly know what he was thinking, but we can make an educated guess that he'd probably done that kind of thing before and doing things the right way took more time and effort than his poor, tired body had left in him at that point.
You don't appear to be aware of all the bad incentives that aren't going anywhere and are advocating something that will cause more people in more factories to roll more dice that will have more injuries. and hoping that the same tired, overworked, short-handed people will make a fuss over these rules instead of rolling the dice as they have so many times before if you just try to warn them or give them tests which they could skip to save 5 minutes they could've been working and then go home that much earlier.
Most of the ways to fix these problems require more staff and/or resources, shorter and more stable shifts, etc. all of which costs more money. Then those labor costs make them less competitive with factories in places like China where they may be trying to compete with literal slave labor in a race to the bottom. The factories already do look at incidents, as well as close calls, but there's only so much you can do when your grand ideas are paired with awful execution thereof.
The best ideas come when you understand their job and help them do things in a better, safer and, ideally, easier way.
I think the point of the tests is like vaccination. It’s about reducing risk. And it errs on the side of caution. A test won’t catch every instance of drug use, but will catch a drug usage behavior pattern. You want people who are trustworthy to never do it because you can’t test everyone all the time. It’s more about personal responsibility.
A pre-shift only needs to fail once and you have a co-workers recklessness injuring another worker.
I wonder what unions think of drug tests? As a union member I might prefer that my coworkers were tested to be honest if I worked closely with them around heavy machinery.
Drugs, in many cases, outside of working hours can have effects during working hours.
Many software developers working for companies have agreements that they can't compete with their current employer on what they do while employed there. It's something employees give up while employed somewhere.
In the name of safety, many jobs with safety issues have to give up certain things (i.e. drugs) while employed there.
Stupid analogy, the worker can be told to remove the headphones during paid hours, non-compliance makes you fired.
We are talking about whether what you do outside of work, that is isolated from work, should get you fired.
First, I'm attempting to describe how the system works rather than give my opinion on how it should be.
Second, the headphones situation is meant to illustrate how safety plays in. This isn't a "what if" example. People on job sites wearing headphones have died because they missed the warning tones. I am aware of one case, personally.
Safety is a big deal. It plays into the insurance companies who drive much of the policies and practices. They are driving the things they do to keep their costs down. Insurance companies often try to be pretty methodical in what they do to keep costs down. It's not just random ideas but looking at cause/effect relationships.
Third, many drugs have effects outside of the time they are used. It's not just the impact of the drug while one is on it but how it affects them in the time they are not on it, as well. From a safety perspective that cannot be discounted.
From the standpoint of the companies and the people involved, if you want to do drugs than work elsewhere. Safety is a higher priority.
I agree Safety is the top priority. Don't risk people with drugs traces in their blood; it may degrade their competence. Also don't risk a guy that didn't sleep last night working - his competence will be degraded.
A lot of this is driven by insurance agencies and data from investigations of events. I don't have insight into that. Insurance companies, these days, tend to be very data driven.
It would be great if there was a way to test for competence. Some drugs cause long term issues with decision making and being able to see what's likely to happen. This reminds me of a job I had years ago framing houses. I remember some of the work men firing nails from a nail gun into a nearby woods. An area where neighborhood kids happen to play.
That's poor decision making and a liability. How do you test for complex things like that?
Hmm perhaps decree a method/routine to processes like nail gunning. A bit like the Japanese rail staff with their pointing routines.
Film the worksite or send surprise inspectors to catch workers too lazy/reckless about their nail gunning. Maybe show them videos of nail gun injuries!
Improper nailgunning I think is more related to ingrained attitude than ephemeral competence degraders (drugs)
Do you have the same attitude to other safety procedures? If an electrician routinely, consciously failed to check the mains had been turned off before working do you think he shouldn't be reprimanded until he electrocutes himself or someone else?
I know how to tell if mains is off — use a multimeter. Please provide a citation for the safety procedure for determining if my electrician has used drugs that might impact his judgement.
Not sure what you mean. I believe mine and op’s point is that you have no objective criteria for determining if someone is impaired. The criteria for determining someone didn’t follow safety procedures is well defined.
This is really going overboard personal freedom. It reminds me of arguments like Clinton's "what is, is". No, having heroin addicts at work is not OK even if they perform well because it's very clear that they will not perform well very soon and you don't need to wait for that as an employer.
I read TFA, and didn't see any such mention. I've gone back to it with the search tool, and still don't see any such thing. Would you mind pointing to where these numerous points are please?
> Hart reports that more than 70 percent of drug users—whether they use alcohol, cocaine, prescription medications, or heroin—do not meet the health criteria for drug addiction
> “My heroin use is as rational as my alcohol use,” Carl Hart writes
> Let’s just talk about alcohol first. When you’re at a wedding reception, alcohol serves as a social lubricant. People are more gregarious. They talk, they interact. The same is true with cocaine at parties, heroin among friends, or opium among friends, NDMA among lovers.
> It’s just like with alcohol. Most people drink alcohol on a regular basis, but they don’t become physically dependent
> I don’t know a term. I simply mean people who take drugs, like alcohol users, somebody who may have a glass of wine or two every night for dinner, whereas somebody else may only drink on the weekend. It’s a wide range. And the same can be true with cocaine or heroin
> Why do you use heroin?
> That’s like saying, “Why do you use alcohol?”
Just because it's used by a vast number of people. Getting rational, for every 100 alcohol and 100 heroin users who do you think is in better health shape?
>> Carl is a white collar professor. The worst thing that can happen if his drug indulgence becomes a problem is he knocks over the water cooler or loses his job.
No. The worst that can happen to him is that he is pulled over by a cop in the parking lot. Gets charged with possession of heroin. Goes to jail for a couple nights, then looses his job/pension/car/house/wife/kids (in whatever order) and winds up on the street. Regardless of the biological realities of heroin, the realworld criminal consequences of regular heroin possession can be worse.
And I have yet to meet any longterm drug user who hasn't on occasion sold some to a friend. Get caught "dealing" and you will face an entirely different legal regime.
I don't know if you've ever worked a blue collar job with a drug user, but what they were saying is that the Carl isn't going to lose a limb, kill himself, or worse, kill me on the job as a professor because he's on drugs. That can be a very different story working on a drilling rig for instance.
One dude left his 3 and 5 yo kids in his locked car for a full hot afternoon with no water while using in the heroin den in my appartment complex in San Francisco.
He was not a bad guy, just a totally confused person. When we told him what could have happened, he realized his mistake. We never saw him again.
Most "dealers" are actually charged with 'intent to distribute', a crime that doesn't require evidence of money changing hands. Giving drugs to your friends, even for free, will result in basically the same drug charges as if you were selling. The law is setup this was specifically to avoid the need to money evidence. The cops only need to see you hand over the drugs. They don't need to also see you receive any money. (Actually, you don't even need to hand over the drugs. Possess a large amount, or a smaller amount divided into little bags, and that will be enough for intent to distribute.)
Many street-level drug dealers will still separate the drug and money handovers between different people. This isn't to avoid legal issues. It is to avoid the money being seized when the cops move on the guy they see handing over bags of drugs.
But, the response here seems to be "this is too dangerous an idea to talk about, or consider" which seems really shitty.
It's been 45 years since it was first established that heroin CAN be used safely when accompanied by a social ritual. Part of the problem IS the mindset and stigma around addiction, and that "insanely addictive drugs" have full power over people, and there is no ability to moderate their use, which is false. People are either 100% sober or a social pariah. The response in these comments mostly confirms this sort of black or white thinking. Maybe somebody should ask if its the lack of social ritual / social controls causing the problem, not the drug. Maybe society is failing otherwise responsible drug use by making all users outcasts. Or is a spectrum and complex interaction of multiple issues, and not just drugs. "This is too dangerous of a conversation to have" puts us in danger of not having productive conversations.
Someone hooks your wife, or kid, or parents to junk and ruins their life. They're a protected class. All those police and soldiers protect them.
If addicts get to do that, why can't I do the same to them? Instead of heroin, I'm going to go after a genetic cancer cure, or see what applications of Bell's Theorem I can create on human cellular mitosis and quantum biology.
Feels like it’s too dangerous a conversation to have in the open.
I think the mistake siliconvalleyites have is that they imagine everyone as intelligent and rational as they think they themselves are which leads them to encourage open discussion.
But it’s clear throughout history that all people are stupid sheep on occasion and their thinking needs to be curated in a way.
Therapeutic use for diagnosed conditions - interesting.
Safety for recreational use - interesting.
As a recreational activity - seems like we have enough fun already without adding more risk.
I want to agree with what your saying but with a caveat.
Years ago I was an office manager at a battery supply warehouse (car batteries not AA’s). We had an employee that had started working for us for about 6 months when it became vary apparent that he had a drug problem. Because his brother also worked there we knew that he had suffered a major car accident, was in crippling debt from the medical bills, and developed a pain pill habit as a result. He was only 19 at the time.
The issues that involved the work place were things like being consistently late, taking 2-3 hour lunch breaks and coming back high. So high, that he could not perform basic job tasks like counting a pallet of battery cores. My biggest concern was that he was licensed to use our fork lifts and so I had our warehouse manager do his best to keep him off the forklifts.
At this point I recommended to my boss that we fire him for the repeated offenses, as well as recommend that he seek drug consoling. I felt bad for him. He had a problem. He needed help. But he did not need to be working at that job for his and others safety. My boss and my boss’ boss, on the other hand, decided it was best to send to him to a “random” drug test, so that when the fired him they could do so with indisputable cause. This did not work, he disappeared for many hours, despite the drug testing facility being just down the street, and the results came back clean. I know that people have many ways of faking drug tests. I suggested again that he be fired for the offenses and not the drug test. Again my bosses disagreed and sent him to two more “random” tests each week after that.
The employee in question got wise to this. He knew what they were trying to do. So he went to a therapist and got a declaration of temporary disability. My company then had to pay him his full wages for 6 months with out him needed to come to work.
And I sat back and laughed at my bosses, as the unemployment claim would have be nominal by comparison.
edit: not sure why this would be down-voted. It is just a real story, relevant to the thread. I was only suggested that waiting for test results when possible danger lurks was not the right course of action. i forgot to add the employee did come back after his psychological disability ran out. And of course they sent him to take a drug test again. He failed that one and was fired.
His whole point is you can use drugs and keep up all your normal daily responsibilities. He states this several times as the definition of “functioning”. If you show up to work on drugs you’re not functioning and that’s not what he’s advocating for.
>all this article reports about is this anecdotal nonsense. I've too many friends to Heroin to know the reality of the drug
The experiences of your friends is anecdotal. This article discusses the mechanisms of the drug, both the physical and personal cause of addiction, the common factors that lead to death, and the rate of users that end up addicted.
The dangers of the drug mostly come from its legal status and that it is being adulterated with various substances in the unregulated market. People also don't get a leaflet that they can consult on the strength or dosage so often they overdose.
Medical grade heroin is not as dangerous as people supporting prohibition would like it to be. You can take clean heroin for decades and be perfectly fine. This would rather not apply to alcohol or other legal drugs.
If you suffer from chronic pain, that's your only option if everything else fails. Opiates plus cannabis can make one's life bearable. Unfortunately many people would like them to suffer instead just to satisfy their own morals - for them someone else's suffering is a virtue.
I would say the main danger is the crippling physical addiction (as well as psychological, but that is harder to quantify) it causes in a substantial amount of users.
Yes, the downside is that you have to take it every so often, but after a while it becomes a second nature so you won't be even notice apart from occasional situations where "medication" is not possible.
Sorry, I call BS. First, ranked by whom? Besides internet listicles, I mean. Second, those rankings, valid or not, are always a mix of legal and illegal drugs, with legal ones like alcohol, nicotine, and benzodiazepines sitting above heroin, morphine, and opium. Not to mention caffeine, which we begin feeding to children at extremely young ages alongside the amphetamines we pump them full of if they have trouble paying attention when locked in a classroom all day.
Third, as someone else says below, stories about your friends are also anecdotes. (I'm sorry, genuinely, that they died.) You don't know "the reality" of heroin because there are a litany of such realities - and here's a scientist telling you about his. The thousands (more?) who use heroin like my aunt uses a snifter of brandy at Christmas don't appear on anyone's radar because they're not dying and they're not rocking the boat. I could go on and on about the lives lost or ruined by alcohol in my family tree alone, let alone just "people I know", but I'm not terrified and calling to ban alcohol.
Finally, that so many people on a web forum whose userbase is wealthier, whiter, and way more privileged than the population at large rushing breathlessly into a post to call a black man (from the ghetto of Miami FL, no less) who uses small amounts of opiates "dangerous" is, excuse me, pretty effing rich. I thought tech-libertarians were supposed to be less reactionary.
Obviously this is highly anecdotal, but for the 5 years that I lived in Spain, I was a regular drug user.
With the exception made of MDMA & speed (That I'll consume both on occasions) I was consuming weed, hash and mushrooms on a weekly basis.
And everybody on a certain group of friends was doing the same. We had a surplus of mushrooms, as we had somebody in our group (A neurobiologist) growing them.
13 years ago I came back to Argentina, and then stopped consuming cold turkey.
I am one. I have used a lot of stuff, anything I could get my hands on (not "just 'cause", I'm trying to find something to fix specific problems).
And in the end, it's only alcohol and nicotine that have me firmly in their grasp. Perhaps it's just the ease of access.
I believe I could quit nicotine, but not alcohol. I don't even drink a lot. But I do, regularly. I've used way more addictive stuff, and I could go out and buy it tomorrow, but I don't. Kind of funny how it works.
> Responsible drug users sounds like an oxymoron. Is there any data that shows those people even exist?
I mean, there's the billions of people who manage to consume alcohol without it interfering with the rest of their lives and the lives of others. Don't pretend that one substance that alters perception and behavior somehow isn't a "drug" in the same way that many others are just because of its legal status.
But if you mean drugs that are illegal, yes, there are also plenty of responsible users of those too. My wife and I have taken MDMA together a few times and it has been transformative for our relationship. As well as sharing our love for each other it also helped us talk about difficult subjects, something which I found hard for a long time, and as a result I am now better at talking about hard things when sober too. I think most people would say that going on a date night is a "responsible" act of relationship maintenance and I don't see what we did as any different, except much, much more enjoyable than a cocktail and meal. Every time we were careful with dosing, made sure we had no other responsibilities, and so on. It's as responsible as quality time with each other at a cafe.
I recognise that the production of illegal drugs is damaging and awful, but that's the fault of our legal framework. In the same way that producing soft drinks or beer isn't necessarily damaging nor should be producing drugs that are currently illegal.
It’s not anecdotal, and he’s not just talking about heroin. He’s been involved in pharmacology studies for over 20 years.
I wish people didn’t dismiss Carl Hart immediately out of hand. Prohibition has never been a successful strategy. People are going to buy drugs no matter what. The biggest problem we have with drugs in the US is that people are uninformed about safe drug use and they are unable to easily verify the purity of the drugs they buy.
Yes, let’s have your anecdotal experience be the basis for curbing speech.
I’ve lost dozens of friends and family to alcoholism and drunk driving.
I can’t really get behind the cherry picking; society is being damaged in other real ways to a much greater extent than heroin, yet we find the ennui to overlook them; freedom of choice, speech, too expensive to bother, political authority...
Portugal has the model we should adopt and let this be as solved a problem it can be.
Hard agree. I've lost some loved ones to meth, and it tears up whole communities. When I was young I was lax about drugs, but after seeing the same story over and over...drug addiction is real and it hurts.
Is it just a matter of degrees though? Lots of people have ruined lives (sometimes ended lives) due to alcohol as well. We expect people to use alcohol responsibly, and there is social stigma and other consequences when it's not used responsibly. But we accept that people are free to choose to use alcohol if they want to. Why don't we have the same attitude towards other drugs?
I’ve listened to Hart a few times on JRE podcast. His heart might be in a good place – trying to destigmatize/humanize drug users, but the flip side is he is making actually addictive substances seem like no big deal. Irresponsible.
On the flip-flip side, he's one person spreading harm reduction about drugs that are currently frowned upon. If you look in society right now, you have people (and businesses!) marketing much more harmful drugs to people of all ages with fancy ads and more. Not a lot of people are reacting to that though.
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[ 9.3 ms ] story [ 304 ms ] threadI am often wondering about how addiction "feels". I don't consider myself being addicted to anything, and always wonder how an addiction actually manifests itself. Is it a pain? Is it comparable to being extremely hungry or thirsty?
Slightly related: a few years ago, I overheard a conversation between a fairly large woman and a child. The child said that it was hungry. The woman said: "Oh yes, that hurts". That struck me as odd, because even after eating nothing for 1-2 days, I never actually felt pain when I was hungry. It was surprising to me that some people seem to do, and it would have certainly explained why the woman was so heavy: I, too, would of course eat much more if being hungry was painful.
I got stinking headaches for a week, but not an overwhelming urge to drink caffeine
When smokers quit, they almost always describe the urge to smoke rather than the physical side effects, often described more like hunger.
This is exactly my experience after not drinking coffee for 1-2 days. Headaches that make the thought of drinking coffee slightly disgusting.
And when you decide to quit, it takes quite a while before you stop feeling that strange thirst.
Sounds like pop psychology. There are tons of extremely addictive substances.
Try one and you will get addicted after a while, even if your whole childhood was hugs and roses and ponies.
Maybe, but why would it be due to childhood trauma alone?
I can imagine someone with a happy childhood and a big 20-something or 30-something trauma (loss, divorce, various other issues) falling for drugs/alcohol addiction for the first time just the same.
Veterans who had many Adverse Childhood Experiences (A high ACE score), such as coming from a broken home, or faced neglect and isolation growing up, were much more likely to become addicted to the opioids they were given to treat pain.
Do you have any evidence as basis for your theory?
Veterans at that stage are also usually young, so if they came from a broken home, or had isolation growing up, they'd still return to something like that.
What about veterans that have build a succesful family and working life in between (aside from having had childhood trauma)?
Some people might feel a drive to do something completely non-rational, some might go into depression, some might even feel hungry.
then, the press secretary in your brain (the thing between your subconscious & conscious mind) goes into hyper-rationalization (denial) mode and you start to defend the amount and type of chemicals you use, even when they are literally killing you and those around you
If you're asking about what physical or psychological withdrawal from a drug feels like, it depends on the person, the chemical, and other variables. The worst opiates (Suboxone / Methadone) have 6 month+ withdrawal symptoms, and the faster ones are ~7 days. Hellish times. However, while abstinence frees you from withdrawal symptoms, unless the underlying mental issues are addressed it's likely you'll go back to the very same substance that got you here.
I would say that's basically how addiction manifests itself: even if you know that you're dealing with substance abuse, come on, one more time won't matter, will it?
And then there's also the comfort aspect: you're getting back from a hard day's work, you're feeling tired and cranky, you do deserve something nice, don't you?
N.B.: I'm not saying that not being able to drop the book or stop playing that game IS addiction, just that substance addiction might feel the same way.
N.B. 2:And I'm not talking here about the medical aspects of withdrawal, because that's not the thing an addict would usually experience (withdrawal would only happen because you're trying to stop or cannot get access to the substance you need).
Sure, but one can be dependent on e.g. SSRIs or SNRIs. But they aren't addictive!
Dependence + addiction is a special problem with opiates, I think you can die from withdrawals?
SSRI/SNRIs can be problematic. The difference is that SSRIs tend not to have the other features of dependence:
Seeking the meds when you run low; preoccupation with the meds; continuing to take the meds even though you know they're doing harm.
For opiates and benzos it might manifest as stress and depression. For uppers, drowsiness and inability to focus.
It's compounded by the fact that the reason you started is usually that you suffered from those things to start with.
To me, it always felt like there was something like a little pebble be stuck in my brain and there was only one way to get it out. Not physically, but in terms of how it affected me mentally.
It highly depends on the "thing" (it must not really be a thing). I would say "its the desire to plug a hole".
Do you drink tea? Why dont you drink tea without sugar? There are lots of answers to this question. It can be "it tastes better". Thats what your mind is telling you. It probably would be more healthier to drink tea without sugar but you still add sugar to it.
Thats addiction. And there are tons of other examples and its hard to determine it for every case. Addictions are deeply implemented in our brains. Eating, the urge to be close to people, getting complemented for things you do, all this is kind of an addictional behaivour.
Drugs can basically fill this already existing but empty receptors more efficient. Then your brain tells you to do it again. It will find reasons.
That was harder to explain than i thought. I hope it makes sense.
I generally tried to explain what addiction is and what it feels like. It really depends on the matter.
Hunger never hurt me, but I used to give into it quickly because it distracted me a lot and I enjoyed cooking and eating. The first time I dieted intensively it took about 5 days but I mostly stopped feeling it. It was more of a notice "probably a good time to eat" than a strong urge anymore. It was easy to reframe in my mind as a positive - this is the feeling of fat evaporating! Getting to that point can be tough though.
Btw, in relation to the article, there was a Reddit user who ar some point wanted to "just try" this heroin thing and his message history depicts very amazingly hiw he spiraled to addiction.
This beverage has no redeeming qualities, and I want to kick off this habit.
However, it triggers some addiction mechanism in my brain, and I must drink it every day. No moderation for me -- it really is an addiction. I don't go to McDonald's: I drink it at home. Diet Coke, so no excess sugar, but I'm pretty sure Diet Coke is unhealthy as well, and I'm not sure those sweeteners are good for you anyway.
You might enjoy some of the accounts in The Realm of Hungry Ghosts: https://www.google.com/books/edition/In_the_Realm_of_Hungry_...
Not for me. I used to be a smoker and alcoholic.
For smoking, I just felt uneasy without it, like idk when you're anxiously waiting for something important.
That's the physical dependence and was only the first two weeks and relatively easy to overcome. I got dizzy and other withdrawal symptoms but you can fight through that for a couple of weeks. The other part is the ritual to it. E.g. like most people probably brush their teeth once a day, smoking after eating is just something you do, give in once and you're back to physical dependence.
Alcohol was different for me. Self medication. Once i solved the issues i was medicating (insomnia and stress) i... just stopped drinking and never missed it. The biggest adjustment here was getting used to not being drunk and figuring out what to do with all the time i had now.
> Hart presents himself as a model drug user. “I am now entering my fifth year as a regular heroin user,” he writes. “I do not have a drug-use problem. Never have. Each day, I meet my parental, personal, and professional responsibilities. I pay my taxes, serve as a volunteer in my community on a regular basis, and contribute to the global community as an informed and engaged citizen. I am better for my drug use.”
Anyone who has plumbed the depths of addiction either with a family member or personally has spoken this exact paragraph, potentially word for word. It's a rationalization for addiction, and honestly the most common and basic one.
Good luck to him as he descends through addiction. He's extremely educated and very assured of his self-perception so for him to hit Step 1: Realize you have a Problem, is going to be a lot harder than the average person.
People die when they over-dose (which more often than not happens because they don't know exactly what they're getting, or the purity of it) or mix with other substances that they shouldn't.
A person quits for a while, decides to start using again and shoots up their usual dose for which they no longer have sufficient tolerance.
If that person knew that this is a common way people end up killing themselves, they probably wouldn't make this mistake.
Legal substances also have lots of information readily available around them - if I go to my pharmacy and ask for ibuprofen, they will tell me the dosages in advance. If I go to my doctor and they put me on oxycodone, they will give me a dose that they think is safe, (and in theory, a plan to reduce my dependence on them) without judgement. If you develop an opiod addiction, your support options are much more limited.
So heroin is actually pretty safe if used correctly.
Not many legal drugs has such short list of side effects.
Also, Joplin took heroin AND massive quantities of alcohol on the day of her death. It will be close to saying that when someone dies in a car crash while DUI, driving is the real and unique problem here.
But the drug-war irrationality is better exposed by taking a look at weed and MDMA. Two quite safe substances (certainly more safe than alcohol), with clear medical applications, and forbidden just because some ignorant decided to put them in Schedule I. MDMA at the time of its prohibition was being used in psychotherapy with success in tens of thousands of patients [1]. Today, no medical use is recognized, and being in Schedule I (making it un-researchable), none will be. I wouldn't be too surprised that some country discover that it could be used as a treatment for depression or PTSD.
[1] https://www.amazon.com/dp/0791418189
Users often mix heroin with benzos and/or alcohol which increases the level of risk enormously. The vast majority of overdoses are caused by mixing CNS depressants in with heroin, not by heroin use alone.
If you can't get a steady supply then withdrawals are vicious and can cause a host of other problems (crime in order to get money for more heroin being a commonly cited one).
One of the ways that heroin itself can cause overdose deaths is relapses - users may take a dose that they were previously tolerant to. I believe this is still far less of a danger than combining with other substances.
Many classic drugs (as opposed to research chemicals which introduce small molecular changes to circumvent banns on another substance) are pretty safe or at least have a well known safety profile.
Here's a reddit famous account from someone claiming to be an opiate addict that some find enlightening/haunting: https://www.reddit.com/r/IAmA/comments/wnj2d/iama_heroin_add...
"Repeated heroin use changes the physical structure and physiology of the brain, creating long-term imbalances in neuronal and hormonal systems that are not easily reversed. Studies have shown some deterioration of the brain’s white matter due to heroin use, which may affect decision-making abilities, the ability to regulate behavior, and responses to stressful situations."
I expected something more damning. Unfortunately, I feel that we don't have enough studies (incl. long-term ones) when it comes to recreational drugs.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6758897/
Personally, I've always felt I had a personality that is prone to addiction, so I've stayed away from even alcohol on a regular basis. (Though at one point I was having my favorite alcoholic drink every night... I stopped when I realized what I was doing.)
Even breaking away from caffeine (again) is tough for me. Soda was also tough, and I ended up on soda water instead and still drink way too many of those.
I've also spent too much money on mobile gacha games, but because I know my personality, I managed to keep it from spiraling out of control. (Some people would even say the amount I spent wasn't a big deal, but it was far more than a single game is worth, so it's a sign that I was going wrong.)
Someone else asked how addiction feels, and I almost answered there, but didn't because I'm sure they meant hard addiction that you need help to correct, and I haven't been there. But as far as I've been, it's an almost-uncontrollable desire and subsequent rationalization and then capitulation. Each time. Fighting the feeling is depressing, even if everything else is going great. I only ever escape when I make myself feel worse about doing the thing than I feel from not doing it.
That there exists people like this person who can chip (controlled use of opiates) always intrigues me -- as this drug was the ultimate pathway to euphoria and thus I became the mouse hitting the button for more more more. If you're on the chipping path I hope you can find peace just for today.
I am pro-legalization of all drugs with some FDA oversight on quality.
When the pain subsided, I stopped taking them, and within a day I found myself curled up in a ball and wanting to rip my own skin off. It's really true when addicts describe it as "being uncomfortable in your own skin".
The moment I realized I was experiencing withdrawal, I flushed the meds down the toilet and just suffered through it for a couple days.
Never ever touch heroin. Stay away from prescription opioids unless it's really really needed, and make sure it's short term only.
This is the kind of FUD that TFA is specifically addressing. Namely, that this is not always a true statement.
Of course, for many people, it is, which is why people make such sweeping (and incorrect) statements. Your warning is valid, your claimed facts are not.
"Treat every gun as if it were loaded" is the traditional advice, and is a wonderful attitude to have about firearms. But if it's not loaded, it's not loaded, those are the facts.
Perhaps the same with opiods: treat them as if they are highly addictive, in a rapid manner. But if (for you) they aren't, they aren't.
Here's one showing only 5% of people filling opioid scripts go on to long term use.[1]
Another older study citing 2% of US adults regularly using opioids, while a further 29% use them infrequently. Other more recent studies I seen hold this pretty constant. [2]
Here [3] only 13% of elective surgery patients fill opioid scripts beyond 90 days, and "mental health disorders, and tobacco dependence or abuse were associated with prolonged opioid use". It's well known that people with one substance abuse issue tend to be at higher risk for developing others.
You could go on and on finding studies that show that relatively few people with high risk medical/mental health history go on to develop opioid addiction after using these substances. There doesn't seem to be any support for the idea that the average person can take these drugs once and become "hooked".
All that said, they are dangerous and have strong addictive potential so caution is warranted.
[1] https://link.springer.com/article/10.1007/s11606-016-3810-3?...
[2]https://www.sciencedirect.com/science/article/abs/pii/S03043...
[3] https://www.sciencedirect.com/science/article/abs/pii/S03635...
And for what?
It is an incredibly slippery slope for people to walk out on. It would be incredibly hard for someone to say whether or not they will spiral out of control if they try it and the consequences of becoming heavily addicted are life destroying. It seems like playing Russian roulette and I'm not sure it's a good thing to raise the idea that one can potentially manage it. Also, the person being interviewed could be one of the people that can't control it and will spiral out of control or him saying he manages it well and it's possible to do so could be a facade and he could be trying to do whatever possible to keep his habit alive, but we just don't know. Many people manage it fine for years without anyone knowing until they start their sharp decline towards bottom.
Wherw do you think he got these assertions? There have already been studies about how often heroin users are addicts or what the addiction rate of prescription opioids are.
He's very clearly advising against getting addicted, something most opiate users accomplish.
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/...
Is that true generally, or just for a subset of people who have some predisposition to addiction?
While it could just be Purdue Pharma propaganda, I vaguely recall hearing that the "instant addiction" was a myth. However, people like you have experiences like yours, so there must be some truth to the "instant addiction" idea.
Edit for downvoters: I think it totally makes sense for everyone treat opioids like a loaded gun, like another poster said, if some people are vulnerable to an instant addiction effect. I just want to clarify what the actual situation is (for me and all the other people who were told it was a myth).
A prerequisite for addiction is that one must believe the drug makes them feel “normal” or functional in some way. “I can’t live with this pain - I need it.”
If instead you as a user go into the drug experience with the mindset that you are entering a temporary state, one that is reserved for special occasions, you’re far less likely to become addicted.
If it were true that it was instantly physically addictive, then literally every human being that has ever had any kind of surgery or been to the ER for trauma would be a rabid opioid zombie. But they aren’t.
My cousin is a social worker, dealing with addicts. I've done heroin myself. I know heroin addicts, though not as many as he does.
We both agree: almost all addicts have a backdrop of broken families, poverty, unemployment, some kind of trauma or just a general lack of opportunities in life. Heroin makes all that go away... for a while. How could they NOT become addicted?
The myth is about shifting blame from social inequality onto a drug. The addiction is but a symptom of a societal disease.
LOL no. Some people here, most of them highly educated, are spewing myths like it's "instantly addictive", lies laid out to try to curb the epidemic from the 80s.
It takes relatively long daily use for one to become dependent, and basically you only do that if you don't have a job or anything you value waiting for you after the high, really. Sure, there are exceptions, but that's the norm. The fact that drug abuse heavily correlates with economic recessions and unemployment increases should give everyone a hint. [0]
In 2020, we know roughly 80% of the users never become dependent. [1] In the same ballpark as alcohol, unsurprisingly.
And it's normal. Because it's bliss, but then it's pretty shitty. For a few hours of high you have a few hours of nausea and general discomfort.
> You have to be seld destructive to even try.
No, you just have to be curious and know how to evaluate risks and benefits. It's not a "starter happy drug", but it's not the devil. In 2020, the people doing heroin know a good deal more what they're doing than the ones from the 80s.
Harm prevention and reduction has moved on a lot too. There are high precision scales for very cheap. There are testing kits, too. In the 80s pharmacies in most countries were told not to sell syringes to addicts, again to curb the epidemic, causing them to share needles with all the associated problems (HIV expansion, needles leaving more bruises, sepsis...). Now most countries with a sane drug policies provide free needles to addicts, when not straight up supplying heroin to them [2]. Unsurprisingly such countries have lower problematic drug use than the US, where the problem is policed rather than treated.
[0] https://www.sciencedirect.com/science/article/pii/S095539591... [1] https://drugpolicy.org/drug-facts/can-using-heroin-once-make... [2] https://en.wikipedia.org/wiki/Heroin-assisted_treatment
Where did come up with this? This is not accurate.
Some people are definitely more prone or vulnerable to becoming addicted to it. Im lucky, I guess.
I've been through plenty of addictions, but quitting Oxy after surgery is the closest thing to hell I've experienced so far.
After a couple of days he was experiencing identical symptoms as the GP.
I'm not trying to chime in on how strictly we're interpreting "instantly," but for me I will definitely do my best to avoid opiods. Taking the prescribed amount for 2-3 days, and literally not taking the rest of the pills (both GP and my brother), and having serious physical withdrawals--that's fast enough that I would rather avoid it.
Edit: Just to clarify, she was not prescribed any opioids/drugs to be taken post surgery, it was purely the anesthetics.
Of these drugs, the only ones that might cause withdrawal symptoms would be the benzo or the opioid. The benzo, if it's even given at all, is going to be tiny. Even if we were to hypothesize that a single unusually large dose of an opioid could induce dependency, a surgery where the patient isn't even given opioids to take home wouldn't warrant such a dose in the OR.
In short, your second-hand account makes no sense.
I am fuzzy on the details, because the person was just an acquaintance. There was a huge investigation on her history, looking for substance abuse. They found nothing.
I've smoked opium a handful of times. It smells wonderfully.
And yet, if I take any drug regularly, I'm using something with THC in it (hash or pot, in general). I currently do not, however, and tend to have a few drinks and get high on the weekends. Not a big deal if I don't, though.
I've had medical grade heroin in the hospital (morphine didn't take care of the pain). No withdrawal, though I was wonderfully high. Haven't gone to a morphine habit.
The prudent thing to do is not to say, "opioids are instantly addictive", but to give folks safe ways to detox from them and give folks information on signs of addiction - because not everyone has such experiences.
Would I do opium again? Sure. It was fun. Would I do medical grade heroin or morphine again, under controlled circumstances with a nursing staff dosing me? Yeah. It was fun. Did I have some weird urge to go out and do it frequently? Nope. But to be fair, lots of folks drink on more than one occasion as well. They get high more than once. They might even have more than one drink or hit in one day. Simply wanting to do something again doesn't mean anything. I've done acid more times than I can count, and I wouldn't call it a habit. The only drug that I'd probably do more often if it were not dangerous to do too often is MDMA because it feels spectacular (better than opioids, to me anyway), but I'd not even call it a strong urge.
This isn't addiction, nor is it anything uncontrollable in general.
Unless you are implying that folks get uncontrollable urges, and in that case, please back that up with facts. Though I've met my share of addicts, most things just aren't instantly addictive. Even heroin isn't that way - especially if you actually improve an addicts like (hence, troops addicted to heroin in wars came home to be non-addicts).
With as much respect as I can offer I think you should consider the following notion, which in my personal experience is an actual fact:
"Until and unless you have been an addict you truly cannot understand the experience. And subsequently you are not able to point out what is and is not addiction."
I believe the most-essential factor is this: loss-of-control over the behavior in question.
IOW, when the behavior takes places in spite of the individual wishing to stop, or committing to stopping -- then it is almost certainly "an addiction". It is the behavior that is most important, not 'substances' particularly.
The trouble is that it is very, very difficult for someone to recognize AND admit that they are unable to control some aspect of their behavior.
Most of us will create elaborate explanations to avoid admitting (to ourselves mostly) that sometimes we window up in a situations where we are completely powerless to control our behavior.
No, the 'vast majority' do not. I've supervised medical grade opioid administration to more than a few people, both acutely and chronically, and *folks without a pre-existing substance use problem* do not often develop one, especially if it's over the short term. The idea that "I give you an opioid and then BAM I want more!" is highly divergent from my clinical experience.
Use != Misuse, but use for pleasure is a direct precursor of misuse.
[1] https://en.wikipedia.org/wiki/FOSB?wprov=sfla1
The grand-parent comment to which I am replying describes near-instant addiction in the context of an opioid prescribed for pain control.
FWIW, good on you for recognizing that you're one of the third group and getting off of it entirely before the addiction gets even worse.
And I say this as someone who's plenty happy with drugs legalization, who likes the occasional MDMA, and who drinks plenty of alcohol. I guess I'm lucky I never run the risk of opiates addiction, because despite all that I have no desire to every touch the stuff again.
Do you have a source for this assertion? I'm just a physician with a particular specialty in medically managed (as opposed to procedurally managed) pain, and I've never seen a "I took it once and was instantly addicted." I don't mean to undercut your subjective experience, but I've seen a few folks on pain killers, and if what you described was more common than "very rare", I would have by now.
They may be instantly addictive for you, but they are not for everyone.
After I had a pleurodesis, the nurse sat me down in the chair next to the hospital bed and gave me a little controller I could use to release morphine into my saline solution if the pain became unbearable (and it did). It was the strangest sensation—I could 'feel' the pain, in a sense, but it was like I was on a different plane, and it didn't quite bother me.
But to say it was instantly addictive—nope. Not at all. Have had no desire to try anything like that again outside of a hospital setting. Maybe some people are just not prone to it.
Heroin terrifies me.
Most relevantly, coffee contains a relatively large amount of Harmala alkaloids, which are a family of beta-carboline monoamine oxidase inhibitors commonly found in Ayahuasca brews (and named after one of its ingredients, Penganum harmala).
Honestly, I need to ween myself back a bit.
Try caffeine pills, they have a cleaner effect with no stomach/intestine troubles. Somewhat easier to quit, too.
It's probably some variable physiological response - hopefully one day we'll have a good way of profiling a priori which people may have difficulty with using opioids in a controlled fashion so people don't have to suffer to find out they're among the unlucky ones. (Or maybe we'll come up with either a new class of drugs to replace opioids entirely, or a cocktail to block the adverse effects...)
Some of us don’t like the “sinking into oblivion” feeling of that class of drugs. I don’t want to feel like my IQ has been sliced in half. Really hate it actually.
The dragon to chase is of the functional businessman’s variety- cocaine. I’d rather take something that enhances my life experience, turns conversation in liquid gold oozing from mouth. Opiates and barbiturates temporarily hide your problems under a blanket of haze, confusion, and constipation. No thanks.
But I love cocaine, psychedelics, and weed though, and I have been somewhat addicted to all three at different times in my life. I specifically wouldn't ever get drunk if I didn't have weed to go with it, as that's the only way to make alcohol any fun for me.
I was a dumb teenager (I'm still not very smart) but I'm grateful I had the intuition to realize how dangerous it was. The only way I can describe it was that I felt the pleasure overwhelming my ability to reason, and that felt very disabling.
This does lead to the weird situation where an entire population has easy access to opium should they want to raid nearby fields; the fields are lightly fenced with warning signs stating that it's bad for your health. Perhaps surprisingly to many Tasmania doesn't really have any issues from this. This may lend some credence to the above article - it takes more than just access to lead to issues for people.
https://en.wikipedia.org/wiki/Tasmanian_opium_poppy_farming_...
The process is very crude but works well for experimentation. I think if you were a serious opiate user it would probably be too inefficient and inconvenient to warrant over simply buying opium.
https://depts.washington.edu/hortlib/resources/wp-resource_s...
Michael Pollan also wrote an essay about it (I think taking a slightly stronger position).
I think substances can be addictive on their own, which gets occluded by many on the "pro-drugs" side.
It was a small community whose members looked more like the Hacker News crowds than the meth heads you'd see in the news.
[edit]: My bad, now it's back!
The one drug that has interestingly been demonized is meth. It’s used as a prescription drug and was commonly used recreationally in the 70’s. Now it’s viewed as a one way road to destitution and death.
Drugs are illegal so the media covers the train wrecks. The users who aren’t train wrecks don’t make the news.
Can you imagine if alcohol was illegal and the only stories you heard about users were the people who drank themselves to death? You’d assume nobody could use alcohol in moderation, which isn’t true.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5357144/
Insulin users don't just need to have insulin for the sake of it. They have a medical issue that forces them to take it.
>I think at the core of the issue is that our society generally regards psychological ailments as a personal flaw, rather than a health issue
I think that our society tends to do the inverse: tends to see all kinds of personal flaws as issues beyond the control of the person.
How many insulin users lose their jobs, lose their homes, turn to acquisitive crime or prostitution to fund their insulin habit?
We can talk about how many people who use heroin this happens to, and how much it's caused by current drug prohibition laws, but it's more than zero.
Decriminalisation makes a lot of sense but we need to be realistic about the harm caused to about 10% of people who become addicts.
It’s really difficult to disentangle this from the illegality of the drug.
This article is very clearly about recreational drug use
You want to talk about some shit that gets demonized for no reason? Testosterone replacement therapy is legal, but if you decide that you want to use an extra 100mg, suddenly it’s a criminal offense and you are a bad person. For what? Wanting to have bigger biceps or train harder in the gym? What is the alternative? Drink alcohol which has a measurable death rate per year, or smoke some legal cigarettes and second hand smoke poison countless people?
Controlled use of anabolic steroids is demonstrably safe and effective.
I saw an interview years ago on TV and someone was saying it felt like that appendage was not part of their body, it belonged to someone else. It was so mentally uncomfortable they'd rather remove it.
When you use the term "recreationally", my assumption is that you are asking about how to use these drugs in contrast to using them in an "addicted" state. Since I am very interested in fitness and physical culture, my .02 is that recreational use is anything where you are not endangering your short term health, endangering anyone else's health or well being, you can afford and understand everything you are using and what side effects and ancillaries you would need to take, and you are taking an amount of drugs that are "way less" than what would be necessary to compete at the Mr.Olympia.
I don't think it's about health criteria. It's about whether you want to add yet another item to things you depend on just to feel normal.
Also, the need is a symptom of a real issue that needs to be addressed instead of just numbed and berried i.e., unhappy at a job or a situation etc that needs to be addressed.
I think this is likely wrong. I guess it partly depends on the definition of a "drug user" (like, does it include alcohol drinkers) but I would be very surprised if most heroin users are responsible professionals - how can you do anything when you're high on heroin? I'd go so far as to say that saying people that are addicted are "typically responsible professionals" is a little disrespectful and downplays the reality of those that are actually afflicted with addiction, as it feels like it's just pushing the "burden" onto the drug user, which reinforces negative stereotypes and makes it harder to get people on the side of treating addiction as a health issue and not a moral failing.
It is a straw-man to assume that drug users are high during work. There are plenty of hours in the day. Erowid puts the duration of a heroin high at 2-4 hours.
https://erowid.org/chemicals/heroin/heroin_basics.shtml
8 hours for getting your $80 for the day to get high
4 hours to get high
4 hours for...I don't know, working on a novel or something
The statistics for alcohol consumption in the Nordic countries in the 19th century are staggering, adult males were basically drinking hard liquor all day every day as they went about their work. Alcohol definitely has its effects on the body and is a huge safety risk, but apparently men were still able regardless to run their farms, build the buildings they needed, chop wood, etc.
Design work though? There was many a time I awoke the next morning and had a dread-chill panic thinking I'd need to get some project done, only to find I'd not only done it the night before, but I'd actually not hate it. Which, as a designer at the time, was high praise. Sure, there might be some rough edges or stupid typos, but the overall work would be Great, by my standards at least, so after a quick review, would be ready to go. I used to refer to it as 'free work'.
I guess letting go is more of a useful trait in design.
I'd not recommend it for doing work in critically-important fields, obviously!
- ed last line
For most of my life I also cooked sober. But when I started cooking tipsy, I began preparing meals I could have never believed I made myself. My current lasagna recipe is an absolute bomb and it's been perfected over a dozen drunken cooking sessions. Even Italians asked me for the recipe.
Main problem there is replicability. My partner often gets annoyed at me when she asks if I can cook some nice thing I'd recently made, only for me to umm and aaah because I didn't write down the exact ingredients... .
For several years I made a living playing poker, and I played a lot better with morphine in my system. It made me more patient and focused. I even tracked my results in different databases (with pokertracker) to compare my results while high. I made almost 10% more while high, and this is over hundreds of hours played.
Every single person in group homes and foster system had same sort of tale.
Helps them keep calm when navigating a road which has sections only marginally wider than the truck, with a 500m drop on one side.
I'm not promoting DUI (lost too many friends that way, mostly from OTHER people DUI'ing and hitting them), just saying that there are professions where the people engaged think that dulling the fear/panic response is worth the reduced reaction times.
The rock scene of the 80s comes to mind. Lots of them did it af the time while they were touring.
> A typical drug user is someone who uses drugs.
It's impossible to neatly encapsulate every single type of drug user into a "typical" category. Everyone is different.
Some people use drugs. Others don't. Some people can use drugs recreationaly, others can't (including myself).
Like in Russian group Splin lyrics: "Я наяву вижу то, что многим даже не снилось, Hе являлось под кайфом".
Rough translation: "I see the things in reality, others don't even when dreaming, when getting high"
I eventually completely quit because it seemed like a black hole in my day and in my life, where the sober me just lost valuable time and focus. It also dampened my motivation. Part of it may have been physiological, I would be less focused the next day. But part of it was also that compared to being on weed, life was just not as enjoyable when I was sober. I did not like that contrast.
Certainly not only drugs are fake or toxic.
Addiction is a force that counteracts your will power. You may not have drug problem but you are an addict if you feel compulsion to use the drug.
Today you may have enough willpower to counteract that force to consume more alcohol or drugs. But the next day may be worse, you may find some family or work problem and your will power may decrease enough that you will run into drug problem and have really hard time getting rid of it if at all.
It is called slippery slope for a reason.
Don't dismiss power of addiction just because you "don't have a problem now". Our willpower levels change so what isn't a problem now may become another day.
You may loose your job and have hard time finding new one and try to use something that has been giving you comfort to lighten your day. And because your "bigger" worries you may not be paying attention to it or you may need that extra comfort so much you will just say "yeah, it will not hurt if I do this for a while". This is frequently how these things start. It doesn't happen that you are completely normal one day and die hard alcoholic or drug user the next.
Now, I wouldn't call what you described even remotely close to a problem. I also consume alcohol socially and even privately. I pay attention to whether I "crave" alcohol and when this happened I cut it instantly.
I have a test for this. Even if you don't drink alcohol, are you constantly thinking about it?
If you are not using but constantly thinking about it it means there exists a force (addiction) that you are currently able to overcome.
Please, don't take this horrible advice. Drugs are harmful and can do fatal damage to you and those around you. I mean, is this guy advocating drug use? It sounds like he wants to justify his dependency.
I’m glad this made it front page news given that the northwest coast of US now gets hard drugs, so maybe one of them will think twice about being a full-on grade A dumbass.
Also remember: with legality especially in a rich entrepreneurial country comes business which lobbies, funds studies, etc. Pot strived for many years for legitimacy, and once they got it, it exploded all over the US.
https://en.wikipedia.org/wiki/Methcathinone
If you don't have or want kids, you're missing what made you and was given to you.
Addiction, as the article says is more complicated than any drug and is factor of a person’s life situation in general. Look at the work of Gabor Mate for a better understanding of addiction.
The world is full of chemicals that affect us, some more than others. People self-medicate all the time (alcohol, coffee, chocolate, sugar); I see no problem with (after learning and carefully experimenting) broadening one's set of "self-medication" tools.
There are plenty of comparisons that might be made, but driving seems an apt comparison. Driving is extremely dangerous, magnifies even small mistakes, and kills or maims very large numbers of people on a regular basis. And yet even with similar evidence of harm and habit formation people do not treat driving with the same fear but instead face driving with irrational positivity and optimism.
Scientists using rigorous observations and mathematical analysis do not see drug use and driving as having risk profiles that are completely different.
Driving was my go-to analogy too (I've got a longer post where I go into it) Surely there's the concept of legal drugs though too? You're allowed to have wine, but not drive at 120 miles per hour past school gates.
My feeling is that there's a difference between "safe" and "worth the risk". And as far as lawmakers are concerned, for most drugs there's not case where it's worth the risks.
The problem is that what it takes "negatively affect the rest of your life" depends a lot on what role you have in society.
Short of pornography producer, fantasy fiction author, songwriter and other professions where copious drug use fit one's "brand image" or potentially enhance one's work, a tenured college professor gets about about as much leeway from the rest of society as a white collar professional can get. He can be "eccentric" and nobody blinks twice. But for other professions the standards of behavior are different (and generally get more permissive as you go down the economic ladder).
Defining the difference between acceptable use and addiction, and by proxy who's problems are bad enough to be considered problems and therefore in need of solving in a way that is relative to one's place in society is very dangerous. If you're blind in one eye you're still blind in one eye even if it doesn't negatively affect you. Addiction (and a multitude of other conditions) are the same.
Doesn’t this bolster the argument that the principal damage from this type of drug use is social, not chemical?
Most people would rather not be debilitated than have society be accommodating.
That's what distinguishes dependency from addiction.
I think he's glossing over the fact that some drugs can be addictive, which is a thing on its own, aside from promoting happiness.
> Despite the current false narrative, the addiction rate among people prescribed opioids for pain in the United States, for example, ranges from less than 1 percent to 8 percent.
What's the threshold where it's a problem? 1% of prescription drug users getting addicted sounds like a terrible situation to me. Let alone 8%. Especially if they're already in a situation where finding a way to escape is tempting.
There would be few to no deaths, suffering, or crime associated with heroin if it were cheap and accessible, and if addicts were under the care of a doctor or social worker. It would be a mild burden to public health services tasked with helping people quit, but far cheaper than tobacco smoking or alcoholism.
I think legalizing it to the point where an addict had access to predictable dosage would save countless lives.
If anyone were left to their own devices and still in pain, I suspect a lot more than 8% would continue to take the painkillers.
As for knowing any functional, well I've seen many have functional phases would be the best I could attest to that from experience and out of about 30 heroin addicts I've endured in the past 2 decades, I'd say only 2 would be close to being classed as functional.
Really gets down to if somebody who is using drugs can just stop and take a break every now and then, then in that clean period - still hold the same mentalities towards their usage and if they can come to the same conclusion - bravo as that is what I would call somebody with their head working well for them.
What really is the issue for many drug users is the point in which the drugs use them - that's the turning point of addiction I'd say.
Yet all that said, you can't help but accept that the brain is driven by chemical stimulus and there lays the hard barrier of having the will power to quite.
I've personally never done heroin, no desire too as like a fine wine, I might like it and it is easier to miss what you never had and one step I've become very mindful never to take having learned from others, many who's lifestyle choices I had thrust upon me and I will say, not best neibours to have from my numerous experiences.
personally I lean more in the direction that heroin and friends are significantly more addictive than most other drugs. but I have to say, if there were a sizable group of recreational users, they would probably know better than to ever say anything about it in public.
Without a doubt, how else do they get introduced/exposed to such temptations otherwise.
Pattern that usually follows is, cocaine, then onto doing crack as suddenly in their mind it's cheaper better high or other mental juggling to avoid having a break and carry on chasing that next level of high, building tolerance all the time. Then the comedowns, well whilst the highs may not seem as good and cost more to reach that level the downsides are less easier to adjust tolerance wise. So you find that chasing a line of heroin solves all that nasty crack come down and once in a while, you won't get hooked, after all you are able to do all that crack and your mentally strong and other decisions made whilst completely out of it on crack cocaine. So you make that leap, the odd bit becomes more and year on and your addicted. Coz prices and that, not long before your after that next level, so injecting for many becomes a hurdle that gets lower and more appealing and justified in crossing. You will just do it the once, case of only way to solve your needs as not enough to chase and sort the cramps. I've seen all this play out many times, heck even audio surveillance from chasing to shooting up to introducing new recruits into junkie club, via crack and then heroin. After all, opportunity to sort somebody out and charge them extra for sorting it, kickback from dealer and chance to share a hit - addiction makes people greedy and that greed plays out in doing what's best for them, if others freely bit that apple, they will certainly not stop them that hard. After all, how they themselves started doing drugs. Seen it play out just too many times and from start to coffin too many times and shocking how much goes on, ignored as society as a whole class the addicts as the victims and the dealers as the baddies in a clear cut way when I can attest that the lines are very blurred indeed.
> Hiya kids. Here is an important message from your Uncle Bill. Don't buy drugs. Become a pop star, and they give you them for free.
... except in this case the message is don't do drugs kids, but "grown ups" should (as defined as a state of maturity where you know how the drugs behave, know your limits and can balance your experimentation with fulfilling your societal obligations)
I see this as a bit like speeding. The government sets fairly arbitrary speed limits for different types of road. They do it based on what they think the majority of people can cope with, versus the likelihood of risks, vs the need to get from A to B in a reasonable amount of time. The government hasn't been amazingly scientific about the speed limits, and don't take into account time of day, traffic, weather conditions etc. A healthy, fully-alert person can probably go at 150% of the speed limit on an ambient clear day on an empty road - and do so perfectly safely. But that isn't the message they give people, because it would be impossible to assess person-by-person, minute-by-minute.
And yet, some would consider the above information to be recklessly given, because some people will on read "go at 150% of the speed limit... perfectly safely" and take that as my advice.
So the question is, should it be legal to travel at any speed, provided you feel like you're doing a good job of it? In both cases, misjudgement can be disastrous for yourself and the people around you (and innocent bystanders too)
And when you are talking about something that can alter your perceptions, you would surely need a non-drug-taking associate with you at all times who could give you an honest blow-by-blow assessment of where you are dropping the ball as a "normal" human being, and where your drug-fuelled failings are happening?
When the potential downsides so vastly outweigh the benefits, I can understand why laws take the side they do. That said, I absolutely do think that there are massive downsides to making drugs illegal when taken responsibly. Countries should be realistic about what they can and can't do. If they can't eradicate drug use - and most countries can't - they need to put effort into safeguarding above incarceration.
But I think that's the consensus anyway on most social issues. And it seems to be a lesson that governments globally are very slow to learn.
This was a good story to flag.
When a person reports something about their own life and internal state, you need to have overwhelming evidence before you can dismiss what they are saying. On what grounds do you dismiss the author's claims about their life? He clearly has his life well-enough-together to get an essay published in a reputable science magazine.
I don't think I would use getting published as evidence that somebody "has their life together". Again, I don't care if he does have his life together. It may entirely fake, it can be temporary, and it can be one account.
Look, I'm wholly for the idea of not shaming people who use drugs. I am also wholly against treating drugs which have established track records of destroying lives as recreational or not a problem when used regularly, especially to avoid personal problems. So I'm strongly against publishing essays which tell a soft story to play down the millions of other stories, which this absolutely does.
Why doesn't he talk about how this impairs his motor or thinking? Is he somehow magic, isn't the entire point to alter his conciousness? No, it's all positive about drugs. Ridiculous. Why doesn't he point to the side effects? Using alcohol as an example of how "harmless" drugs are is obscene. Alcohol destroys millions of lives every year as well.
If he wants to sell tolerance of people's choices in the name of the freedom to ruin your own life, then so be it. Don't soft peddle me bullshit.
Could we have a story about all the men and women who had their entire lives destroyed by drugs as a counter example?
Hearing an opposing point of view is a breath of fresh air for people who are fed up with the one sidedness and hysteria.
Stories distort reality. They oversimplify and hide details.
Think about a parallel: pizza. People in the US are notoriously (unhealthily) overweight. Should we be hysterical about someone who says "I can eat pizza without going overboard"?
What an incredibly dangerous idea to promote. Do not mess with opioids. You think you are in control, until you are not.
Otherwise the people who inevitably will/do use, only hear and have only heard, 'don't do it to start' or get ostracized instead of getting the help they need or the education they need to know when they are overdoing it or not in control any more.
We also need more clinics and support for safely quitting or managing drugs and tools for it similar to what we have for tobacco.
Shamefully, here in Canada, some of these clinics in Vancouver are getting shut down, rather than more of them popping up, during the worst opioid crisis this country has ever seen.
These closures are a direct result of a 'don't ever do/touch drugs' policy and the stigma and ostracization that come with it.
Speaking from experience...education is better than 'don't'. I have had friends who have died from using drugs, and I have many, many friends who are regular users but not abusers - pull an insane variety of different full-time jobs. (And well!)
The huge difference between these two groups of people for me is education (for instance, preexisting mental health conditions that would be made worse by a particular substance and the knowledge to avoid it), and having a support system, etc..
It is fascinating and inspiring that someone has chosen to put themselves in the very vulnerable position of coming out about their personal use, and I believe the intention is to help remove the stigma around drug use, so education can be bettered. :)
Edit: Maybe better to say 'Drugs can be extremely harmful and addictive. If you choose to use them, please be sure you are educated, safe, and have someone nearby.'
In fact, that doesn't seem dissimilar to the surgeon general warnings on cigarette packs, anyway.
What kind of warning labels will we see on cocaine, heroin, etc - in countries where its sale will inevitably be legalized? These are the kinds of statements we should be making rather than 'just stay away from opioids.'
for existing users. We should not tempt people who would have otherwise never used them with false fantasies that they will be able to dabble and remain in control without getting addicted
Right, but this is harm-denial.
You should also examine the proportion of heroin "users" who become abusers. You should then do the same comparison for alcohol use.
I'm willing to entertain the notion that the risks of heroin are overblown. I'm even willing to believe it. What seems entirely unsupported by evidence is the notion that alcohol and heroin are in remotely the same league.
That's an orthogonal concern. That being said, I don't understand your reasoning.
Firstly, this is opioid abuse. Granted, the responsibility for this abuse falls on the prescriber rather than the user, but it is nevertheless a pathological pattern of use.
Secondly, you've substituted "heroin" for "pharmaceutical-grade opiates" in your argument. The irony is that this supports my position more than yours because it demonstrates that the slope is particularly slippery, even with medical-grade opioids. This point bears repeating: the addictive and toxicological potential of opioid medicine is greater than alcohol. The trend is even less in your favor when we return to the topic at hand: heroin.
I share your concern about opioid-based medication, but this argues against your point.
Doctors are rationally ok with such prescriptions because the effects are not as bad as alcohol.
Simply put: opiate abusers and users don't need liver transplants or get such severe brain damage; alcohol is more damaging in a myriad of ways for both uses and abusers. There is plenty of data supporting this, and it is valid to use data regarding medical grade opiates.
The risks of heroin are almost entirely side-effects of the war on drugs rather than the drug itself.
It's not nearly as addictive. It's not nearly as deadly. It's much easier to control dosage. It has modes of consumption that are non-pathological.
This is typical of the distorted anglo-saxon view of alcohol as a tool for getting flat-out drunk. This is not how most of the world relates to alcohol, nor is it a healthy relationship with it.
Honestly, this says more about you than about booze.
Strangely I know more ex-heroin addicts than ex-alcoholics, and there are way more alcoholics out there, but that's just anecdotal data I guess :)
> It's not nearly as deadly.
Maybe if you leave out all of the DUI and accidents where alcohol played a role, you'd be right, but overall alcohol causes way more damage than heroin. While David Nutt ranked heroin as more addictive than alcohol, overall he found alcohol more harmful.[0] Precisely because even though it doesn't harm one as much as heroin, it's way more likely that you harm others with alcohol.
> It's much easier to control dosage.
Actually no. Lots of things affect gastrointestinal absorption of alcohol. Just compare a few shots on empty stomach vs after a meal. Also don't get me started with the absurdly long and not always obvious list of drug interactions that alcohol has.
Heroin, assuming known purity, will work roughly the same, either snorted, smoked or injected. If you make a point about its purity, that's a consequence of its legal status. Most, if not all of the interactions are self-evident (other CNS depressants).
> It has modes of consumption that are non-pathological.
I guess you have preconceptions about what heroin use implies. How is unwinding after work a pathological use of heroin vs whiskey?
> Honestly, this says more about you than about booze.
Ah, ad hominem to finish, a classic.
[0] https://www.bbc.com/news/uk-11660210
Indeed it is! You conveniently ignore all alcohol consumers except the ones with dependency problems.
>Actually no.
Actually, yes! You're arguing that there is variance in absorbtion, and you are right. That is different, however, from e.g. the LD50 or the ability of people to measure dosage accurately.
>I guess you have preconceptions about what heroin use implies.
You're conveniently ignoring that non-pathological use of heroin is extremely small. It's a rounding error when compared to alcohol usage. You are cherry-picking.
> Strangely I know more ex-heroin addicts than ex-alcoholics, and there are way more alcoholics out there, but that's just anecdotal data I guess :)
Good thing this has been formally studied
>Maybe if you leave out all of the DUI and accidents where alcohol played a role, you'd be right [...]
Yes, and people with pools in their back-yards experience more drowning. Color me surprised.
You're also leaving out all the incidental damage from heroin use in your analysis. Shall we factor in drug-related murders? How about secondary complications like pneumonia?
Again, cherry-picking.
>Ah, ad hominem to finish, a classic.
An observation, actually. I've rarely seen this level of bad-faith argumentation.
Actually a significant part of alcohol users have dependency problems, roughly 10% as someone already mentioned.
> Actually, yes! You're arguing that there is variance in absorbtion, and you are right. That is different, however, from e.g. the LD50 or the ability of people to measure dosage accurately.
So... no? Unless you ignore all that I said, that is. Active to LD50 ratio for alcohol it's 0.1, for heroin it's 0.17, in the same ballpark. When you factor in the variability of oral administration, alcohol is way more dangerous. Most overdoses in heroin are due to fentanyl or changes in purity; in case of alcohol it's due to wanting to get drunk fast, and doing it too fast (plus interactions).
> You're also leaving out all the incidental damage from heroin use in your analysis.
There is a lot of it, it's just that alcohol is bigger. People on heroin don't usually go driving or picking up fights, they're usually just lying on the couch.
> Shall we factor in drug-related murders?
I wouldn't factor anything external to the use/abuse of the substance, like its legal status. It'd be interesting to compare them with roughly 25% of vehicle deaths that can be attributed to alcohol.
> How about secondary complications like pneumonia?
Which was already accounted for in Nutt's analysis.
> An observation, actually. I've rarely seen this level of bad-faith argumentation.
I could say the same, it feels like you have a horse in this race, pun intended.
Then you can also argue that you might not have lost your friends only because of Heroin the substance, but also how people with heroin addiction is "treated" and frowned upon in society.
I think what the article is trying to say is that harm reduction is a much more human and possibly effective approach to fighting real addition. Compared to other ways, which some of them include "there is no such thing as responsible drug use, it's all addiction" and treating people as such.
That coupled with the fact of how heroin is treated in society makes it worse. On top of that, add that not everyone that uses it is healthy and responsible, makes it even worse providing some bad validation. And then, not everyone is capable of making the distinction between fun or addiction early on when an addiction is starting.
I too think it's dangerous.
The article is an interview with a Heroin user. It's as dangerous as an interview with a sex-worker. The interviewer even seems to bring up some interesting counter-points to the interviewee.
In the end, the interview is just providing a voice for the person getting interviewed. Are you saying that interviewing people who might do harm to world is dangerous?
I think that's the logic, anyway. It's ironic that most people here are in the camp of "decriminalize drugs! Oh wait, no, not these drugs, just some drugs."
While Portugal is probably the most famous example of decriminalizing working in humans favor, it's not the only example, it has been employed in other states too. Netherlands has de-facto decriminalized all drugs (in practice, not in law), Czech Republic has decriminalized all (most?) drugs as well.
Illegal heroin is very dangerous.
The story, as it was told to me, was that he chased a few Vicodin with a single beer, which resulted in him registering a 0.03, but he fell asleep in an intersection with his foot on the brake pedal. Despite this, he passed the field sobriety test, but the officer judged him to be intoxicated, and he was arrested. Apparently he was supposed to get a blood test; he was taken in early on Saturday and held until Monday, but they didn't do the test until he was "on his way out". It turned up nothing and he got out with a lawyer bill.
[0] I'm convinced that things are so bad/ineffective right now, that I'm pretty close to support of all-out decriminalization (of possession), simply because it reduces the impact of addiction on the addicted.
'All substances of abuse self-administered by humans that can result in addiction are believed to exert their reinforcing effects by increasing DA in the nucleus accumbens (NAc)'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3050051/
Anecdata and broad brush strokes of course - In my experience anyway, the actually responsible and heathy adults I know haven’t felt the need to use heroin. The people who somehow are able to delude themselves into thinking they are responsible and healthy while obviously in crippling mental and/or physical pain, have - and it’s been devastating to them.
I’ve had prescription opioids before (hydrocodone, codeine, morphine) during medical emergencies. The feeling of peace and calm is amazing - which is exactly why it attracts people in pain and suffering, destructively so in many cases. It is difficult to know if that feeling is going to be magnetic or repulsive to you until you try it. It happens to be repulsive in my case (I know it’s a trap), thankfully.
It’s a complicated story of course, and bad outcomes tend to get the press. Better treatment (including in many cases mental health treatment) is definitely needed.
It is not the only substance like this - alcohol, tobacco, amphetamines, and others have track records of similar problems.
Pretending that anyone and everyone could self evaluate and go for it without a decent percent of them having major problems for them and those around them is unfortunately just not a good idea.
You do. It's not up to someone to decide, you're responsible for your own body and your own decisions to improve/harm it.
I don't think they are saying advising governments to setup some sort of screening process for this. It's more for the people who are interested in the drugs themselves. When I first started getting interested in drugs, many pushed the idea that I should be psychologically healthy first (mostly because my first interest was psychedelics and I have good and well-meaning friends). I think that's what the article is trying to signal here.
The libertarian 'you can do what you want and it's your own responsibility' is great until the people who obviously made the wrong decision stop quietly owning the results of their decisions and start murdering random people for money to fund their habit.
An argument can be made that the answer is free heroin and mental health treatment of course, and maybe it is the right answer. It seems hard for societies to accept however, outside of some very niche locations (Netherlands) though.
Some might not even have a drug habit if not for illegal drugs laced with addictive substances they didn’t even know were there.
If you're saying 'I meant it should be legal to buy over the counter for cheap and/or given away for free', then that might decrease the number of people being robbed for it - but doesn't seem to decrease the number of overdose deaths, area crime rate, or urban decay by as huge an amount (or maybe it just concentrates it?), at least based on the experiment in Vancouver, BC, Canada's lower east side. The Netherlands is also problematic, and not a solved problem. [https://www.areavibes.com/vancouver-bc/downtown+eastside/cri..., and overdose deaths have continued to skyrocket in Vancouver [http://www.vch.ca/Documents/CMHO-report.pdf] despite harm reduction, decriminalization, and other means.
Areas like San Francisco with de-facto decriminalization also have major problems with people, for lack of a better word, rotting of neglect on the street - something that I've also seen first hand in Vancouver. I also have friends who have seen this first hand in Seattle. Resident complaints around muggings, being assaulted unpredictably by unstable mentally ill people (on drugs or not is hard to say, but there is a high correlation with this and these areas in my personal experience) are hard to ignore.
This isn't a solved problem, and I'm not advocating for 'lock them up' policies - but pretending this will all be cool if everyone can walk down to the corner store and buy heroin if they think they're up for it isn't helping anyone either.
Also, correct me if I’m wrong, but that doesn’t seem to address my core point?
Legality can reduce some negative effects, but it isn’t a cure-all. There are also a lot of people that should just not use opiates or bad things will happen, and we can’t predict who those people will be reliably until it is too late.
So please don’t use opiates unless you really really need to, and be aware of the dangers.
Commit any infraction, drive or work heavy machinery while under the influence, your license is suspended until you complete rehab. Do it too many times and it’s suspended permanently. Use while unlicensed, it’s jail time.
This way there is a progression. We don’t have to waste police resources on those who can handle it. The minority who can’t are directed into rehab to deal with their issues first, and only the minority of that group who fail to shake up get jail time.
Meanwhile crime is down because drugs are affordable. New addicts are down because kids aren’t getting laced drugs. Deaths and overdoses are down for same reason.
And it all costs society less, less police, less crime, less hospitalization and less death means less taxes.
And legal drugs have known potencies, and aren’t mixed with other more addictive drugs.
Don’t compare decriminalization to legalization, they are entire different things. Decriminalization still suffers from higher addiction and death rates because selling the drugs is still illegal.
Economic tide : the 80ies was a different time with lots of youth unemployment in NL/NWE.
> You do. It's not up to someone to decide, you're responsible for your own body and your own decisions to improve/harm it.
That's obviously not that black and white. If it was, then breathalyzer interlocks wouldn't be a thing, for instance.
I was thinking in the context of "Should I be able to use drugs", which we normally leave up to the individual to decide, except for _those_ drugs that we don't leave up to the individual to peruse on their own.
Yeah, but that's just an example. If you were about to make a suicide attempt, you could be involuntarily committed, and the only person's life being protected would be your own.
The point that I was trying to get at was that black and white individualist statements like:
>>> You do. It's not up to someone to decide, you're responsible for your own body and your own decisions to improve/harm it.
...paper over some important complexities of real life. There are many, many cases where people have responsibility for others (and I'm not just talking about legal responsibility, even though my examples all intersected with the law in some way).
So if you create an accomodating and encouraging area for taking heroin you will find it surges in population when heroin is freely available and detox discouraged. Everybody points to the European model but they must have done something different than just harm reduction, like proactive policing breaking up open air drug markets and shutting down slums teeming with addicts forcing them into detox.
And because it’s illegal most addicts have to pay high prices for heroin of unknown potency, and frequent laced with Fentanyl. That directly leads to overdoses and hundreds of deaths, along with street crime to fund expensive habits.
Every bus stop since March last year in the drug slums also has instructions where to get prescribed opiates. Area only got worse
> The Vancouver motion however for the moment has no force in law.
A municipality doesn't have the authority to decriminalize drugs. They're just requesting the Federal government to act. It's not official, though it could eventually be.
Also, Europe is a collection of sovereign countries, each of whom has their own drug policies.
The impact of failure to somehow prevent yourself from being addicted can be catastrophic ... even if you are successful in getting them out of the cycle of addition. And that impact can extend WAY beyond the individual.
I'm open to the possibility that some drugs really can't be used responsibly by enough people that they absolutely should not be legal.
This not a very helpful observation, as we all know that this is far from what happens and is not going to become the norm.
Furthermore, quite a lot of people became addicted to opiates through acting seemingly responsibly (at least initially taking the drugs under the supervision of a doctor whom they could reasonably assume was looking out for their best interests) and in the persuit of better health.
I should add that Hart himself punted on this issue when the interviewer touched on it. In the interview, he does this a lot - for example, when the interviewer raised the question of physical addiction, Hart merely discussed the physiological basis, without touching the obvious issues it raises for the concept of responsible use. It may be telling that, in his description of himself as a responsible user, he avoided saying anything about this particular issue.
> Then you can also argue that you might not have lost your friends only because of Heroin the substance, but also how people with heroin addiction is "treated" and frowned upon in society.
This is also rather beside the point, as, while the way addiction is treated is also a problem, it is not an issue except where there is already a problem with addiction.
That aside, there is such a thing as responsible addictive-drug use (including, but not necessarily limited to, people with chronic pain that only responds to such drugs) and the way we respond to addiction today is in many ways ineffective and in some ways very harmful. One cannot make a very good argument for reform, however, on the basis that some people can use some of these drugs responsibly.
Exposing oneself to developing a heroin addiction seems a somewhat irresponsible and unhealthy thing to do.
A few years ago I had a lot of stress and started drinking to help me sleep. After only a few months I felt kind of agitated without a nightcap. I immediately stopped and now I just don't drink when I'm stressed.
So maybe in one sense I was right about being responsible, but on the other hand it could have very easily become a habit and now I understand how people slowly slide into addiction. It's arrogant to assume anyone knows how they'll respond to a drug as habit forming as heroin.
The funny thing I've been reading the article and the tone of it reminded me of heroin addicts who was not hit by their addiction heavily yet. I mean, Carl Hart thinks he is a responsible user, that he have an ability to decide for himself. It doesn't seem so for me. It is hard to tell, having as a data only one interview with him. But... you know, I'm an addict also, a nicotine one. I know how it is. First ten years of my addiction I though that there is nothing wrong with that, it costs some money and gives an urge to smoke sometimes, but it brings some benefits too. A few years ago I stopped smoking, after a month of abstinence I saw no benefits in smoking at all. My abstinence lasted for a couple of years, now I'm smoking again. Seeing no benefits at all.
I know what I'm speaking about, I know the signs, I see the signs, and I see Carl Hart as a fellow addict, though with a different substance.
I drink alcohol sometimes, and I know that I'm not an addict. Even despite the fact that sometimes I want to drink. A wish to drink is a warning sign of course, but I see no other signs. Like a despair coming with the thought that now it is not the good time to drink for some reasons. I have no ideas about benefits of being drunk: it is a funny state of mind, but mostly annoying, I'm really stupid when drunk, I see my stupidity and can do nothing to it. An addiction is a special state of mind, I believe one (i.e. me) could feel it as distinct from other states. Though it takes some learning, one needs to become an addict and to stop using an addictive substance of his choice. If Carl Hart wanted to prove that he is not an addict, he should stop using heroin for a couple of years, and then try to state his freedom from an addiction with a straight face. While he is using heroin for just five years and didn't tried to stop, I'd never believe his words that he is not an addict. When it would be 10-15 years or 5 years of abstinence, I'll probably believe his word on it.
Having known someone who was a responsible, highly educated adult with a fantastic career who died of a heroin overdose, this whole article sounded eerily familiar.
> If Carl Hart wanted to prove that he is not an addict, he should stop using heroin for a couple of years, and then try to state his freedom from an addiction with a straight face.
So by that logic... we should only believe that you're not an alcohol addict after you stop using alcohol for a couple of years?
I don't know if ordu has thought of that, but they don't appear to have from their comment.
I find the idea that the only way to know if you're not an addict is to give up for a period of years to be very problematic. Most definitions of addict suggest they are unable to control their compulsion, but I couldn't see any indication of that from the article. If the author of the article can sustain occasional use while maintaining a high profile job (science professor), their use doesn't appear to be out of control.
Yeah, something like this. I'm not entirely sure that alcoholic addiction would be just like a nicotine one, but I believe it would be similar enough for me to detect it. If I'm right I might hope that my experience with nicotine could be generalized to alcohol.
Maybe unrelated to a discussion of "is a period of abstinence is revealing", but I rarely drink alcohol, and a year or two without a drop of alcohol is a normal to me.
> Most definitions of addict suggest they are unable to control their compulsion, but I couldn't see any indication of that from the article.
I see no indication that he is able to control it. He is like "I want to take heroin, so I'm taking it". It is a very popular stance for addicts. When I tried to control my nicotine addiction it mostly ended with "I do not want to control". Even now I do not want to control, though I now see the difference between "I do not want to control" and "I want to smoke". I do not want to smoke and do not want to control my addiction.
When plane uncontrollable falling to a ground due to a failure, a pilot could state that it is his intention, and therefore the fall is a controlled one. People often do something like this, but for an addict it is a symptom by itself.
Carl is a white collar professor. The worst thing that can happen if his drug indulgence becomes a problem is he knocks over the water cooler or loses his job.
I work a blue collar job servicing heavy diesel engines. Casual hard drug users are aggravatingly cavalier to work alongside. They forget important things constantly. They show up late and lose things often. You'll spend all day repeating things they'll never retain and at the end of the month they will lose a finger or toe or suffer a massive back injury and get fired. The back injury usually turns the casual heroin into constant endless heroin.
Drug tests exist in my field for a really valid reason and it has nothing to do with having a problem but becoming one.
The issues is "drug decriminalization" people treating addictions like it's not a real problem for many people.
Many of these folks want it to get to a point where you can quite easily buy heroin and suffer no legal consequences.
I'm not saying our drug laws are just or can't be reformed but the fact that heroin is illegal prevents a LOT of people from using it. How many people will then use, aided by these pronouncements that "Heroin isn't actually that addictive!" and ruin their lives?
We already have an opioid epidemic in this country that has destroyed communities.
There's a middle ground between our terrible war on drugs and the naive "make it all legal and experiment with heroin!"
Do you know a lot of people who have expressed to you that they would use heroin recreationally if only it were legal? My gut is that the number isn’t large.
My impression of the evidence from places that have tried decriminalization (eg Portugal) is that the number of people who use and then are able to get their lives back on the rails is higher than the extra people who use because it’s decriminalized.
What if people tell them it's not addictive? And now it's not illegal?
What illegal does is make it far more likely to die from using heroin.
Lack of access (or not knowing how to access it) comes to mind, among many other reasons.
Also, my understanding of most drug legalization is that the intent is to legalize usage/possession, not distribution. This is done with the intent to make it easier/safer to gain treatment and decrease addiction.
I don’t know if you read it, but it also talks about how many deaths are from bad education (not understanding drug interactions, i.e. between two depressants), and bad drugs (i.e. lacing heroin with fentanyl) with no easy way for users to test their drugs.
It further goes on to discuss that addiction treatment in the US is terrible precisely because it focuses on the drugs as a pathology and does not consider the holistic person or helping the person solve their underlying problems.
Progressive drug policy isn’t “legalize it all”, it is “prevent needless deaths and treat addiction properly”. It has been for some time. Here are garden variety articles I found about these policies being implemented in the wild:
https://www.washingtonpost.com/world/2019/01/04/allow-festiv...
https://www.fda.gov/news-events/press-announcements/statemen...
The middle ground you seek is already defined clearly. Are you sure your perspective here is as informed as it could be?
I wholeheartedly agree. a couple google searches showed buying alcohol for a minor was a $1000 fine, but heroin possession for personal use is $20000 and a year in jail.
I think there's room to scale back the penalties and still be a deterrent. I think there's room to scale up addiction recovery.
Hell, keep the horrible penalties, but waive them if the accused, with counseling and whatever other support makes sense, can stay clean for a year.
So much of the system is about papering over problems rather than fixing the root cause.
Most people that fall into heavy addiction are probably driven there more by chaotic circumstances than intellectual considerations.
Social contagion can have significant effects on social issues like this.
You are right. I ended up with easily maintained hypertension and the urge to smoke that probably will never go away.(While on it, I also had significantly worse anxiety, decreased sleep quality, and bubbly urine. I definitely don't recommend trying it)
But the social dynamics between it and heroin are the same. If we normalize its use and downplay its risks, more people will use it. And the physical and social harms from heroin use are far worse than nicotine.
(I was turned onto this after listening to an interview with Dr. Peter Attia [haven't yet made up my mind on whether he is a huckster])
To quit, I switched to vaping for a few weeks, then tapered the nicotine concentration to zero over the course of a month or two. Cigarettes have MAOIs which make it more addictive which is why I switched.
I was irritable for weeks and still get the urge to smoke sometimes(it's been over 5 years since I quit). I don't recommend starting.
I've listened to him off and on, and think he's ok. He tests on himself pretty relentlessly, and still sees patients (though it's a boutique practice). He also appears open to new ideas as new research presents itself. And while crazy people can come from anywhere, he also has all the proper credentials.
There's this guy who hates him lol: https://www.libertariannews.org/2016/03/07/dr-peter-attia-re...
Finally, if you haven't already, you should find the podcast episode where he talks about Theranos. Pretty wild that he was asked to join and turned Holmes down.
Did you get addicted to the gum or the patch?
That's something important to consider when reading about experiences on the internet. There are people who are relatively resistant to addiction. When they talk about their experiences, they make it sound like it's no big deal, and it's not to them. But that's not how it is for everyone.
Nowadays I have a pretty big nicotine consumption and probably extremely marginal nootropic effects.
How many people are going to storm a national capitol because of what they see online?
It all sounds farcical and easy to dismiss until you actually put some thought into it.
You can't just lie to people and tell them that everything is deadly or they're gonna question everything else you've said. That's basically what DARE was.
I know a chainsaw is dangerous. But listening to every Youtuber lecture me about how I have lock out tag out to change a lightbulb my own home and every Redditor jump at the opportunity to engage in a monologue about how I should wear safety classes when I use a screwdriver sure lends a lot of legitimacy to the people who say their dad never wore PPE and retired with all his limbs so it must be fine.
Edit for more context:
Depending on the drug, substances consumed outside of working hours would still show up in a drug test. Firing someone for something they do outside of work shouldn't be acceptable.
If you can prove they consumed drugs that would impair their ability to perform their job during working hours, that'd be a valid cause for dismissal. Drug tests don't measure that precisely enough though.
Not to mention, drug tests are not infallible. They can come back positive for morphine if you eat a poppy seed bagel in the morning [1].
[1] https://www.snopes.com/fact-check/poppy-seeds-alter-drug-tes...
Airline pilots, I believe, have a no-drink-within-X-hours rule. I'm not sure whether X is 12, 24, or more. So even one drink the night before a morning flight would be prohibited, even though logically a single drink with dinner the night before should be a non-issue.
Did you know eating a poppyseed bagel will cause a positive for heroin for upto 60 hours afterwards while doing a small amount of heroin will not show up on that same test.
Here's a non-drug related one. In many places road construction companies will disallow workers from wearing headphones. This is because of the heavy machinery and you need to hear the beeps of a machine backing up. Drivers of those do not have good sight around the machinery and large trailers. Headphones on can mean not hearing a warning sound and being struck and possibly killed.
Are wearing headphones a problem? Do you want to fire someone until an accident happens?
Part of the proactive nature to this is insurance companies. If there aren't strict safety policies that are enforced than insurance companies won't cover companies. When accidents occur they have to pay out and want to avoid that.
Drug use has been proven to cause certain issues depending on the drug that can have safety impacts at work sights. This can costs lives and money.
This is why it becomes a big deal in certain fields.
I had to mummify a guy's hand because it was sliced open by glass, once. They were airlifted to the hospital because the bleeding couldn't be controlled.
Another guy was doing something unsafe with his forklift, probably because he was in a hurry, right before Christmas, it rolled over on him and he died.
That's why we couldn't keep people who were careless for any reason around. People could, and did, die for a moment of carelessness.
You're asking for more of this kind of story.
Make workers do a 30 second ability test before going on shift. Design the test to measure reaction speed, short term memory, etc.
[follow up thought] - Test must be immune to practice/muscle memory. Don't want a drunk passing the test through familiarity, then performing shit on the job.
I think the better solution is to abstract out the judgement into a formula that the pilot must follow, so not courting "gethereitis"
At least pilots mostly actually do their paperwork and checklists, even if they sometimes fall prey to things like neglecting to land their helicopter when they end up in IFR conditions while, say, transporting Kobe to a game.
A) when getting hired B) if you show up to work intoxicated C) after any serious accident
So other than at hiring, which the person can anticipate the timing of, the drug tests are effectively only done after failing such a test to begin with. The average factory doesn't care about hiring people with a record, either, so long as it's not too serious or likely to impact work.
Your test is one of those things that sounds like a good idea until you realize that the people who are needed for some big customer's order are too tired, but still able to work and you don't have anyone to replace them. Rolling the dice on that kind of stuff enough times until a failure happens is what gets factory floors in trouble.
That poor guy just wanted to get home to see his family for Christmas and busted ass to get one more dumpster of trash dumped even if it meant messing with the dumpster while the forklift was on too much of an incline. I don't truly know what he was thinking, but we can make an educated guess that he'd probably done that kind of thing before and doing things the right way took more time and effort than his poor, tired body had left in him at that point.
You don't appear to be aware of all the bad incentives that aren't going anywhere and are advocating something that will cause more people in more factories to roll more dice that will have more injuries. and hoping that the same tired, overworked, short-handed people will make a fuss over these rules instead of rolling the dice as they have so many times before if you just try to warn them or give them tests which they could skip to save 5 minutes they could've been working and then go home that much earlier.
Most of the ways to fix these problems require more staff and/or resources, shorter and more stable shifts, etc. all of which costs more money. Then those labor costs make them less competitive with factories in places like China where they may be trying to compete with literal slave labor in a race to the bottom. The factories already do look at incidents, as well as close calls, but there's only so much you can do when your grand ideas are paired with awful execution thereof.
The best ideas come when you understand their job and help them do things in a better, safer and, ideally, easier way.
A pre-shift only needs to fail once and you have a co-workers recklessness injuring another worker.
I wonder what unions think of drug tests? As a union member I might prefer that my coworkers were tested to be honest if I worked closely with them around heavy machinery.
Many software developers working for companies have agreements that they can't compete with their current employer on what they do while employed there. It's something employees give up while employed somewhere.
In the name of safety, many jobs with safety issues have to give up certain things (i.e. drugs) while employed there.
This same logic would also apply to lack of sleep, and is often glorified as part of the culture (doctors).
First, I'm attempting to describe how the system works rather than give my opinion on how it should be.
Second, the headphones situation is meant to illustrate how safety plays in. This isn't a "what if" example. People on job sites wearing headphones have died because they missed the warning tones. I am aware of one case, personally.
Safety is a big deal. It plays into the insurance companies who drive much of the policies and practices. They are driving the things they do to keep their costs down. Insurance companies often try to be pretty methodical in what they do to keep costs down. It's not just random ideas but looking at cause/effect relationships.
Third, many drugs have effects outside of the time they are used. It's not just the impact of the drug while one is on it but how it affects them in the time they are not on it, as well. From a safety perspective that cannot be discounted.
From the standpoint of the companies and the people involved, if you want to do drugs than work elsewhere. Safety is a higher priority.
I proposed my catch-all solution for this in another comment: https://news.ycombinator.com/item?id=26183297
My ideal is we just ensure competence - guy who smoked weed last night may be more competent than a clean guy getting divorced. Test the competence
It would be great if there was a way to test for competence. Some drugs cause long term issues with decision making and being able to see what's likely to happen. This reminds me of a job I had years ago framing houses. I remember some of the work men firing nails from a nail gun into a nearby woods. An area where neighborhood kids happen to play.
That's poor decision making and a liability. How do you test for complex things like that?
Film the worksite or send surprise inspectors to catch workers too lazy/reckless about their nail gunning. Maybe show them videos of nail gun injuries!
Improper nailgunning I think is more related to ingrained attitude than ephemeral competence degraders (drugs)
> Hart reports that more than 70 percent of drug users—whether they use alcohol, cocaine, prescription medications, or heroin—do not meet the health criteria for drug addiction
> “My heroin use is as rational as my alcohol use,” Carl Hart writes
> Let’s just talk about alcohol first. When you’re at a wedding reception, alcohol serves as a social lubricant. People are more gregarious. They talk, they interact. The same is true with cocaine at parties, heroin among friends, or opium among friends, NDMA among lovers.
> It’s just like with alcohol. Most people drink alcohol on a regular basis, but they don’t become physically dependent
> I don’t know a term. I simply mean people who take drugs, like alcohol users, somebody who may have a glass of wine or two every night for dinner, whereas somebody else may only drink on the weekend. It’s a wide range. And the same can be true with cocaine or heroin
> Why do you use heroin? > That’s like saying, “Why do you use alcohol?”
Although realistically, alcohol is probably one of the worst from a work safety perspective.
No. The worst that can happen to him is that he is pulled over by a cop in the parking lot. Gets charged with possession of heroin. Goes to jail for a couple nights, then looses his job/pension/car/house/wife/kids (in whatever order) and winds up on the street. Regardless of the biological realities of heroin, the realworld criminal consequences of regular heroin possession can be worse.
And I have yet to meet any longterm drug user who hasn't on occasion sold some to a friend. Get caught "dealing" and you will face an entirely different legal regime.
Many street-level drug dealers will still separate the drug and money handovers between different people. This isn't to avoid legal issues. It is to avoid the money being seized when the cops move on the guy they see handing over bags of drugs.
It's been 45 years since it was first established that heroin CAN be used safely when accompanied by a social ritual. Part of the problem IS the mindset and stigma around addiction, and that "insanely addictive drugs" have full power over people, and there is no ability to moderate their use, which is false. People are either 100% sober or a social pariah. The response in these comments mostly confirms this sort of black or white thinking. Maybe somebody should ask if its the lack of social ritual / social controls causing the problem, not the drug. Maybe society is failing otherwise responsible drug use by making all users outcasts. Or is a spectrum and complex interaction of multiple issues, and not just drugs. "This is too dangerous of a conversation to have" puts us in danger of not having productive conversations.
https://web.archive.org/web/20201111183716/https://www.harva...
If addicts get to do that, why can't I do the same to them? Instead of heroin, I'm going to go after a genetic cancer cure, or see what applications of Bell's Theorem I can create on human cellular mitosis and quantum biology.
I think the mistake siliconvalleyites have is that they imagine everyone as intelligent and rational as they think they themselves are which leads them to encourage open discussion.
But it’s clear throughout history that all people are stupid sheep on occasion and their thinking needs to be curated in a way.
Therapeutic use for diagnosed conditions - interesting.
Safety for recreational use - interesting.
As a recreational activity - seems like we have enough fun already without adding more risk.
Just my 2cents.
Years ago I was an office manager at a battery supply warehouse (car batteries not AA’s). We had an employee that had started working for us for about 6 months when it became vary apparent that he had a drug problem. Because his brother also worked there we knew that he had suffered a major car accident, was in crippling debt from the medical bills, and developed a pain pill habit as a result. He was only 19 at the time.
The issues that involved the work place were things like being consistently late, taking 2-3 hour lunch breaks and coming back high. So high, that he could not perform basic job tasks like counting a pallet of battery cores. My biggest concern was that he was licensed to use our fork lifts and so I had our warehouse manager do his best to keep him off the forklifts.
At this point I recommended to my boss that we fire him for the repeated offenses, as well as recommend that he seek drug consoling. I felt bad for him. He had a problem. He needed help. But he did not need to be working at that job for his and others safety. My boss and my boss’ boss, on the other hand, decided it was best to send to him to a “random” drug test, so that when the fired him they could do so with indisputable cause. This did not work, he disappeared for many hours, despite the drug testing facility being just down the street, and the results came back clean. I know that people have many ways of faking drug tests. I suggested again that he be fired for the offenses and not the drug test. Again my bosses disagreed and sent him to two more “random” tests each week after that.
The employee in question got wise to this. He knew what they were trying to do. So he went to a therapist and got a declaration of temporary disability. My company then had to pay him his full wages for 6 months with out him needed to come to work.
And I sat back and laughed at my bosses, as the unemployment claim would have be nominal by comparison.
edit: not sure why this would be down-voted. It is just a real story, relevant to the thread. I was only suggested that waiting for test results when possible danger lurks was not the right course of action. i forgot to add the employee did come back after his psychological disability ran out. And of course they sent him to take a drug test again. He failed that one and was fired.
The experiences of your friends is anecdotal. This article discusses the mechanisms of the drug, both the physical and personal cause of addiction, the common factors that lead to death, and the rate of users that end up addicted.
This seems to me to be a excessively myopic way of thinking about it. To the point of amounting to rationalization.
Third, as someone else says below, stories about your friends are also anecdotes. (I'm sorry, genuinely, that they died.) You don't know "the reality" of heroin because there are a litany of such realities - and here's a scientist telling you about his. The thousands (more?) who use heroin like my aunt uses a snifter of brandy at Christmas don't appear on anyone's radar because they're not dying and they're not rocking the boat. I could go on and on about the lives lost or ruined by alcohol in my family tree alone, let alone just "people I know", but I'm not terrified and calling to ban alcohol.
Finally, that so many people on a web forum whose userbase is wealthier, whiter, and way more privileged than the population at large rushing breathlessly into a post to call a black man (from the ghetto of Miami FL, no less) who uses small amounts of opiates "dangerous" is, excuse me, pretty effing rich. I thought tech-libertarians were supposed to be less reactionary.
On the WHO lists, alcohol ranks below heroin and the like, but not far below, and certainly not as low as cannabis.
Harmfulness seems largely irrelevant for legislation.
Responsible drug users are invisible to society and to judgemental people like you. You have no data to discredit it.
With the exception made of MDMA & speed (That I'll consume both on occasions) I was consuming weed, hash and mushrooms on a weekly basis.
And everybody on a certain group of friends was doing the same. We had a surplus of mushrooms, as we had somebody in our group (A neurobiologist) growing them.
13 years ago I came back to Argentina, and then stopped consuming cold turkey.
And in the end, it's only alcohol and nicotine that have me firmly in their grasp. Perhaps it's just the ease of access.
I believe I could quit nicotine, but not alcohol. I don't even drink a lot. But I do, regularly. I've used way more addictive stuff, and I could go out and buy it tomorrow, but I don't. Kind of funny how it works.
I mean, there's the billions of people who manage to consume alcohol without it interfering with the rest of their lives and the lives of others. Don't pretend that one substance that alters perception and behavior somehow isn't a "drug" in the same way that many others are just because of its legal status.
But if you mean drugs that are illegal, yes, there are also plenty of responsible users of those too. My wife and I have taken MDMA together a few times and it has been transformative for our relationship. As well as sharing our love for each other it also helped us talk about difficult subjects, something which I found hard for a long time, and as a result I am now better at talking about hard things when sober too. I think most people would say that going on a date night is a "responsible" act of relationship maintenance and I don't see what we did as any different, except much, much more enjoyable than a cocktail and meal. Every time we were careful with dosing, made sure we had no other responsibilities, and so on. It's as responsible as quality time with each other at a cafe.
I recognise that the production of illegal drugs is damaging and awful, but that's the fault of our legal framework. In the same way that producing soft drinks or beer isn't necessarily damaging nor should be producing drugs that are currently illegal.
Even more so, _nobody_ wants to hear about responsible drug users, because that'll contradict the general discourse.
I wish people didn’t dismiss Carl Hart immediately out of hand. Prohibition has never been a successful strategy. People are going to buy drugs no matter what. The biggest problem we have with drugs in the US is that people are uninformed about safe drug use and they are unable to easily verify the purity of the drugs they buy.
I’ve lost dozens of friends and family to alcoholism and drunk driving.
I can’t really get behind the cherry picking; society is being damaged in other real ways to a much greater extent than heroin, yet we find the ennui to overlook them; freedom of choice, speech, too expensive to bother, political authority...
Portugal has the model we should adopt and let this be as solved a problem it can be.
Stigma around drug use is dangerous. This is extremely evident from the state of treatment of heroin addiction in society today.
I don't really see how challenging this stigma is more dangerous than pandering to the status quo here.