For those that don't know, I am a former heroin addict who has been in buprenorphine maintenance going on 5 years now. I plan on giving total abstience (from opiates) a go sometime in the coming months. I am writing a series of diaries on drug prohibition, aka what is currently known as the "War on Drugs." This would technically be my third installment. My second, a diary that got little notice: Drug Prohibition: a Primer on Drugs From my Vantage Point
consisted of my personal opinion on "recreational" [read: self-medicinal] drug use in general.
I ask you shamelessly to please recommend this, as quite to my surprize there are many on DKos who have personal reasons to read this, and I want them to read it, every single one of them, and I write and dedicate this to them.
continued below the fold
While I strongly advise you to read at least the first edition, Treatment for heroin/opiate addiction: a primer, I realize that many will not and I will reiterate major concepts in this diary to some extent. Luckily, I think, many who are reading this have read my first diary on this subject (or hopefully already have knowledge of it's subject matter.)
This diary is certain to be quite long, so do be prepared. The one apology I will make is for it's length, but it is unavoidable, so I guess I am just sorry that is the case. If it's too much for you, skim it, read pieces of it, whatever - but hopefully read it in full whenever you can.
[As I stated in the "primer," the correct term for "opiates" generally where used here is "opioids," as I stated in my other diary, but I will use "opiates" just because it's far more common and easier to read. This is not a scientific paper, and this is not the place for making sure every bit of [scientific] terminology is correct, and it's just unnecessary for the most part.]
A Few Plugs
Most of these plugs have been outlined in my first diary. I will mention those that aren't.
Thanks to Subversive for infoming me of this group.
There are many other drug reform groups, but many focus solely on marijuana. I will not plug them here.
I mentioned Ibogaine in my previous diary, as an edit. It is a hallucinogenic drug that some feel makes the drug user re-evalue his or her life and no longer desire to use drugs. There is clinical evidence of it's effectiveness - which you can find at the above organization - however I still feel it's to be taken with a grain of salt. However, it has helped many people quit, and for that I am grateful. That said, I do not think Ibogaine will be some miracle cure for heroin/opiate addiction. It needs much further evaluation and scientific study. THAT said, I see little harm in giving it a try - it has been proven safe. I hope.
This topic is important for many reasons
It's important, for one, because it's a political issue - one that is strongly regulated by federal and state law, in both the illegality and (often extremely harsh) punishment (what is supposed to be "justice") regarding opiates and other drugs, and the equally strongly regulations by federal, and to a lesser extent state and even local law, regarding maintenance as a treatment option. I am not sure I made this clear in my first diary, but as stated in the CSA (the Controlled Substances Act of 1970,) the (HUGE) federal drug law regarding drugs both illegal and prescription, amended dozens of times over the years (essentially any time they change any drug regulations, including the DATA of 2000 described in the primer,) prescription of opiates to treat opiate (including heroin) addiction is illegal except under very specific circumstances, which I outlined in Treatment for heroin/opiate addiction: a primer. I discuss and outline the CSA briefly in Drug Prohibition: a Primer on Drugs From my Vantage Point, under it's own heading which you can scroll down to if so inclined. I will discuss the CSA much more in depth in coming diaries.
Unfortunately (for me) this diary won't be fingering Bush or the neo-cons anywhere, in fact buprenorphine was approved by the FDA in October 2002, under the Republican Administration, leaving many in quite a bit of shock, especially considering all the stonewalling that went in to buprenorphine's FDA approval (as a maintenance medication, buprenorphine has been used for pain for decades.) There will be plenty of fingering of the Republicans, of many stripes, even the neo-cons, and the "War on Drugs", however, but mostly in diaries to come. Because it's a political issue, it's important to understand it when it does one day come to further debate.
It's also important in a non-political way to understand about drugs such as heroin, which is becoming, if it hasn't already, a major force in our society - America in particular. It's important we are all educated about these matters so we can help those in need and respond properly, politically, when necessary. It's also important for those who have had to experience the tragedy of a heroin addict whom is friend or family - or a drug addict in general, to a lesser extent in this particular diary, for that matter.
It's important because in order to discuss drug prohibition, and the implications of legalizing drugs, we must understand drugs. And the so-called "hard drugs," which tends to be a euphamism for "[physically] addictive drug," are poorly understood - if at all - by virtually anyone who hasn't been exposed to them directly or indirectly. "Hard Drugs" mainly consists of Heroin, Crack and Cocaine, Speed [Meth/Crystal Meth,] a hugh problem in much of the country, on par or worse than heroin IMO, but virtually non-existant on the East Coast at this time although we've seen some growth - which has even been associated with "immoral homosexual club orgies" by the SCLM (although not in those exact words, of course.)], and finally the no-longer-used ["recreationally"] Barbituates. Some people would consider drugs such as Acid and PCP "hard" drugs, but I do not, although they are clearly borderline, as while they have no addictive properties (PCP [aka "Angel Dust"] might but I don't think so, and it's a rarely used drug today,) they do have long lasting, if not permanent, effects, most notably with Acid.
I have personal experience with all of these drugs, except for crack (used once - I think. You know things are bad when you aren't sure if you have used crack,) and Speed, of which I haven't had the experience of using it's more potent forms. I take some sort of pride in understanding what I am taking - although, obviously, I ignored the dangers (which mainly consisted of addiction) for many reasons, which I will discuss.
Finally, it's important a source of non-propagandized information. I guess I can't really be considered a neutral source, as I am a former heroin addict who is currently in maintenace, and am clearly advocating maintenance. There also were 3 or 4 AA/NA advocates who vehemently objected to my diary (actually, there was only one (really) vehement objection which I couldn't respond to without getting angry, as it contained quite a bit of mis-information, so I didn't. However, where the facts are concerned, the facts will remain as facts, and I will do my best to let you draw your own conclusions. There will be no "spin" in this diary, except to advocate maintenance [which is not synonymous with methadone] as a valid and important treatment option, unless I make it clear I am doing so by stating my opinion. Most of it will be in the "Personal Statement" headings, which happens to be the next heading - where I will make a lot of opinion very clear. However that is opinion, and I have no conflicted interest, such as belonging to some group or having a financial stake in another. The only interest I have is seeing, and hopefully helping, people succeed.
Another Personal Statement - Part I - Group Therapy
I first want to wrap up something I was talking about earlier first, real quick. Believe it or not, Acid is an extremely popular and available drug - at least when I was in high school - 7 years ago - (virtually anyone who smoked pot (with some regularity) has used it,) and in the places I lived. I think ecstacy has to a large extent replaced it. There always seems to be some extremely popular "hard" or semi-"hard" drug among teenagers (and on the West Coast and much of the country for that matter I have no hesitation in saying at the current time it is Speed, along with Ecstacy.)
Another important topic I want to address is Narcotics Anonymous. As I said in the heading - this is a personal statement - this is 100% opinion, but with factual backup as available. This is not meant to state outright "I am right and you are wrong," because I hoped to keep this as controversy free - and objective - as possible, which is less likely in this edition. Please, let's not turn this into an AA/NA vs. everything else fight, to those few (here) whom strongly believe in NA.
I even included, in Treatment for heroin/opiate addiction: a primer, an entire long post by glibfidget, which while I disagreed with and included my rebuttal, was well-thought-out and not inflamatory, and I thank him for that. I am writing this not as a rebuttal, or to defend myself, but to clarify a vital point I should have made the first time around.
I won't address Alcoholics Anonymous here, I will only say that due to the reason that alcohol isn't illegal, some of the problems I have with NA aren't relevant to AA. Also, some of the family help groups by the same organization have very little objections by me, and for people who are religious are a very nice thing - as long as those people realize that these groups are for comfort through friendship and not to be a source of information - especially a sole source of information.
Back to NA. I have a problem with NA, several problems with NA, and I would be less than honest if I didn't make it clear right now. It is important to say that these problems aren't exclusive, most of them at least, to NA. The problems (most of them) is with group therapy, especially in this model, in general. So this isn't really about NA in particular - although there might be one or two specific objections to them. It's just that they are the poster group for this type of therapy.
I have been accused (by one or two people) of taking "pot shots" at NA. That sounds like a talking point to me, no offense, and I didn't take the so-called "pot shots" at NA in my first diary - although I made a brief mention in a comment, and even that mention was hardly a "pot shot." Now, while it is extremely important to mention that there is no one-size-fits-all solution for such a complex problem as drug addiction (heroin in particular,) I feel that NA is a poor choice for the treatment of heroin addiction. It has worked for some people - in which case I say "GREAT!", (my neighbor sucessfully quit drinking while in AA for that matter,) but in many people it proves to be a downfall more than a hand-up, and it's hard to know exactly who these people are until it's too late.
I know there are a few people here who personally know someone or they themselves personally succeeded in NA/AA when they failed at everything else. It's normal to feel so strongly about something in such a case. However, to these people, I ask, did they try maintenance? I doubt it. Were they even heroin addicts? There is a big difference when we're talking about heroin. And I, personally, know thousands (perhaps close to, at least,) of people who were absolutely doomed to death and/or prison without maintenance. I hope I am making this very clear - nothing works for everyone. If you want to try NA, that's your business, not mine, the important point I am trying to make is that maintenance is a necessary alternative.
Glibfidget did a great job, I think, defending your organization and beliefs, so I ask everyone to go read that post in my diary if you haven't, to make sure the other side is has an adequate voice.
Anyway, why could it be a downfall? Because, in some cases, you are sticking someone who is trying to get out of the drug using lifestyle right in to a group full of those exact people they are trying to avoid. I can't emphasize this enough. And heroin, to a heroin addict, is simply irresistible, and considering the chances of long-term (not permanent) abstinence for heroin addicts, as was mentioned in the "primer," is about 5%-15% depending on the study you look at - you are only that much more lowering your odds. I don't think anyone will argue that getting drugs, (and people secretly using drugs,) is a pretty rampant problem in any group therapy situation.
NA has not allowed scientific studies of their treatment method - a very eyebrow-raising piece of information. So while it's hard to say exactly what the success of this program is, IMHO it's safe to assume the worst - what valid reason could they have for such a denial?
Maintenance, on the other hand, has been studied in depth, and has a sucess rate of upwards of 50% (over the long term, many use opiates/heroin on a couple of occassions most notably at the beginning of treatment,) for while you are on maintenance, of keeping people clean. The success rate of eventual abstinence, however, has not been studied very well, or at all in buprenorphine's case [in which case I suspect the results will be astonishing - in fact I have some anecdotal proof of that personally - which I unfortunately can't share,] and what little solid studies are available show success at abstinence being about the same as those who haven't been on maintenance (with methadone.) I had to highlight this, as it's an important fact, but I will delve into it further later and I have quite a bit to say about it. However, whether or not maintenance increases your chances of eventual abstinence or not from a statistical point of view, it can be argued that it is quite simply the only humane thing to do in many cases - and can work, quite well, as a lifelong maintenance drug even though that's not the goal. If you want to know more about maintenance, how it works, and why it's humane, you'll have to read Treatment for heroin/opiate addiction: a primer.
I will end this little bit by simply saying that in the end, trying to get clean, if your odds are indeed the same (which I will argue against throughout this diary,) it is simply showing how different things work for different people - which is most definitely the case - although it is my belief that some methods are clearly better than others (if eventual abstinence is your goal,) and I intend to use other facts to back up my opinion.
Let's get personal. When I finally got into treatment, I was in France. My supply of heroin ran dry, and I was left in withdrawals with no hope of heroin. My mom, the blessed soul that she is, even tried to find some heroin for me she felt so bad - those withdrawals were truly the worst in my life - and I have "kicked" hydrocodone (what is considered a weak opiate, although in some people such as myself has a much stronger reaction similar to oxycodone[oxycontin], and one of the most commonly prescribed medications, on more than one occasion, and even did it undetected - attending work and all!) She went to the hospital to find me a doctor. Thank my lucky stars I was in France, where buprenorphine was pioneered as a drug treatment and readily available to those in need, and I got on buprenorphine - and continued to be on it until it was approved via participation in research programs and trips to France.
Why should I "thank my lucky stars" I was in France and got buprenorphine? Well, the important thing here is that if I didn't, went through the withdrawals, and went home, I would have been back on heroin within a week. It's extremely sad to admit, but there is no doubt in my mind - in fact I even used some, one bag I had left over my family didn't find - right when I got back. And thanks to buprenorphine, it did little, and I kept with it. I haven't used illicit drugs in over 3 years now, and don't plan on it, and have only used them about 3 times during my entire 5 years in maintenance.
There's another reason I should be thankful, and that's because methadone, in comparison to buprenorphine, is a terrible alternative. I will get in to this later.
The main point here is that, even though I wanted to quit - hell, I intended to quit during that trip through tapering (which proved to be impossible,) I still would have immediately relapsed. Yes, this is but one anecdote, but it's my anecdote, and one that needs to be told. It happens all too often.
Continuing on this train of though, we lead into another problem with NA/AA. I don't know about NA, but with AA you have to be clean for 90 days before you can really begin - and if you fail, you start again. This isn't too bad, but people can fail just one day - I did - 3 times - without having a total relapse (although I was on maintenance making total relapse less likely.) This can cause major grief, guilt, etc., for the person in therapy. I mentioned to glibfidget the "look in a junkie's eyes who has tried to quit time and time again yet failed." If you have ever seen that look....I hope you will feel, as I do, that maintenance for these people is the only humane choice.
However, if we get out of the realm of NA/AA, we find many crackpot money making schemes. My parents found one, looking for some therapy for me, I unfortunately don't remember the name of the organization. They had a one year program, and if at any time during that one year your urine comes up positive, you have to start at the beginning. I don't think I need to explain, at this point, why such a system is nothing more than a crackpot money making scheme, one that will cause extreme harm to the user.
Alright, let's get back to the subject at hand. I have another major objection to NA/AA, and that's the "giving yourself to a higher power" aspect of their program - a critical aspect. If you truly believe in God, then this isn't an issue. But if you don't, it's almost unhealthy, trading one addiction for another (although everyone has addictions, and trading one for another is often an element of success in getting clean - although it is possible otherwise.) I even, as an atheist, take offense to it - that they offer no alternative to offering yourself helpless to god. Of equal importance is the aspect of helplessness to drugs that NA, and many other group therapy systems, preaches. Drugs aren't the problem: You are the problem. I can't emphasize this enough. If you can't realize you are self-medicating your problems, and until those problems are gone you won't be able to get clean, you will never get clean. And I am an addict, so for me to say so is quite telling. It took me a long time to realize this, and to admit it.
nephthys said "This is why * Anonymous tells their members to take it day by day... even minute by minute, because THAT is the struggle. To get from one moment to the next, ignoring your own brain, forever and ever amen, that's recovery."
While the rest of his post was excellent, and I told him so, I can't tell you how adamantly I disagree with this statement. It's not simply about ignoring your own brain, taking it minute by minute - that's, quite simply, virtually impossible (although I am sure a few people have succeeded - as I said, there is no "one-size-fits-all approach.) It's about fixing the problems that caused you to use drugs in the first place. Then, and only then, can you really go on to the next step with hopes of healthy success. If you plan on simply "ignoring your brain", I have no doubt 99% of the time you will fail - and if you don't, you will likely fail many years later. That's one reason why it's so hard to accurately measure success getting off drugs, relapse can happen many many years later - and oftentimes does.
I delved into this concept a bit in my second diary Drug Prohibition: a Primer on Drugs From my Vantage Point, and plan on delving into much further in just a moment.
I see a psychiatrist once a week for my drug addiction, and I strongly advocate the same for anyone trying to get clean, along with buprenorphine maintenance (with the goal, and at least an attempt (although it has to be a true desire), at abstinence. I will get into why buprenorphine later. If, for whatever reason, methadone or total abstinence is chosen, a psychologist is fine, or might even be preferrable to a psychiatrist. The key here is strong support from family and friends (whom aren't current drug addicts) - it's the most crucial element to escaping the circle of heroin addiction.
One final comment on NA/group therapy: if maintenance programs told you that NA, which may have happened to work for you, was unnacceptable, how would you feel? Well that's what NA has to say about maintenance. It's getting that "sorry, not you" at the door - and it feels really shitty, despite what other issues I have with them.
NA, however, is one of the better group therapy systems, aside from the god issue, which to me is a major issue. But if you put that aside, there are a great many of those "crackpot money making schemes" out there, and if you are going to go for group therapy, or any outpatient therapy for that matter, go for NA! And if you don't: "Let the buyer beware."
Another Personal Statement - Part II - The $64,000 question. (why do people use heroin in the first place?)
I want to quote a comment from my first diary:
Rumblelizard: This drug is evil. And I will never, never understand why a person will think that they, out of all the thousands and thousands of people who have done heroin over the years, will be the ONE PERSON who will be able to "handle" it and not become a junkie.
This is the type of programmed thinking that is just plain incorrect - and leads to false assumptions - which leads to many different things. I don't mean any offense Rumblelizard, hell if I didn't study the matter ad nauseum, I would probably think the same thing. But, sad to say, it's wrong.
Did I ever tell you about the first time I used heroin?
Ahh...everyone loves these stories. Some sort of sick fantasy, I don't know, but the movies sure do good! Then again, in the movies they all wind up in the gutter, only to get clean or die at the end. I want to mention the movies, but this is going to be so long to be unreadable. Let me just say that the other day, watching the Basketball Diaries, the story of Jim Carroll's Life, not only was it one long rock-bottom (lower than I have ever hit,) implying the whole thing is rock bottom (it isn't,) but at the end they vaguely show him in some group therapy thing, clean, implying that was the end of the story. But it wasn't. He went on another drug rampage 4 years later. Hollywood really is insulting in their attempts to...Hollywood-ize...something as personal as drug addiction.
Anyway, the first time I did heroin. I was with a group of friends, about 7 or 8, and we managed to get heroin - which was no easy feat. We didn't go out of our way - I did, by getting a tip these 2 people were junkies, and having them get me some. Well we all did it. I brought some home and finished the bag, sniffing it. It was paradise - that virgin high I will always be chasing - it was never, ever the same. It was like everything was....exactly as it should be. Everything was perfect. With waves of euphoria. I can't describe just how wonderful this is. But, anyway, the point here is that I all of a sudden found a way to solve all my problem within minutes - and eventually to be seconds. My heroin habit didn't quite develop yet at that point, as I was ripped off by the first two junkies I meet - how typical and cliche.
Now, there is a much more important point here. All 7 or so of my friends did the heroin with me. They all had extensive histories of drug use - heavy drug use. They all loved the experience. So, you would expect them all to become junkies, right? Nope. Not one. Even with my evil whispers: "hey, you want to get some more tomorrow?" - I was responded to with a resounding "no thanks."
So why did I, in the face of all the clear evidence of the hell that would likely become my life (and largely did,) throw all that into the wind? I simply didn't care. My life was bad. It wasn't bad in that I was being beaten, I was poor, my life was in the gutter. It was bad because I was unhappy to the depths of my soul, and that wonderful feeling that heroin gave me - I didn't think about it much, your brain just says "MORE!", but what little I did - I thought it was worth it.
Why was I so different? I said how I was depressed, anhedonia is more of the word. But I suspect there was brain chemistry involved, both in my depression and in how well heroin fit the key-hole. So, in short, while I do feel, especially in my case, that brain chemistry plays an important role, and when it does getting clean is all that much harder, the most important fact here is that I was using heroin to solve a problem. No, I wasn't trying to escape - I was simply trying to feel good, to feel "reward", to feel all those things I just didn't feel my entire life.
Yes, this is an anecdote. But a big one. And, again, it is my anecdote.
Which brings me to a point I made earlier: Drugs aren't the problem: YOU are the problem. Yes, that clearly includes me. Unless that problem that let you become a heroin addict in the first place is solved, the chances of getting clean, in the short and/or long term, are slim to none. Which is why, perhaps, the statistics are where they are. The focus is always on the drug - the drug is the bad-guy. I'm sorry, but I am the "bad-guy," not the drug. The drug is merely the manifestation.
Everyone has problems, and everyone has addictions. Some addictions, especially in response to more severe problems, can be just as bad as a drug addiction. Eating in particular - because you have to eat - no matter what. And while I simply can't emphasize this enough, heroin is unique as a solution for a problem, in that it brings physical addiction and complete and utter instant gratification, which is virtually impossible to escape from. Once your brain has learned instant gratification...it's hard, to say the least, to escape from it. But I have argued, and will argue to my death, that until that original problem(s) are solved, escaping the learned method of reward is virtually impossible. Keep in mind, as I have said a few times, even after getting over the initial hurdles, people oftentimes relapse years later.
And this is why maintenance is important - it allows you to get out of the heroin lifestyle, improve your life, and (hopefully) solve your problems (or at the very least acknowledge them.) Only does attempting abstinence actually justify the risk (which is pretty great - relapse is often deadly.) I will speak a little more about this in the section about methadone.
I guess I should finish the story. But first, another anecdote. The very first time I saw heroin. I was living with a roommate, a guy I didn't know from beforehand, who was from California. One day I came home, and to my shock found a spent spoon (Spoon? Who uses spoons?) and needle on my night table. I had never seen a needle before for that matter. He says to me "I took the "H" train" with a smile on his face. I was shocked someone, who I never saw drugs before, could be so nonchalant about it. I was interested - even though at this point I hadn't "tasted" it - and asked if he wanted to get some more tomorrow and do some with me. "No thanks," once again. He didn't do heroin again in the rest of the time I knew him.
I started a heavy pill habit, hydrocodone, which I mentioned earlier. I managed to get some morphine, don't remember how, and since it works so badly orally, I knew I had to shoot it. But I didn't know how. I was hanging on to it a few days when I happened to run in to someone I didn't know, and I don't remember how, but heroin came up (something that almost never came up...fate, I guess, or perhaps it was me seeking for assistance.) He mentioned he had done heroin before. Boy did my ears perk up. I whispered to him that I had some morphine, and a pin (needle,) and boy did that get his attention. He did, for me as I didn't know what I was doing, my very first IV. Sadly, he took the very same needle and followed after me. Luckily, I didn't have any communicable diseases. (I have never, ever, shared a needle - that is, used a needle that has been used by someone else.)
So while the guy was currently clean from opiates, me being the bastard I was, having a heavy pill habit and needing something stronger, without much pushing, got him to take me to brooklyn, and get us all some heroin. He took me two or three times, at which point, I learned how to get it myself. And that's pretty much it. I IM'ed it a while (muscle shot,) as I didn't know how to IV, but eventually learned - it really isn't that difficult - but you'd be amazed how people screw it up (and screwing it up is what causes the injection problems, for the most part - another reason why addict education, aka harm reduction is so important.)
That acquantaince didn't go on to form a full-fledged heroin habit. He was a junkie before, used for a week, and stopped. He DID use again after that for a while - along with his wife, who insisted I take her to get heroin once (because her husband was opposed,) and boy did I feel like crap for exposing her to that - I would never do anything like that again....she was just so insistent...sigh.
There's more to this story, but I don't have the room to tell it. Even though the wife wound up institutionalized (due to severe mental problems I wasn't aware of,) and the husband wound up in jail (unrelated offense, shoplifting to buy food, they were quite poor,) neither developed a serious heroin addiction and are now living a normal life together. Let's hope it sticks. I think it will - their lives are very different now than they were. But, to be completely honest, I haven't spoken to them in a long time and don't know the entirety of their current story.
Not So Personal Anymore.
So, what do the statistics say about who goes on to develop a heroin habit? Well, of those who use heroin, about 10% go on to become a full addict when we are talking about teenagers, the place we have the most reliable numbers. When we are talking about adults, the number rises to about 20-25%. But it's hard to get good numbers, and I feel that not only might these numbers might be skewed, but they miss an important point. That important point is this is not a random sample of a population, that is to say if everyone on the planet used heroin 10-25% would become junkies. Which brings us to another very relevant statistic I will mention in a moment. This may seem shocking. It IS shocking. But it only emphasizes my point.
I'd like to link an article, one that describes some of this. While I don't agree with everything in the article, it is still a very good read.
The surprizing truth about heroin and addiction
Please don't get the wrong idea: I am not, nor would I ever, advocate heroin use! I made this very clear in my first diary. But I will not hestitate to make the facts of the matter clear - and that includes heroin's comparison to alcohol (just look at the facts - see my first diary.) A drug is a drug. And while heroin is especially dangerous, causing an extreme programmed instant gratification pathway in the brain, making it not worth anyone risking their lives (which is what you are doing when you try heroin, or any opiate for that matter,) it's only difference from any other addictive substance, in a negative way, is exactly what I just said - how it rewires the brain, especially in people who have chemical or psychological risks, of which I have both - which is why I would have been far better off with another addiction.
However, I will argue, that I would have found heroin virtually no matter what. And since I have found it, and found it when I did, I need to work from where I am. And that included maintenance while I get my life, and my problems, in order. Only now, after so much soul-searching - and reaching these conclusions based on these facts - do I realize that I really can break the cycle. But I need to fix myself before I can get anywhere. You need to walk before you can fly.
I almost forgot to mention the troops! Studies (contemporary) of troops who served in Vietnam show that while 50% used heroin out there, only 14% continued use back home. And of those 14% who did continue using, many managed to just used recreationally without developing an addiction. This information is astounding. It clearly shows how if the situation changes, and the problem disapears (if there was one, and you were an addict,) that most junkies can become clean. Unfortunately, in real life here in the USA, such an ideal situation doesn't exist. The situation rarely changes, and the problem almost never goes away.
Many people asked about the troops in Iraq and moreso Afghanistan. I honestly don't know - no one does. Is it likely that a situation will exist similar to Vietnam? Yes, it is. But that's all I can really say about it at the current point in time.
The War on Doctors.
Finally, we are able to look at a more legitimate benchmark - the percentage of those treated with opiates, for pain in a medical setting, who go on to become drug addicts [using the full definition of the word addict]. This number is anywhere between 1-5%, with the information we have today. The DEA has waged war on doctors, and on treating legitimate pain, and has started a new propaganda program. Hell, their whole foundation is based on propaganda.
There has been some really sick things going on as of lately. Doctors are being questioned, stripped of their licenses, even thrown in jail, for doing nothing more than treat pain in patients legitimately. If the DEA decides, based on their extreme ideals, that a doctor is prescribing "too much" or to the "wrong person," they will stop at nothing until "justice" is done. They have even brought criminal charges against pharmacists who did nothing more than fill a legitimate prescription, saying "based on the amount they should have known the prescription was not legitimate." Well, in order to believe the prescription was not legitimate, you'd have to believe their ridiculous ideals on what is "legitimate" in the first place.
There is a huge problem now growing in this country. People in pain are simply unable to get the relief they need. It even has a name - "opiophobia." Doctors are scared, shitless, of writing that script, even a small one for a weaker drug. Due to this, thousands if not millions of people are suffering needlessly. Compounding this problem are the recent finding that NSAIDs (Non-Steroidal Anti-Imflamatory Drugs), such as Vioxx and Celebrex, may be more dangerous than opiates! Now we'll have doctors afraid to write any script for pain. This is nothing short of a crisis.
I will go much more into this in a future diary - this is just a "primer" - a word I seem to use way too often.
More about Methadone and Buprenorphine - Maintenance, Corporate Interests, Relapse Rates, and Eventual Abstinence.
I need to make a few points that I didn't, or didn't make clear enough.
- While Methadone was the only option available for maintenance for many years, and was warranted, now that buprenorphine is around it doesn't make much sense for most people. There are many downsides of methadone, which I added to my "primer" diary. While buprenorphine is a much tougher transition from heroin, anyone who's serious about being healthy and sober won't care. It is simply not the best drug if you plan on getting sober at any time, the withdrawals are terrible - and not making it through the withdrawals is rarely, if at all, taken into account in relapse statistics. I do think it should continue to be offered, especially to street addicts who's situation is hopeless, but not as a primary choice. We need more alternatives, and there is a good reason we haven't seen any.
- Methadone has become a corporate goldmine. Even though methadone is beneficial to everyone involved, in virtually every way including cost to society, as opposed to a heroin addict, corporate interests have found that there is a lot of money to be made off heroin addicts. This, surely, doesn't stop at the methadone clinic - there are a great many abstinence-only programs that are nothing more than a money-making scheme. As if heroin addicts don't have enough problems. Treatment for something like this needs to be in the hands of government, not corporations. Unfortunately today they are indecernable. Luckily, this is not the case with other countries - many of whom have done the right thing in switching to buprenorphine as the primary drug for maintenance.
- The goal of methadone maintenance (and buprenorphine) is eventual abstinence, often with a timeframe in mind from the outset. It should not, and is not, forced, however, and lifelong maintenance works just fine for many people that simply have no other options.
- There is little to no data on the relapse rates for buprenorphine, and I strongly suspect - with many case studies to back up my claims - that the results will be astonishing. Buprenorphine seems almost made for this. I spoke about this a bit in my first diary. It also makes an excellent "detox" drug, something I didn't mention - detox is when you get only very temporary treatment with opiates, to ease withdrawals until they are over. But that's "the easy part" - any heroin addict present or former can tell you that.
- I said I felt that the relapse rates for abstinence after methadone aren't accurate - they were roughly the same as someone who was never on methadone. Here's why I feel that way. They don't take into account many things, such as the amount of time a user has been on methadone. Almost every study is short-term methadone use, a year at maximum. There is some anecdotal evidence suggesting that those on methadone longer have more chances of success at long-term abstinence. They also rarely take into account those that don't finish treatment, those that don't make it through the withdrawals, or multiple attempts (no statistics on this subject take multiple attempts into account.)
There is something very unique about heroin, with the closest runner-up being crack, and then cocaine - which I will address in another diary. While everyone has the ability, inherit within them, to cure themselves, for some people this is just not possible, whether it be due to their life situation or the inability to deal with their severe problems. Heroin use, despite ALL the education, ALL the outreach, ALL the proven treatment - is still a major problem, one that hit a small lull recently and is clearly back on the rise, back to the levels it was at, among true addicts at least. These people need to be treated humanely, and even the NIH (National Institutes of Health) recognizes these facts. I'd like to share some NIH quotes with you, ones which my opinion shares. Thanks to www.drugwarfacts.org for these quotes.
- "Methadone maintenance treatment is effective in reducing illicit opiate drug use, in reducing crime, in enhancing social productivity, and in reducing the spread of viral diseases such as AIDS and hepatitis."
- "According to the National Institutes of Health (NIH), "All opiate-dependent persons under legal supervision should have access to methadone maintenance therapy..."
- "The current narcotic treatment system is able to provide the most effective medical treatment for opioid dependence, opioid agonist maintenance, to only 170,000 of the estimated 810,000 opioid-dependent individuals in the United States."
- "The unnecessary regulations of methadone maintenance therapy and other long- acting opiate agonist treatment programs should be reduced, and coverage for these programs should be a required benefit in public and private insurance programs."
- "Whatever conditions may lead to opiate exposure, opiate dependence is a brain-related disorder with the requisite characteristics of a medical illness."
- "Twin, family, and adoption studies show that vulnerability to drug abuse may be a partially inherited condition with strong influences from environmental factors."
- "The safety and efficacy of narcotic agonist (methadone [AND Buprenorphine]) maintenance treatment has been unequivocally established."
- "Of the various treatments available, Methadone Maintenance Treatment, combined with attention to medical, psychiatric and socioeconomic issues, as well as drug counseling, has the highest probability of being effective."
- "Opiate-dependent persons are often perceived not as individuals with a disease but as 'other' or 'different.' Factors such as racism play a large role here but so does the popular image of dependence itself. Many people believe that dependence is self-induced or a failure of willpower and that efforts to treat it will inevitably fail. Vigorous and effective leadership is needed to inform the public that dependence is a medical disorder that can be effectively treated with significant benefits for the patient and society."
- "Although a drug-free state represents an optimal treatment goal, research has demonstrated that this goal cannot be achieved or sustained by the majority of opiate-dependent people."
(That one came from the AMA, and was from before buprenorphine's introduction. Buprenorphine, however, is also grossly underused - far worse than methadone.)
Unfortunately, for some people, although they are in the minority (over the long run at least,) even methadone doesn't work. And for those that it does, at least 50% do not have immediate 100% success.
Getting Personal - Again.
Heroin addiction is a very sad fact of life. And when it is possible for these people to live a normal life in such that they are not harmful to others, or to themselves, it is the only humane thing to do. The continual stigmization of heroin addiction doesn't stop people from becoming heroin addicts - it only ruins their lives that much more.
When I was on heroin, thanks to the fact that I didn't have to steal to support my habit - which is possible, for virtually everyone, in a world where the heroin supply isn't ruled by drug cartels, not only did I lead a normal life, for a while it was better. Obviously, the "better" aspect completely faded away and I was taking the drug for a 5 second rush and to feel normal, however, it didn't affect my ability to function in society. I saw and had a normal relationship with my family. I held a job. Not even my parents knew anything was amiss.
Clearly, many heroin addicts hit what can only be described as rock-bottom, and live nothing less than a life in hell. However, for many if not most of these people, their problems are clearly caused by prohibition - not heroin.
Let me make it clear: heroin addiction is a terrible thing - but so is addiction to anything. The main reason it's so bad is because of the problems of prohibition and supply, which I have and will address. Another major reason why it's so bad, one that will never go away, is that it not only assists, but almost forces you, to ignore your problems. This is why heroin addicts need all the help they can get - and that help must come to them wherever they are.
Some people just can not get clean, or it could take them many, many years to do so. Throwing them in prison...I just feel like crying. In fact, I am crying. I just watched a movie about the struggle for blacks for civil rights - and while being black is something that has no choice involved in it and heroin does, once that choice is made, and the damage is done, simple choice is no longer part of the equation. Getting clean is extremely difficult, and while it is a choice - success is not.
For these people, which once included myself, we have two final things to cover: Harm Reduction, and Heroin Legalization (heroin maintenance.)
Harm Reduction - Today and Tomorrow - in America and Beyond.
Unfortunately, America, land of the free and home of the brave, has hardly been the pioneer in reforming the horrible drug policies of old - ones that are clearly a failure. Although methadone, along with harm reduction - which, in America, only really consists of needle exchanges (and needle legalization), along with addict outreach, are two very important harm reduction (and treatment) policies, it's all we have. I added a brief topic about this to my first diary. But there are other methods of harm reduction - ones that have been used in other countries.
Obviously, there are clear reasons why we have our drug policy the way it is in America, and why there is little hope of reforming it anytime soon. It goes beyond corporate benefits and the prison-industrial complex, all the way down to the CIA and the benefit of being a "drug police" [and even drug distributor] throughout the globe. It can even be traced back to the beginnings of the neo-cons. In fact, drugs are illegal all over the globe, in every single country, because it is mandated by the UN, which was all thanks to us. There has been a growing movement to get the UN out of drug policy, and I strongly urge you to take part. This is a topic for my next diary, or perhaps the one after.
Back to harm reduction. These harm reduction policies - as well as maintenance with other medications, including morphine and even heroin (which I will discuss in a moment,) unfortunately have not been used enough to really weigh in on how well they have really worked. Hopefully this will change in the near future. Needle exchanges were once thought of as unspeakable - Guliani himself fought the first one in the USA tooth and nail - and they have been proven to be one of the best things to happen to heroin addicts, with substantial benefits to the population at large without detriment. Needle exchanges not only stem the flow of HIV and Hep C, as well as other communicable diseases - which not only affect the addict, but everyone who has the chance to catch it from them - and everyone who was the chance to catch it from them - and so on, they greatly increase the proper disposal of needles, and give addicts a place where they can be reached out to.
As for some of the other policies that have been explored by other countries, first of all, we have Safe Injection Sites (SIS.) While they are often referred to as "shooting galleries", and while I wouldn't suggest anyone visit one, they have the potential to offer great benefit. They can prevent many things: junkies shooting up in places they shouldn't and leaving bio-hazards behind, junkies dropping dead from overdose (as I said in the first diary, there is a cure for overdose, and the watchers in these shooting galleries are there for this reason,) as well as virtually ensuring safe needle use.
Accodording to Lisainvan, someone who lives in Vancouver, a place with an enourmous heroin and drug problem, which is the only thing that seems to make some politicans see the light, the cops have been supportive - something I can't really imagine happening here - not harassing the people going in these places and not going in them themselves. She also said the dealers weren't bad either, hanging around the places to sell drugs (something else I can't see here - we really need to reform our drug policy.) Anecdotes are the only real way to look as these programs at this point in time, and I thank her for the valuable information.
Safe Injection Sites are one of the main progressive harm reduction policies. I do consider decriminalization of heroin, like they have in Holland, to be a harm reduction policy - quite simply, it reduces harm to the addict (prison = severe, irreprable harm.) And that leads us in to our last topic, which is not decriminalization - although that should be an aspect of it - but legalization (for addicts.)
UPDATE: The information on Vancouver came from media reports, not a first hand account. I apologize for making this assumption. LisainVan has shared some links with us, which I will post here.
The Legalization of Heroin (as a "harm reduction" strategy - and possibility for the future.)
The final topic of this diary whew. I am not talking about outright legalization - even though I feel if such was done, in a properly regulated way, it wouldn't make much of a difference (in a negative way.) When I go on to explore the future of the drug war, this will certainly be a question. But even if we do legalize it, this is an essential stepping stone.
I see a way that we can end all of the problems associated with heroin addiction, except the harm the addiction itself does to the user - drug cartels being financed and promoted, addicts overdosing (not completely eliminated but greatly reduced,) toxic substances or whatever else is associated with getting drugs on the street (which includes unknown purity which often leads to overdose, that's why I mentioned it,) crime associated with drug addicts stealing to support their habit, just about anything you can imagine. That way is for the government to provide pure, clean heroin directly addicts, along with clean needles. This can also be known as heroin maintenance. By doing this, you can even largely prevent heroin use among teens and even adults - as since the demand won't be there, neither will the supply. Along with that, now that drugs and the illegal lifestyle of heroin aren't a central part of the addicts life, he can hopefully improve it the way many on maintenance, including myself, have.
Many countries have already done this - including Britian! But their programs all for short of what I am thinking.
Obviously, there needs to be a way to only do this for the addicts that simply have no other choice at that point in time. Buprenorphine maintenance should be greatly preferrable to this, and people should at least have to try. We shouldn't do this because we want to advocate heroin, we should do this to help addicts, who will hopefully eventually help themselves, and as a benefit to society at large in so many different ways - which includes financially. It would be far cheaper in costs to society. It would let police focus on more important crimes. The benefits are endless, to everyone involved.
But what about the downsides? Surely, there are downsides. For one, that clean heroin can wind up on the streets - and that should be a severe crime. It's a problem that's largely solvable, in my opinion, simply by threatening the loss of this privledge. No junkie would risk such an arrangement for a couple of bucks.
Obviously, there is also the downside in that perhaps a small amount of addicts who could get clean with a lot of hard work - and, as the facts show, they are in the minority, a very sad thing to admit - although I will never tell anyone not to try - unless they've done it time and time again and are endangering their lives. They endager their lives the first time they try - but it's still worth it, however small the odds. Hell, I am going to try it myself, and thanks to buprenorphine and how my life situation has greatly improved, along with all the time I have had to think about it, I am convinced I have a reasonable shot, and will definitely give it my all. However, if one were to look at it objectively, weigh the good and the bad, the costs and risks, I hope enough people will eventually come to the same conclusion.
That said, there still clearly needs to be some sort of system to prevent abuse of such a program. What that system should be, I honestly can't say.
Thank you for taking the time to read this, and I truly hope that I have done some good. I want to take a moment to once again thank everyone who flooded me with so many kind words in my first diary, it was truly wonderful and really made me feel great. I really have nothing to offer the world....except myself.
Please forgive any typos or errors in this diary. It is too long to format well enough to be able to really check it over thoroughly.
Finally, once again, please let's not start fighting about what method of treatment is best. If you can't agree that nothing works for everyone, and that some addicts simply cannot get out of the situation they are in....I have little (if anything) to say to you. But otherwise, it's all good, and whatever your beliefs may be - fine. Let's just keep it civil, OK? It's to everyone's detriment if this turns into some sort of fight.