Smoking heroin doesn't make it any safer

boing
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It’s a huge problem for a lot of people. But, no, not for everyone.

High-functioning addicts are still addicts. Some people are unlikely to ever become addicted (me, for example, as opiates make me feel angry, sick, and the opposite of euphoric) but nobody can assume that they’ll be among them, and those that aren’t–which is the majority of people, sorry–won’t usually figure it out until they’ve already got a problem.

When you talk about “medical grade” you should know that most addicts don’t start on heroin, they start on pills, which eventually become too expensive, and they turn to heroin because it’s significantly cheaper.

It’s cheaper less because it’s “low grade” and more because it’s has been adulterated with other substances in order to maximize profits, but in terms of what the active ingredients do, it produces the same metabolites as morphine, albeit with some variation in ratio.

So while I understand what you’re getting at, and it is technically true that most people who try heroin don’t end up sticking with it, please don’t minimize the risks. It is still a very dangerous thing to do. For every one Paul Erdős, there are a dozen nameless people whose lives were ruined, or at least came to near ruined because of drug abuse. (Yes, I know Paul Erdős was an avid amphetamine user rather than opiates, but that’s not really relevant) I don’t just mean heroin, either, I mean prescribed medications too. If a doctor prescribes you (speaking generally) opiates to control some kind of pain, take only the bare minimum needed to control that pain because pain is definitely

Some of those nameless people were my friends. They’re dead now. I’ve got other friends that I hope to god don’t join them. Please don’t downplay the risk, and if you consider yourself among those who will “never” get addicted, please stop now if you can. It’s not worth the gamble.

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How do you read "It’s a huge problem for a lot of people. " and interpret that as “minimizing the risk”?

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About 3/4 of casual heroin users never become addicted to it.
Lots of anecdotal evidence that medical-grade heroin or morphine can be used by high functioning individuals for decades without being “fucked up” by it.
It’s a huge problem for a lot of people. But, no, not for everyone.

Don’t cherry pick your own words. I was responding to the overall message you were conveying, which appears to me to be, “heroin isn’t as dangerous as you’re making it out to be because a lot of people don’t get addicted to it.”

There is a meaningful variation in the susceptibility to opiate dependency and addiction in general, but if you use them long enough, you will become addicted. There’s no way around that. You speak of “casual heroin users” as though that’s really a thing. While there are certainly some people who fit that description, they’re not a large enough group to matter. Casual opiate users tend to stick to pills because they mistakenly believe they are safe, and because they don’t carry as much social stigma as heroin. That is how the vast majority of heroin addicts start out, at least in the US. People tend to move to heroin once their pill habit has become too expensive to sustain.

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You will become physically dependent. There’s a difference between physical dependence and the syndrome that constitutes addiction.

At an earlier time in my life, I used opioids, medically, for severe pain. I went through a whole series of wrong diagnoses before they hit on the right one, which was correctible surgically.

I had surely become dependent on the opioids physically, and had to have a careful taper - which I accelerated somewhat, thinking that the withdrawal symptoms were tolerable and wanting to get off the stuff as quickly as I could manage with only ‘some discomfort.’ The withdrawal, while not pleasant, was surely better than the horrible pain for which I was on the drugs to begin with!

At no point did I have drug cravings beyond the withdrawal symptoms. I’ve had the stuff a couple of times since for acute indications (sedation for a surgical intervention; a sprained knee; that sort of thing). Aside from that, I haven’t touched it, and don’t miss it any. I used it because I hurt - and stopped it once I didn’t hurt any more.

I don’t think that anyone in the field would consider the physical dependence I once had to be an addiction. It missed several of the criteria:

  • Inability to stop using. I stopped.
  • Failure to meet work, social or family obligations. Except for the period of hospitalization and a couple weeks’ recovery time (plus a few hous off here and there for visits to various doctors during the “wrong diagnoses” period), I reported to work normally, attended conferences, did volunteer work, oversaw moving the family to a larger house (my daughter had arrived a year earlier), and so on.
  • Drug tolerance. Check. After six months or so I was on maybe 2-3 times the dose I’d started with.
  • Withdrawal. Check. Unpleasant.

The last two symptoms are symptoms of physical dependence, but addiction is not diagnosed unless all four are present.

Now, perhaps, you are arguing that had the medical use continued longer, the psychosocial syndrome would have followed inevitably. Or perhaps you’d argue that I’m in denial, despite the fact that over twenty years later, I’m happily married to the same wife, planning a wedding for our grown daughter, and still employed at the same company - albeit contemplating retirement. I’m going to be charitable and assume that you don’t consider the difference between dependence and addiction.

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A bunch of panicked reports start appearing in English around 1965-- at least according to Google ngram viewer. The citations before that are a misdated citation (from a book that was first published in 1833 and has been updated and revised ever since), and a reference to children chasing dragonflies.

https://books.google.com/ngrams/graph?content=chasing+the+dragon&year_start=1800&year_end=2000&corpus=15&smoothing=3&share=&direct_url=t1%3B%2Cchasing%20the%20dragon%3B%2Cc0#

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Your one anecdote proves what? That you were remarkably fortunate when so many were not? Or are you using it to bolster the notion that you’re somehow superior to people who do succumb to addiction?

It’s disgusting that I’m even having this conversation. In 2016 over 63 thousand people died of opiate overdoses in the United States alone, but you didn’t become addicted and that means what? Why muddy the waters of a global epidemic with utterly pointless anecdotes that mean nothing against the overwhelming majority of cases?

Congratulations on being an exception, but quite a lot of people are not. Furthermore, you assume that addicts can’t hold down a life. Do you have any idea how many productive, conformist suburbanites hold down six figure jobs while having a spouse and two children? The fact that they continue to meet society’s expectations while cold-water extracting 30 Vicodin a day means they aren’t addicts?

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So somebody who had a different experience with the drug is supposed to shut up and not talk about it because it might make people believe the truth that not all outcomes are the same?

Is the Fox News style of reporting catching on even here?

A broad perspective doesn’t diminish the plight of those suffering from addiction. Considering all the possibilities is what allows people the best chance at making informed decisions.

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I’m not saying they can’t share their opinion, I’m questioning their motives for doing so. Are we seriously arguing about whether or not heroin is a dangerous drug? Because it sure seems that way.

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Seems to me his motivation was to share his personal experience with getting off the drug, one he wanted to get off quickly.

And here’s the thing about that:

  1. There may be something to be learned about that. Why was he able to get off the drug when so many can’t? Willpower? Genetics? An all kale diet? There might be something useful that can be used to help those that struggle with this addiction.

  2. Simply by sharing a story where he could live a normal life by powering through the withdrawal symptoms might give someone hope they could do the same.

So even though it doesn’t fit your narrative, what he had to say might actually have been helpful to the people you claim you want to help.

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My doctors told me that my experience was closer to the norm, and the available research bears that out. Most pain patients quit the drugs pretty readily if the underlying condition is cured and the dose is carefully tapered. Only a minority develop the psychosocial pattern of addiction. I’m not “remarkably fortunate,” I’m typical.

The fate of the minority who do develop addiction is a major public health problem. Criminalizing patients and doctors does nothing to solve it. If death from overdose isn’t a deterrent, why would the additional threat of prison be one?

Treating patients and doctors like criminals only exacerbates the problem. A patient scores too high on a drug test? He must be supplementing the prescription with street drugs. Too low? He must be diverting the prescription. God forbid he should have good days and bad days, because that pill count better come out exact! Otherwise, he’s lumped as ‘high risk’, cut off without taper or social support, and faces the choice between street drugs, a lifetime of agony, or suicide.

Nobody does these drugs because they think they’re safe. Coming up with ever more draconian deterrents only increases the suffering for both the addicts and the patients and caregivers caught in the ever-expanding legal net.

Now, can we please talk about harm reduction? The current policies are set up to give even more power to the police - plant a bag of dope on one of those people, and you get to rough them up and then send them up the river for a long time. This sort of thing i isn’t working. I’ve not heard anything from people who scream and shout about the prescription drug crisis, other than that we simply haven’t pursued prohibition hard enough.

How’s Portugal doing?

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Do you seriously think that I’m against harm reduction? I’m absolutely pro-harm reduction, I’m against minimizing the dangers of opiates. I have friends that are dead because of them, and I have friends who are currently undergoing treatment.

I am very much on the side of the people who are suffering, not some jack-booted fascist who wants to revive the war on drugs.

Regardless of what your doctors told you, you are lucky.

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I would lay long odds that your deceased friends are not dead because of FDA-approved opioids prescribed for them by a physician. In fact, we don’t have an addiction crisis - addiction rates are stable - we have an overdose crisis (largely related to street drugs). The Portuguese experiment suggests strongly that if addicts have access to a ready supply of drugs of known potency, they don’t die - at least not in the horrible numbers that we’re seeing today. The first priority here has to be preventing the premature death, and the changes (safe injection sites, needle exchange, opioid maintenance therapy, decriminalization above all) are fairly simple - but don’t fit our moralizing attitude. That attitude now extends to labeling medical patients as weak - and doctors who believe in relieving suffering as enablers.

I am indeed fortunate - but well over 9/10 of other pain patients are equally fortunate.

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You are really missing my point here, you seem to think that I’m casting moral judgment on people who use opiates, and I’m not doing that. I literally decried the exact thing you’re accusing me of.

What I take issue with is people minimizing the risk when it is very real. Those deceased friends? Both started with legally prescribed, FDA-approved opiates. They were both addicts, and never would have been if they hadn’t been prescribed excessively powerful drugs to mitigate the pain from their health conditions. One of them died from an accidental overdose caused by an opiate-induced lapse of memory, the other died because he became heavily addicted on prescribed drugs, and ended up moving to heroin because they couldn’t afford the legally prescribed medications anymore.

I am in favor of harm reduction, needle exchanges, maintenance therapy, physician-assisted cessation, and even controlled administration for highly resistant cases. Giving addicts a safe, clean place to go, where they can use under controlled conditions without risk of arrest is ultimately a good thing.

Your replies seem to suggest that you think that I’m advocating for harsher penalties, and that is absolutely not the case, and I really don’t understand where you got the idea that I was. I am, as I have been from the beginning, speaking as an advocate for the people struggling with addiction, the first sentence of my post that started all of this:

I wonder sometimes if the biggest motivator that people have for treating addicts like shit is that it’s a category of people that they can irrationally hate with little risk of judgment from others.

I am lambasting people who cast moral judgment on what is ultimately a medical issue, and trying to warn people that virtually no opiates are “safe.” Virtually any one of them (loperamide doesn’t pass the blood/brain barrier in meaningful amounts, so it isn’t a risk) can result in addiction so people need to be well-informed about those risks and if they are prescribed medications, they not only need to follow the dosage guidelines, but they should question whether or not the dose is too high. A big part of how we got into this mess was because pharmaceutical companies in the 1990’s lobbied the government and engaged in a massive marketing push to convince people that opiate painkillers are safer than they actually are. There is a massive over prescription problem in the US, with some states like Arkansas, Indiana, and West Virginia actually having more opiate prescriptions written per year than there are people in the state. We’re talking like 110 prescriptions per 100 people, those numbers are absolutely outrageous.

The thing that I’m taking issue with is people downplaying the threat that opiates pose to your well-being. I’m not saying they should be banned, but I am suggesting that people be very, very careful when dealing with long-term use of prescribed opiates because that is a common vector toward abuse.

I took objection to a comment that seemed to downplay the horror of addiction by talking about the fact that some people can be completely addicted to opiates, or any drug really, and lead apparently normal lives. I know enough living addicts to know that, yes, on the surface that appears to be the case, but that’s just superficial. Being an addict isn’t fun, it’s a scary and depressing thing. Even if you can maintain the trappings of a “normal” life, you’re still under the control of a substance that dictates where you can go and when, leaves you up at night worrying about running out and not being able to find/afford more, not to mention the immense amount of guilt that addicts have been told they should feel.

Roughly 30% of people who are prescribed opiates abuse them. About twelve percent of those people develop a problem. 80% of heroin addicts start by misusing prescribed drugs. I live in the Midwest, and we saw a 70% increase in overdoses between July 2016 and July 2017.

So it’s great that you had a positive outcome, and I’m genuinely happy for you, but whether you realize it or not, the things you’re saying aren’t going to amount to any good outcome. It’s not that I don’t believe you, it’s that I’m more concerned about the people reading it who have opiate problems that they’re still in denial about. People in that situation, and there are many, tend to hang on tightly to anything that helps delay the inevitable realization that they have a problem. They read things like your post and say, “well yeah, I’m like that guy, I can stop any time.” Some people can, but a really depressing number of people can’t.

I was on a long-term opiate prescription too, as well as a long-term amphetamine prescription. I didn’t have a lot of trouble quitting either of them, but that’s immaterial because lots of other people do. Tens of thousands of people die every year from overdoses, the fact that you or I didn’t develop a serious problem doesn’t change the fact that lots of other people do. I’m not condemning anyone (apart from judgmental people who assume that addicts are bad people, or who feel justified in treating them like garbage) I’m condemning what I see as the irresponsible diminution of of a very real and serious risk.

I’m strongly in favor of decriminalization, harm reduction, and medically-supervised use for people who simply cannot quit, but they’re not the people I’m talking to or about. The people I’m talking to, the people that I’m trying to warn, are the people who aren’t knowingly addicts, and who are under the mistaken assumption that prescription opiates are “safe” because they came from a pharmaceutical company, when that is simply not the case. That’s a massively pervasive misconception, and it has created situations like nearly 3% of high school seniors have experimented with Oxycontin, and that number jumps up to 7.1% for people between the ages of 18-25.

Your anecdote is nice, but the reality of my situation is that I carry Naloxone in my car in case I get a panicked phone call from someone too scared to call 911. It wouldn’t be the first time. My point is, opiates are more dangerous than most people often realize, that addicts are just people with an illness and should not be villified, and that anyone who has been prescribed an opiate should take exercise extreme care.

So what exactly is the point that you’re trying to make? That not everybody develops a problem? Big damned deal, it doesn’t change the fact that a huge number of people do, nor does it change the fact that opiates aren’t dangerous.

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OK, we’re roughly on the same page.

You’re right, they’re dangerous - which is why I tried hard to get off them as quickly as possible once they were no longer warranted.

Most everyone who harps on the point that “opioids are damned dangerous” leaps to trying to restrict prescribers from using them, trying to force stable patients off them, limiting the total quantity that pharma companies can make, and similar draconian measures. Jeff Sessions himself has made odious remarks that medical patients should just “take two aspirin and suck it up.” Sorry if I leapt to the conclusion that you were on that side of the fence - it seems as if half my countrymen are in favour of having the police make medical decisions, physicians and patients be damned.

I now consider, given your post, the possibility of carrying naloxone in my emergency kit, so thank you for that. It would join the glucagon, epinephrine, diphenhydramine, famotidine, and salbutamol that are already there. I’ve been fortunate enough never to witness an opioid overdose at first hand, but there’s a first time for everything, I suppose. (There are a half-a-dozen other drugs that join these in my wilderness kit. If I’m travelling twenty miles from the nearest road, there’s stuff I might need that I could otherwise get at the nearest ER. With most of those, if I start them, I have to see a doc, but I have to get to a doc.)

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