Item — HN Reader

It is a generalisation but a good one. "Getting clean" is a loaded term. Most (not all) people who have "drug" problems actually have police problems. The drugs do them very little harm (impurities are a different story, but not as common as people think) but the police and legal systems do them untold damage.

Making the drugs available is by far the best treatment for most forms of drug addiction in the vast majority of cases. The simplest way to do that is to remove criminal sanctions from drugs and make prescription for addiction legal.

Addiction is a complex beast and demanding that people deal with the chemical dependence before dealing with the other problems in an addicts life is usually a cruel approach and ineffective.

This is something a psychiatrist should know.

1 comments

I can't really agree with your premise. Our current situation is pretty broken, and our drug laws and enforcement have not achieved their stated aims.

That said, the legality of alcohol hardly keeps it from causing lots of people very serious problems. "Drugs do them very little harm" is fantasy, though you are quite right that a felony history and time behind bars only makes things worse.

I'm curious about a couple of your points here.

First, when people involved in addiction treatment say that drugs cause people serious problems aside from legal issues related to the drug itself, I wonder if they are biased by only seeing the users who hooked badly enough to land themselves in various sorts of rehab/therapy programs. Do we know how many people are using these drugs in a more casual way, suffering little to no real harm from them, and never coming to the attention of the legal system?

Second, you say below in reference to heroin being dangerous how many people die of overdoses every year. I was under the impression that the reason overdoses are so common is that, since it is illegal, there is no regulation or easy way to determine the purity of any given batch of it, so it is easy to accidentally overdose if you get a stronger batch than you're used to. If opioids are really that fundamentally dangerous, why is long-term monitored use of methadone etc not considered to be a bad thing, as opposed to going cold-turkey ASAP?

1. There is a strong selection bias among the people I see, biased towards people who are much more impaired. That said, many of them had a pattern of spending more time/energy on their addiction causing themselves lots of problems before they sought help. It is true that for some substances there are many people who use recreationally without major problems, and I don't see them (and don't need to see them) for treatment. I have never seen a casual user of intravenous heroin, but perhaps there are some.

2. Difficulty establishing purity is one issue, but the overdoses happen just as often with prescription pain pills with predictable strength. Many people will continue to chase a bigger high and get in trouble that way. Other people (as described in the article) will stop using for a time and lose their tolerance, then assume that a dose that was previously safe is OK. Then they stop breathing.

Methadone clinics generally provide the same steady dose, which avoids this problem.

"There is a strong selection bias among the people I see" This is a real problem in drug policy. The majority of drug users stay well clear of medical professionals. They learn quickly not to discuss their habits with doctors or nurses as it leads all sorts of problems.

Prescription pain pills are not heroin. They are dangerous in overdoes because of the effect they have on the breathing reflex. It is a common practice among the drug addicts I knew to never let a fellow user 'nod off', that is loose consciousness as it leads to death when they stop breathing.

This is not a problem for heroin addicts using heroin. But (in the world I inhabited 15 years ago) heroin was very rare.

I'm a former drug abuser. I'm white, so I got away with too much I shouldn't have by the legal system.

1. Absent a legal system, a person still has to live in society. To be healthy a person must maintain themselves and their place in society.

Drugs perturb the systems in your brain that give you that ability and awareness. Many drug users already have history with mental illness and make that awareness aspect worse.

2. It is a powerful respiratory depressant. There is a fine line between pleasure and not breathing. It's very easy to tip the scale, especially if you're injecting it directly without an 'undo' switch (vomitting). You lose the ability to care because you're chasing a fleeting feeling.

Tolerance plays a huge part. Someone taking a 10mg hydrocodone pill for the first time might end up higher than the guy who just slammed 5 grams of heroin just to be well for the next few hours. If the first guy did 1/100th of that he might be dead.

Time, purity, dosage and most of all the unknowable limit your body has play the biggest role here.

Opiates combined with other respiratory depressants = death. Alcohol, cough medicines, anxiolytics and sleep aids can kill you if combined with opioids.

Methadone is a wager an addict makes with a professional. It's dangerous (it's a r. depressant), it's addictive and it fucking sucks. But for some people it beats living like trash to find the next high.

For most non-hardcore addicts, methadone would be a terrible thing.

What harm does heroin do a person? Pharmacologically it does very little. Addiction is the main harm.

The vast majority of drug users do not have problems (almost every adult uses drugs) except problems with the legal systems.

This is well known and extensively documented. I would encourage you to study what has happened in Portugal over the last decade.

Different drugs have different effects. Alcohol is one of the more dangerous yet is legal and a huge business. More dangerous than cocaine, heroin, ecstasy.

See David Nutt's research from the UK.

http://www.businessinsider.com.au/alcohol-more-harmful-heroi...

http://www.sciencemediacentre.co.nz/2010/08/06/professor-dav...

You are kidding, right? Do you know how many people die of opioid overdose every year?

I'm not arguing that criminalization has helped, so let's keep these two lines of thought separate. Is alcohol more dangerous than heroin? Perhaps, and David Nutt's research is very interesting on relative harms, but it doesn't magically make either one totally safe.

"You are kidding, right? Do you know how many people die of opioid overdose every year?"

Not of heroin overdose. Often "heroin overdose" is reported in the MSM but it is inaccurate