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Due to the overwhelming response to my first diary on this topic, Treatment for heroin/opiate addiction: a primer, and the many comments and continued discussion that followed, I have decided to continue this topic.

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

I have been busy writing my "memoirs," what was original "my story," and it is shaping up to be way too personal and way too long, and have little political purpose for that matter, so I have decided not to post it [here at least, maybe not at all] unless I get an overwhelming response otherwise. I will, however, put in my personal experiences where they are relevant, irregardless of how personal they are [unless I feel it's something that may be an unwanted read], which will happen to be in a few moments.

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.

The Drug Reform Coordination Network (DRCNET)

the Drug Policy Alliance

Thanks to Subversive for infoming me of this group.

American Civil Liberties Union

There are many other drug reform groups, but many focus solely on marijuana. I will not plug them here.

Buprenorphine FAQ (in need of updating) by Nephalim(27)

Opioids.com, A source of information, including clinical studies, about drugs and opiates

Drugwarfacts.org, whom provided a nice list of quotes that I used in this diary

The Ibogaine Dossier

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.

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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.

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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.)

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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.

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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.

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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.

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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."

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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."
  • (That one came from the AMA, and was from before buprenorphine's introduction. Buprenorphine, however, is also grossly underused - far worse than methadone.)

  • "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."

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.

http://www.vch.ca/sis/index.htm , http://www.cbc.ca/story/science/national/2004/09/27/inject_site040927.html , http://usa.mediamonitors.net/content/view/full/11829/

VANDU (Vancouver Area Network of Drug Users)

.

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.

.

Closing Words

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.

Originally posted to nephalim on Mon Jan 17, 2005 at 01:12 PM PST.

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Comment Preferences

  •  Tip Jar. (4.00)
    Don't want to break the norm. But I don't care. I just want people to read it.

    Resuscitate investigative journalism! Reality-Based does NOT mean investigations are wrong - it means investigations are essential.

    by nephalim on Mon Jan 17, 2005 at 01:00:29 PM PST

    •  Great job, again (4.00)
      In the interest of full disclosure, I've been in AA since 1992 (with time off for bad behaviour between '95 and '96).

      But I don't know shit about heroin. So I have absolutely nothing of value to add to this discussion -- except my standard, from Shakespeare's Hamlet: "There are more things in heav'n and earth, Horation, than are dreamt of in your philosophy."

      Which quote is my pretentious way of saying I will never be one to tell a fellow alcoholic or addict I know what's best for him. AA works for me. I haven't had a drink in over 8 years. On the other hand, I've had some pretty scary journeys into opiate pain medication territory, and the withdrawal from hydrocodone was the worst thing I've ever experienced -- including delerium tremens from alcohol withdrawal.

      I've never been big on NA, simply because AA pretty much covers all the bases for me and I prefer the old fashioned texts.

      I do know one thing -- writing off the entire organization because SOME or MANY people in it presume to tell YOU how YOU should be doing it... is horseshit. Man, if you relapse 52 times in 52 weeks and you're still aboveground, you're winning the battle. Sure, there's a great deal to be said for continuous sobriety. There's also a great deal to be said for breathing in and out on a regular basis -- and if the occasional slip happens without you dying, who the hell is to say that isn't part of the grand plan?

      I'm not advocating maintenance or saying repeated relapses can necessarily continue with impunity (bad word choice, considering this isn't a moral issue) -- but neither am I saying the rigid path of a certain section of humanity is right for all sections of humanity.

      A wise oldtimer I once knew said after 25 years of sobriety, he'd refined his definition of success in AA to this: If I'm alive at the end of the day, I've beaten alcoholism that day. Drunk or sober.

      The GOAL is total sobriety. But "progress, not perfection" is a mantra in AA for a reason. Even if the big shots and spiritual giants tend to forget the literal meaning and start thinking in years and decades instead of hours and days.

      Rage, rage, against the lying of the Right.

      by Maryscott OConnor on Mon Jan 17, 2005 at 03:29:12 PM PST

      [ Parent ]

      •  My husband was (none)
        cross-addicted to alcohol and cocaine (he's only-half joking with the theory that he did coke so he could drink more).  He opted out of NA and went AA.

        Whichever way your pleasure tends, if you plant ice, you're gonna harvest wind -- R. Hunter

        by Frankenoid on Mon Jan 17, 2005 at 03:50:00 PM PST

        [ Parent ]

  •  Looks like I might have overdid it... (none)
    I hope it's worth it to those that read it. I seriously put at least 6 hours in to it....

    Resuscitate investigative journalism! Reality-Based does NOT mean investigations are wrong - it means investigations are essential.

    by nephalim on Mon Jan 17, 2005 at 01:51:10 PM PST

    •  No, you did not (none)
      But what the hell can you say after reading this.

      Thank you for the effort of putting it all together.

      And - your diary has made it to the Recommended List.

      •  I noticed...I hope it will be as good as before... (none)
        but that's just the problem, "what the hell can you say after reading this."

        Kinda stifles discussion a bit...

        Just say whatever is on your mind. We can take it from there.

        Resuscitate investigative journalism! Reality-Based does NOT mean investigations are wrong - it means investigations are essential.

        by nephalim on Mon Jan 17, 2005 at 02:06:51 PM PST

        [ Parent ]

    •  Whew! (none)
      Good job on a tough subject.

      As I was reading this, a report came on the local news- our largest area health care provider is closing their drug/alcohol treatment center. Why? Insurance not covering the costs of running the place. 1200 patients out on the street in the next few days. (I'd link it, but don't think it's up on the net yet)

      Sadly, I think this is going to be the trend for the next few years (or more). Treatment and/or maintenance will be out of the question because there will be no funding, either from insurance or the government.

      We are heading in the wrong direction in this country, on this and, of course, many other issues that effect the public health.

      Keep writing nephalim, and hang on to your ideas. Let's hope we return to sanity someday and they can be put to good use.

    •  Very good diary (none)
      It is definitely worth reading, Nephalim.

      I know a woman who after several years still chews Nicorette gum, which is sort of a maintenance for her.  

      Over the years I spent working in hospitals, I knew several alcoholic doctors and nurses, plus a doctor and a  nurse who stole patients' meds.  

      I even had a doctor, a wonderful doc, who went to a treatment center in Georgia to get clean. I was so glad to see her again--she worked in various ERs and couldn't write any Rxs for pain meds, but she was doing her job. I was so proud of her.

  •  It's not so much that you overdid it (none)
    addiction isn't something one can condense. I am sure many people are just at a loss for words and are in "yeah, what nephalim said" mode. Many Kossacks truly appreciate your efforts to describe some of your experiences, and help us get a grasp on something that most of us have only seen from the outside.

    I wish treatment options were not so stigmatized in this country - the idea of "just deal with it" or "submit to a higher power" clearly isn't an option for many addicts, even if they are the most socially acceptable option.

    I'm never quite sure which is which: empathize vs. sympathize. I'll never be able to fully grok your experience, as I don't seem to have the brain chemistry predisposing me to addiction of any sort. But (as I've mentioned before) I've seen so many acquaintances go down that bad path - I wish I could be the one-woman problem-solving team...

    Re: Acid/ecstasy/meth - only anecdotal evidence, here, but I notice many more people aiming for the ecstasy/meth route. It's so much more clinical and easy to transport. But who knows - I would think with another 2 fucking years of the Chimperor, we'd see another wave of downers abuse?

    Ask Copernicus about pushing limits.

    by Xray the Enforcer on Mon Jan 17, 2005 at 02:06:55 PM PST

    •  heh. I meant to say "4 fucking years" (none)
      of the Chimperor. But maybe we'll only see two...and then Glorious Impeachment!!

      And one more thing: thank you for your mention of your first time using. the Just Say No crowd has been pimping the idea of "one hit and you're addicted" for a really long time. It's good to have some counterexamples that emphasize the interplay between headspace, brain chemistry, and addiction pathways...

      Ask Copernicus about pushing limits.

      by Xray the Enforcer on Mon Jan 17, 2005 at 02:09:57 PM PST

      [ Parent ]

      •  Still... (none)
        I am not so opposed to that "one hit and your addicted" rhetoric as it keeps people away from the stuff - a good thing. But those who are not in danger of addicting, of using heroin at all, it's nice to know the facts...

        Downer abuse (barbituates) is pretty much out of the question, I think. It's just not available - they don't use it in medicine anymore, and it's 100% chemical. In fact I think they even start with Urea!

        If they did start synthesizing the stuff we'd be in a shitload of trouble, as without hesitation I will say that barbituates are far worse than heroin. They are the most dangerous substances known to man.

        Resuscitate investigative journalism! Reality-Based does NOT mean investigations are wrong - it means investigations are essential.

        by nephalim on Mon Jan 17, 2005 at 02:19:18 PM PST

        [ Parent ]

        •  deterrence is the key (none)
          keeping kids away from heroin before they get started is certainly the key. I don't mind putting the Fear into them - as long as people aren't pushing outright fiction and criminalizing all drugs as equally bad.

          As for downers - thank the gods they're not so prevalent. what a fucked up society we'd get if they were...

          Ask Copernicus about pushing limits.

          by Xray the Enforcer on Mon Jan 17, 2005 at 02:33:06 PM PST

          [ Parent ]

        •  I think we need to be (none)
          honest with the kids about drugs and drug abuse.  As I posted in one of your earlier threads, we let our kids know that they are at high risk, and that drug use by adolescents is more problematic because of their changing body chemistry, brain development, and lack of life experience.  But if we lie, if we perptuate the crap that was told to us that we later found out was lies, we lose credibility and when the dangers are real, we aren't believed.

          Reefer Madness!

          Whichever way your pleasure tends, if you plant ice, you're gonna harvest wind -- R. Hunter

          by Frankenoid on Mon Jan 17, 2005 at 07:16:01 PM PST

          [ Parent ]

          •  Very well said. (none)
            I watched reefer madness once. I expected it to be funny in that so-stupid-it's-funny kind of way. It wasn't.

            Man, lots of recommended diaries today - this one is gone already. But se la vie, I am happy with the response - and I know there are many people who read it who didn't comment (nothing to say georgia? You know I always love to hear from you - and you are great at sparking discussions, too.)

            Resuscitate investigative journalism! Reality-Based does NOT mean investigations are wrong - it means investigations are essential.

            by nephalim on Mon Jan 17, 2005 at 07:33:23 PM PST

            [ Parent ]

    •  Thanks. (none)
      I can explain the empathy vs. sympathy thing, as I know it well. Empathy is when you literally feel what the other person is feeling. You are in his shoes, whether it be literal or you just can feel it...

      Sympathy is more like when you can imagine what someone else is feeling, and you pity them for that reason. Perhaps pity isn't the word.

      I think you are likely correct, and acid isn't as popular as it was when I was in school - however, it is very easy to make huge amounts of the stuff, it's one of the most potent substances in existance, although the actual act of making it might be difficult, I am honestly not sure. Meth(amphetamine) and Ecstacy seem to be the current "club drugs." Ecstacy only just hit the street when I was in high school.

      You know, I didn't think of mentioning this, but there is sometimes heroin in ecstacy - and more often cocaine. People think it's there more often than it actually is, however. That's the thing with ecstacy, you really have no idea what is in that pill.

      Resuscitate investigative journalism! Reality-Based does NOT mean investigations are wrong - it means investigations are essential.

      by nephalim on Mon Jan 17, 2005 at 02:16:28 PM PST

      [ Parent ]

      •  excellent point (none)
        it's not so easy to get pure MDMA these days. I remember when I was in school (the long-gone days of yore during the late 80s-early 90s) and acid was frowned upon. Coke was the drug of choice for the rich, pot for the poor. Meth for the kids with Iron Maiden T-shirts.

        When I went to college, it was acid, psilocybin, peyote (we found it growing in someone's front yard!) ecstasy, heroin. Coke was definitely Not Cool. Heroin - the Unspoken Abuse. Lots of heroin use. But it was mostly on the DL.

        These days, in NYC, coke. Lotsa coke. For those who can afford it, that is.

        (I don't mention marijuana, because it's pretty much a given.)

        Ask Copernicus about pushing limits.

        by Xray the Enforcer on Mon Jan 17, 2005 at 02:31:05 PM PST

        [ Parent ]

        •  Oh, god. (none)
          I loved acid. I just...loved it.

          I'm not ruling out acid trips in my 70s.

          Rage, rage, against the lying of the Right.

          by Maryscott OConnor on Mon Jan 17, 2005 at 03:31:41 PM PST

          [ Parent ]

          •  The first time I did acid...well, 2nd, actually (none)
            now that I think about it...the first was one hell of an experience, and one that will be saved for my "memoirs."

            The second time I did acid, it was the most intense euphoria I have ever experienced, more intense than heroin even. Every time I did it after that it progressively got worse until it was a totally unpleasant experience, was is termed a "bad trip."

            Even now, if I smoke some pot, it bring back the feelings of the bad trips and is no longer all that enjoyable...

            Resuscitate investigative journalism! Reality-Based does NOT mean investigations are wrong - it means investigations are essential.

            by nephalim on Mon Jan 17, 2005 at 04:14:32 PM PST

            [ Parent ]

            •  asdf (none)
              Supposedly, LSD availability has plummeted over the last few years:

              National Drug Intelligence Center (NDIC) National Drug Threat Survey (NDTS) 2004 data indicate low and decreasing LSD availability

              "...the number of seized LSD samples submitted for testing decreased from 24,460,969 dosage units in 2000, to 93,973 dosage units in 2001, to 1,624 dosage units in 2002, and remained relatively stable at 1,646.6 dosage units in 2003."

              One of the factors I've seen cited for the decrease in availability is the breaking up of Phish and the Dead.

              The 24 million hit "high" in 2000 seems to have been almost entirely from a single bust, a lab in Kansas.

              Like, wow, man.

              •  I remember that bust! (none)
                A guy busted with gallons and gallons of LSD - enough, I think I calculated it to, put the entire country on an 8 day acid trip. It might even have been more, I don't really remember.

                I guess acid is no longer the popular drug it was. I think we have ecstacy to thank for that.

                Resuscitate investigative journalism! Reality-Based does NOT mean investigations are wrong - it means investigations are essential.

                by nephalim on Mon Jan 17, 2005 at 05:45:55 PM PST

                [ Parent ]

          •  I loved (none)
            hallucinogenics, too.  Grew up in the Northwet, so there were 'shrooms, too.  Peyote upset my stomach, though.

            Damn did we laugh.  I was the canary for everyone --  I was more sensitive, I guess, or perhaps because I'm small.  But everyone knew once I started seeing tracers, they had about a half-hour before it kicked in.

            I only knew one person who abused acid -- a philosophy/photography major who'd trip night after night after night.  Though we had others who became addicted to alcohol or cocaine (this was the late 1970's), only the one guy had a problem with acid.  The rest of, maybe 3-4 times a year.  Anyone know what the abuse rates are?

            Whichever way your pleasure tends, if you plant ice, you're gonna harvest wind -- R. Hunter

            by Frankenoid on Mon Jan 17, 2005 at 07:10:35 PM PST

            [ Parent ]

      •  I worry about the Meth thing (none)
        I've seen a lot of people get very seriously thrashed from Meth use. For all of its consequences, heroin is far less toxic, and I think that once you are in stable maintenance, or are clean, you can be expected to make a full recovery. Meth on the other hand, over time, causes nerve damage that either takes far longer to repair, or is irreparable (probably varies on a case to case basis).

        I've had a lot of experience with everything except heroin, but I've seen it drag down people who were immune to cocaine addiction, and vice versa. IN my own experience, I preferred acid, because it always satisfied me without leaving me wanting any more for a good long time.

        I recently had kidney stones, and after squirming for 4 hours in the emergency room they gave me a giant bolus of morphine; I think I may have glimpsed what it's like to be hooked on H. I pretty much would have done anything for more (fortunately, you don't get choices in a hospital, they just loaded me up and sent me out the door).

        I forgot to say in my previous post (below) that I wish you the best of luck, and congrats for your hard work, both on this diary and in getting your own situation together.

        •  I worry about it too dnamj. (none)
          It is very prevalent, and deserves it's own diary. I am not sure I am the person to write that diary, however, having not even used it. At least not really.

          Heroin, itself, as well as ANY opiate, has no proven detrimental health effects in itself. Well, except for LAAM (heart attack risk), maybe one or two other exceptions...oh, yeah, Demerol (toxic buildup.)

          One of the worst side-effects of heroin is (oftentimes severe) constipation. It can, in some people, also cause what is not-so-affectionately termed "dope dick."

          Resuscitate investigative journalism! Reality-Based does NOT mean investigations are wrong - it means investigations are essential.

          by nephalim on Mon Jan 17, 2005 at 02:59:34 PM PST

          [ Parent ]

        •  a great point about the meth (none)
          the one friend I had who was speed-freak - omigod, she was a mess. I have never seen someone so paranoid and on the cusp of serious violence.

          She's clean now, but she does not look back on those days with any kind of fondness. She said she felt like an animal during those years.

          Ask Copernicus about pushing limits.

          by Xray the Enforcer on Mon Jan 17, 2005 at 03:07:26 PM PST

          [ Parent ]

        •  I hate Meth with a passion that defies description (none)
          When you're a certain age and HIV negative after all these years, the Meth storyline makes you want to tear your hair out.

          The cycle goes something like this:
          Boy meets boy.  They set up house.  They decide not to use condoms with each other anymore.  They party on crystal and have unsafe sex with someone who's not their partner.  One seroconverts and infects the other. (this script also plays with minor variations for married men who screw boys or shoot drugs then go home to their wife).

          Yeah, I've had a few friends--guys my age and younger who KNOW better--seroconvert recently.  I really hate Meth with a passion that defies description.

          I hate it most of all because I don't have a clue what to do about it, but I always feel like there's got to be something more to do to stem the tide.

          "I don't bear a grudge. I have no surviving enemies."

          by usagi on Mon Jan 17, 2005 at 05:07:44 PM PST

          [ Parent ]

  •  Everyone...just say whatever is on your mind... (none)
    don't feel like you need to write a response to the entire thing, OK??

    Resuscitate investigative journalism! Reality-Based does NOT mean investigations are wrong - it means investigations are essential.

    by nephalim on Mon Jan 17, 2005 at 02:11:22 PM PST

  •  a few things (none)
    First, thanks for writing this up.
    Second, I think you may have miswritten a stat in your discussion of NA. I thought the success rate of overcoming heroin addiction was 5-15%, not the relapse rate. If I am remembering your previous diary correctly, you might want to edit that.
    Third, my info about Vancouver is based on media reports not on first hand observation. The Vancouver Police officially support the site, as one part of a four pronged approach at dealing with the problem. I haven't heard stories about dealers congregating. I suspect that is because police would crack down on dealing in public.
    Fourth, here are some websites about the Vancouver program:
    http://www.vch.ca/sis/index.htm
    http://www.cbc.ca/story/science/national/2004/09/27/
    inject_site040927.html
    http://usa.mediamonitors.net/content/view/full/11829/

    You might also be interested in this group: VANDU (Vancouver Area Network of Drug Users)
    http://www.vandu.org/

    •  Thanks alot LisainVan! (none)
      I will be sure to check all that stuff out. I really needed to do more research into programs in use in other places, but it was just too long and too much time went in to it already...

      That is indeed a typo, and I will fix it.

      Resuscitate investigative journalism! Reality-Based does NOT mean investigations are wrong - it means investigations are essential.

      by nephalim on Mon Jan 17, 2005 at 02:20:47 PM PST

      [ Parent ]

  •  Excellent Diary (4.00)
    I think that this issue is actually an amazing microcosm for harm reduction vs. prohibition (i.e. the War On ___ model).

    Harm reduction is far more difficult, and requires a very serious committment to tolerance that I'm not sure our society has at the moment. It seems that America itself has become somewhat of a junkie, addicted to instantaneous gratification, at the cost of all else (including real solutions to our problems). From my own perspective, the AA model is potentially another quick fix, and is thus a pitfall for some, but a true lifesaver for others, in almost the same way that drugs vary in their effects. Extending this reasoning (out on a limb perhaps), the widespread belief that faith, prayer, organized religion, and legislated "traditional" values (like abstinence of all types) is the ONLY solution, is similar to the zero-tolerance anti-individualist environment of some drug-treatment groups, but this model is likely to fail overall. Tolerance and flexibility have historically proved more successful strategies to solve hard problems (like poverty, teenage preganancy, cultural conflicts, and addiciton).

    Is there a lesson in learning how to overcome that mentality, like you did? I certainly think so. Will our county as a whole need to bottom out (i.e. have some sort of catastrophic breakdown) before we get ourselves back on the right track? We'll see.

    It seems that there are quite a lot of things, (drugs are typical), that are manageable for most of us, but disastrous for a minority of us. Everyone has some sort of weakness which can turn a benign behaviour (drug use, religion, politics, even work itself) into an unbalanced dangerous pattern of self-destruction. Heroin is one of the more dangerous routes down this path, but not the most dangerous one.

    Finally, thank you for painting this picture, it all comes down to one's personal experience, and trying to relate that to others. I saw a lot of myself in both your experience, and your analysis.  

    I consider myself lucky that my drug using days, even cigarettes (keep it up, you Kossacks who are stopping smoking), passed into the past uneventfully.

    •  Very excellent post dnamj. Thank you. (none)
      There is no lesson in overcoming the mentality, dnamj. Everyone is different. The only thing I can say is at some point you have to look at yourself and say "I really am fucked up!" and acknowledge what's really there. We are definetely, as a society, not ready for that step. I think, perhaps, we might need to have some sort of bottoming-out.

      "Rock bottom is a college education." Or so they say. I luckily have not had to hit it. I came very close, however.

      Or, alternatively, you can trade one addiction for another. Alot of things which are, in reality, addictions, are not recongized as such. In fact, anything can be that replacement addiction if it's not used healthy and in moderation. IMHO, this can even include god. But that's considered acceptable by society. It all depends on where you draw the lines. I would even say that 95% of the population has unhealthy addict-like behavior and objects, but in many cases it's just considered normal.

      I think what I just wrote is considered a given in psychology, but I am not 100% sure.

      Resuscitate investigative journalism! Reality-Based does NOT mean investigations are wrong - it means investigations are essential.

      by nephalim on Mon Jan 17, 2005 at 03:10:28 PM PST

      [ Parent ]

      •  Yes, totally a given (none)
        And I think that addiction is an approximation for what we are going through as a country. People are more or less addicted to speedballs: the thrills and chills of following every 2 bit crime story on the news, and the blissful ignorance of believing what they see on the teevee.

        My mother said, to get things done, you better not mess with major tom-  D. Bowie.

  •  As a nurse (4.00)
    in a county hospital that sees many patients who use drugs I applaud your dedication in spreading information.

    Drug use (of any kind) is a health issue and should be seen as such.  Our public health system is lacking in many respects, but mental health and drug use are two biggies.  If we want to help decrease drug use, thereby keeping users and those in contact with them healthy and safe, treatment should be easy to get and free of charge.

    The fact that alcohol & tobacco are legal while narcotics, hallucinogens, and marijuana are not is ridiculous.  Anyone who argues that alcohol is somehow less harmful than other drugs is misinformed.  Violence, accidental death, and numerous health issues are increased with the use of alcohol, sometimes more than with illegal drugs.

    As for pain control it is unethical to have patients with a tolerance to narcotics remain in pain.  We treat pain - whether it takes 1mg of morphine or 50mg.  Doing any less should be grounds for malpractice as far as I'm concerned.

    Thanks again for a great piece...

    •  Thanks Callisto. Well said. (none)
      I should have mentioned what happens when Methadone Patients need pain relief. I once had a dentist, after I explained that buprenorphine was like methadone, look at me and say "well then you don't need any pain meds, right?" He actually thought I was permanently numb.
      Getting a doctor willing to write the big-ticket scripts that's necessary for a methadone patient who needs pain relief for things such as surgery is extremely difficult at best, and is a major problem.

      In actuality, studies show that people on methadone are more sensitive to pain.

      Resuscitate investigative journalism! Reality-Based does NOT mean investigations are wrong - it means investigations are essential.

      by nephalim on Mon Jan 17, 2005 at 03:02:30 PM PST

      [ Parent ]

      •  Pain... (none)
        Not treating pain adequately seems to be stem from a variety of places in my experience.

        One is a provider being afraid of killing a patient (through respiratory depression most likely) from too high a dose.  Another is fear of malpractice from prescribing/giving too high of a dose of pain meds.  Another is feeling that pain meds for narcotic users will "make their problem worse".

        At the hospital I worked at there was a "pain relief service" - run by anesthesiologists and a clinical nurse specialist, they specialized in managing pain for high need patients (narcotic users, terminally ill patients, patients with intractable pain).  It was a great thing, but some off service doctors were too slow to consult them...

    •  Amen Callisto (none)
      When I worked in an ICU, there were frequent comments like this: "Oh, he has a psych history, I'm not convinced he's really in pain."  And they were talking about cardiac pain, for God's sake.  Heaven help the man if he had been a drug user.
  •  Start with pot... then liberalize them all (none)
    perhaps from the "emerging Dem majority" idea.  The rate of people who have smoked pot is huge.  Once the generations shift 20 years, more people will have smoked pot in the USA than not.

    We can play the liberatarian card, give the states rights, the fat-cat GOP in washington telling you what to do, incarerating, wasting, blah blah blah.

    Legalize it!  Just so we could see Mothers Against Stoned Driving.

    •  I will definitely write about pot in another diary (none)
      That one will certainly be almost tounge in cheek, the fact that it's illegal...I think I can make an indisputable case for legalization.

      Resuscitate investigative journalism! Reality-Based does NOT mean investigations are wrong - it means investigations are essential.

      by nephalim on Mon Jan 17, 2005 at 03:18:19 PM PST

      [ Parent ]

      •  Save SS: LEGALIZE IT! (4.00)
        we all know that if we legalized pot, it would become really cheap to produce, but you could still charge the same amount, and tax the crap out of it to pay for stuff.

        all pot tax goes to your retirement account, so even when you're gettin high, you're saving for retirement.

        seriously though, legalized pot would create huge amounts of cash for the states and the feds.  and it would free up tons of resources.  frivilous drug charges for pot.

        •  Indeed. (none)
          But it would lessen our global power greatly. That's really why the opposition exists. At this point even the prison-industrial complex isn't making money off of pot. As I said, I will definitely make a diary focusing on this very issue (both legalizing pot, and about the "War on Drug", and another about the history of prohibition, and finally one about possibilities for the future. But not necessarily in that order.)

          Those are the four I have definitely decided to write. I doubt they will be as popular as this, though. But they don't call them "Diaries" for no reason...

          Resuscitate investigative journalism! Reality-Based does NOT mean investigations are wrong - it means investigations are essential.

          by nephalim on Mon Jan 17, 2005 at 03:31:05 PM PST

          [ Parent ]

  •  I was told (none)
    that your higher power could be anything.  From an atheist point of view then, it could be the ocean, science, the forces of nature, whatever you want.  The important thing was that you were aware that there were forces outside of yourself that were greater than you.  

    Also, I agree that anyone who is drinking and drugging addictively is more than likely self-medicating, but it is important/essential to get off the substance before you can do the hard work of figuring out the problem and solving it.  

    BTW, great diary, although I have to admit that I only read about half of it so far, will finish later...

    "I am not bound to please thee with my answers" -William Shakespeare

    by bittergirl on Mon Jan 17, 2005 at 03:35:34 PM PST

  •  I don't think my AA experiences have been (none)
    atypical.  When I sobered up 20 years ago, options other than AA were sparse; that has changed now, but for people in more rural areas of the country, it may be a case of AA/NA or nothing.  So I don't think it behooves us to discourage people from using what tools are available.

    For me the social aspects of AA were very, very important.  I live in Denver, which is a hot-bed of AA activity, and sobered up at the oldest AA club in the country.  I was a solitary drinker, and having somewhere to go was lifesaving.

    I was also fortunate to find a couple of mentors and a handful of good friends to help cut through the BS factor.  One was a lovely older woman who had been sober for 35 years, having sobered up in 1950.  She didn't pound on higher powers or working steps.  She said you live your life as well as you can, and eventually you get used to doing it that way.  The other was George (my younger son's middle name comes from George).  George was the self-assigned protector of young women at the AA club; he threw helacious good Christmas and Thanksgiving dinners for those of us estranged from our families.  And George taught me that it wasn't about accepting a higher power, or that we were helpless worms before the almighty, just recognizing that drinking created problems, but solved none, making your past something that you needn't fear, and going to bed each night with a clear conscience.  By doing these things you could stop being the problem and stop living life as an alcoholic.

    After about 5 years, I noticed that most people stopped growing as people in AA: alot of those who spouted wisdom at meetings and who had been sober for a while were telling the same stories they had  been telling for the last five years (and probably since they first sobered up).  Yet another of my mentors had told me that when you're really sober you don't stop having problems, you just got better problems.  Well, an awful lot of these people were living in the same problems with a different boss, or a different spouse, or with a different neighbor -- but they had not fundamentally changed.  They were still hanging out all the time at the AA club.

    So I stopped attending AA meetings, although I did marry another alcoholic, who has also moved beyond AA.  And my problems have gotten to be much, much better.

    I won't say that AA/NA is the answer for anyone, but it can be an answer, or part of an answer.  You use what tools you got when the time is right.  For me it turned out to be a few special people in AA.  For others it will be something else.  Whatever works.

    Whichever way your pleasure tends, if you plant ice, you're gonna harvest wind -- R. Hunter

    by Frankenoid on Mon Jan 17, 2005 at 03:37:45 PM PST

    •  I think the best candidate for NA (none)
      is someone who is in the drug lifestyle and can't get out of it. If they can, then I think it's a bad idea, for reasons I outlined already - but everyone is different, and I should have said very clearly that they should learn about NA and make their own decision (preferably with the assistance of family and friends - but only you know how to make you better - only sometimes you don't recognize it yet.)

      Unfortunately, someone who can't get out of the drug lifestyle (namely being surrounded by drug users or addicts in a temporary period of sobriety) have most likely the lowest chances of success.

      Resuscitate investigative journalism! Reality-Based does NOT mean investigations are wrong - it means investigations are essential.

      by nephalim on Mon Jan 17, 2005 at 04:40:39 PM PST

      [ Parent ]

  •  Thank you for this, nephalim (4.00)
    It's incredibly open and generous, and I admire your willingness to share it. I hope it helps you wend your way a little further down the right road.

    As for what is happening in Iraq and Afghanistan, it's not surprising that many troops have sunk into depression and addiction. The only thing I've run across recently is this article in Scotland's Sunday Herald. Here are some quotes in case it interests you, and anyone else.


    Drug addicted US troops sent to Scotland for help

    A PICTURESQUE Scottish hospital is being used by the US military as a base to treat drug and alcohol addicted troops who have fought in Iraq, the Sunday Herald can reveal.

    The US department of defence is sending up to 40 damaged servicemen and women a year - including marines, army and airforce personnel - to Castle Craig rehabilitation clinic to undergo intensive treatment.

    But it has now emerged that the centre has landed a huge contract to treat addicts from the military who have turned to drink and drugs after suffering harrowing ordeals in Iraq. The hospital also treats close relatives of military personnel who become addicts.

    Peter McCann, chairman of Castle Craig, said: "We have been getting [US troops] in dribs and drabs, but there have been more coming over recently. I think they are being sent to all the corners of Iraq and are falling to pieces when they get back to base. "

    McCann said troops were coming to the hospital from US bases in the UK, Germany and Turkey to undergo four weeks of intensive counselling and therapy alongside some of the most desperate Scottish drug addicts and alcoholics. While the Scots' treatment is paid for by the NHS and local authorities, the bill for the US troops' £1400-a-week sessions is picked up by the American Department of Defence's Tricare insurance.

    McCann added: "We can have up to about four at any one time, but there's a continuous stream of them coming in. There has been a step up in the numbers since Iraq. We see about 40 a year.

    McCann's comments give an insight into the terrible toll the Iraq war is taking on soldiers. There have been more than 30 recorded suicides among US troops in Iraq, a rate nearly one-third higher than the army's historical average.

    While alcohol consumption is prohibited in Iraq , it is believed many are turning to drink and drugs when they return from their tour of duty. Soldiers suffering psychological disorders are known to have high rates of alcohol and drug abuse and suicide.

    Therapy sessions at Castle Craig are based on the Alcoholics Anonymous 12-step programme, whereby addicts are forced to turn themselves over to God, or a higher power, to overcome their problems.

    While the length of treatment at the clinic normally lasts six weeks, the US troops stay for only 28 days. In that time they complete the first five steps, which include "admitting their wrongs" in confidence to another person.

    Tom Bruce, deputy lead therapist at Castle Craig who treats the US soldiers, said: " Most are young men in their early 20s. They would go back to their base and continue with the 12-step programme."

    Let the great world spin for ever down the ringing grooves of change. - Tennyson

    by bumblebums on Mon Jan 17, 2005 at 03:41:32 PM PST

  •  Hmm (none)
    I'd be curious to know the percenatge of dKos that supports the legalization of Marijuana (probably high {no pun intended}) and the percentage that supports the legalization of all drugs for recreational use (probably low).

    "I feel your scorn and I accept it." - Jon Stewart

    by starkness on Mon Jan 17, 2005 at 03:47:40 PM PST

    •  hmmm? (none)
      I didn't see anywhere in this diary where nephalim advocated legalization of all drugs for recreational use.

      I'm tempted to ding you just for trying to set up that straw man.

      •  Actually, I do. (none)
        But I didn't really say so. I consider it a civil right. To steal a common mantra, "my body, my choice."

        However, as to the implications of legalization, and the specifics, I really don't know. It's something I will think about as this topic progresses in my diaries and we come to the end.

        I definitely think it will need to be a gradual thing, that's for sure, and that you shouldn't be able to walk in to your corner drug store and buy heroin. I think what I described in "Heroin Legalization" would be a good stepping stone, as I said.

        Let me diary about it before you pass judgement on me. There is no doubt that drugs, in the hands of the wrong person, can be extremely harmful. There is also no doubt that not only has prohibition failed, it has made the situation worse. So my personal beliefs as to civil rights really matter little when it all comes down to it.

        Resuscitate investigative journalism! Reality-Based does NOT mean investigations are wrong - it means investigations are essential.

        by nephalim on Mon Jan 17, 2005 at 04:33:00 PM PST

        [ Parent ]

        •  Hell, a Big Mac (none)
          in the wrong hands can be harmful.

          Whichever way your pleasure tends, if you plant ice, you're gonna harvest wind -- R. Hunter

          by Frankenoid on Mon Jan 17, 2005 at 05:27:26 PM PST

          [ Parent ]

        •  I hope you continue this series (none)
          Especially to get to this point of legalization (or at least decriminalization) of most recreational drugs, because my hunch is that it will be quite an unpopular opinion on dKos, but it's one that isn't talked about enough in my opinion.

          "I feel your scorn and I accept it." - Jon Stewart

          by starkness on Mon Jan 17, 2005 at 06:29:57 PM PST

          [ Parent ]

      •  Thanks for the defense, BTW, imatlas. (none)
        He didn't say that I did, however. I don't know that they had any malicious intent. And they are probably right - most people, even here, don't support the legalization of the so-called "hard drugs." But most do support decriminalization.

        I even said quite specifically that, going forward, looking at drug prohibition and where to go for here, we need to understand "hard drugs" in order to really discuss them. That was one purpose of this diary.

        Resuscitate investigative journalism! Reality-Based does NOT mean investigations are wrong - it means investigations are essential.

        by nephalim on Mon Jan 17, 2005 at 04:36:06 PM PST

        [ Parent ]

      •  Sorry (none)
        It was not my intent to suggest that he was taking the latter position (although I had a feeling he might if asked pointedly.)  I was simply curious about the community as a whole.  I would find the results of such a poll quite interesting.

        "I feel your scorn and I accept it." - Jon Stewart

        by starkness on Mon Jan 17, 2005 at 06:21:36 PM PST

        [ Parent ]

  •  Opiate addiction treatment in Europe? (none)
    You touched briefly upon addiction treatment approaches in France (partial agonist buprenorphin) and Britain.

    Quite a while back I recall reading that in Britain, Netherlands, Austria and a few other European countries treat heroin addiction as follows:

    They register them in government sponsored programs that provide safe pharmaceutical quality heroin and clean needles for free.

    The primary aim of these programs is not to get addicts into abstence but rather to safely "stabilize them.   Registered addicts don't ever kick the habit (unless they come around by their own will power), but they do  hold down normal jobs and and maintain stable healthy lifestyles (save for their habits) ie. they are basically law abiding citizens with normal health/families and lifespans, that don't need to resort to crime/prostitution to support their habits.

    Is this still the case in Europe, is it accurate, or have their Tx approaches changed to something closer to that promoted in the US?

    •  Read the part "heroin legalization" (none)
      It's at the bottom.

      As to the exact programs and methods used, whether they have changed, and in which specific countries, that would require a lot of research to answer.

      Resuscitate investigative journalism! Reality-Based does NOT mean investigations are wrong - it means investigations are essential.

      by nephalim on Mon Jan 17, 2005 at 04:27:59 PM PST

      [ Parent ]

      •  In general, have the European heroin (none)
        maintenance programs been considered to be successful, as an public health approach for addressing the social consequences of opiate addiction, and are many of those programs ongoing in Europe?
        •  Most have, some haven't (none)
          The problem is most of these programs are both new and not widespread enough to gauge their effectiveness.

          I really don't know enough about any particular system to say with certainty it's judged effectiveness. The US has been pretty hardcore on trying to keep this stuff under wraps.

          Resuscitate investigative journalism! Reality-Based does NOT mean investigations are wrong - it means investigations are essential.

          by nephalim on Mon Jan 17, 2005 at 05:27:48 PM PST

          [ Parent ]

  •  I still don't understand... (none)
    what happens to people that need to take pain medication for Chronic pain for the rest of their lives or until they find a cure, or the doctors agree that they are a candidate for a certain operation that may cure them of their daily pain? They may be able to function and work while the medication curbs the pain, but will the meds eventually kill them or damage their organs. also, what is a barbituate?    
    Also,
    How does one differentiate between being addicted or the medication just becoming part of your daily life to help with the pain?

    educate 'em when they're young

    by Chamonix on Mon Jan 17, 2005 at 04:01:00 PM PST

    •  Hope this clears it up (none)
      If people need to take pain medication the rest of their lives, due to chronic pain, it used to be done (and still is, but it's a problem, like I mentioned.) Some of these people wind up with physical addiction and a few of them don't. But physical addiction is very different than "addiction." In psychology they use the term "subtance dependence" in lieu of addiction now, for reasons such as this one. One differentiates between physical addiction and substance dependence with many different things, but it can be summed up with psychological dependence, and taking the drug because you like it - to get high.

      I am sorry if I didn't make this clear, but there are no proven detrimental health effects from most opiates, including heroin. Otherwise methadone maintenance wouldn't really work, if it had major detrimental health effects. You can take an opiate your entire life and other than your brain you won't have any health problems from it. As I said in a previous post, one of the worst side effects is constipation, oftentimes severe.

      A barbituate is a "downer," the class of drugs that were once called "major tranquilizers." They are like alcohol but worse. They are extremely physically and mentally addictive, can kill you, are extremely easy to overdose on even taking the dose you are accustomed to, and have life-threatening withdrawals. They are some of the nastiest stuff known to man. They are almost no longer used at all, save one, a weak one - phenobarbital - for seizures, except in inpatient settings, often as part of anesthesia.

      Resuscitate investigative journalism! Reality-Based does NOT mean investigations are wrong - it means investigations are essential.

      by nephalim on Mon Jan 17, 2005 at 04:26:01 PM PST

      [ Parent ]

      •  psuedo-addiction... (none)
        is the term used to describe someone who is "addicted" to pain meds due to chronic pain. Someone who is pseudo-addicted will show no signs of true addictions once there pain issue is managed or resolved.
      •  asdf (none)
        Human brains naturally produce substances with similar action to morphine, endorphins.  The sites in the brain where endorphins do their work?  The opiate receptors.  As I just learned, the word endorphin is a contraction of "endogenous morphine".

        Not only that, but morphine itself might be an "endorphin":

        Several persistent researchers finally have proof for a theory they have held for more than a decade, despite dissent from the larger scientific community: Morphine occurs naturally in the human brain.

        •  Yeah I really didn't get in to that... (none)
          That would be a long topic that doesn't really belong here.

          One very interesting thing to note is that a virgin heroin high is extremely similar to what happens when you die.

          Resuscitate investigative journalism! Reality-Based does NOT mean investigations are wrong - it means investigations are essential.

          by nephalim on Mon Jan 17, 2005 at 05:02:09 PM PST

          [ Parent ]

      •  Thanks Nep...again (none)
        a great diary..so good, I plan on reading it again. Thanks again for you answers. I have a friend who has chronic pain and they won't operate so this is the life they will lead. I have heard so many mixed crap about the medications. Like Liver damage, hear attacks, you know the stuff they put out there. Anyway, thanks again..keep up the great work..glad memebers are reading and recommending..Glad Georgia10 persuaded you to write about this topic you know so well.

        educate 'em when they're young

        by Chamonix on Mon Jan 17, 2005 at 05:36:23 PM PST

        [ Parent ]

        •  Liver damage can happen (none)
          from some prescription pain meds, as they contain Tylenol (Acetaminophen, APAP.) Tylenol can cause liver failure at doses as low as 6 times the recommended dose. Just a heads up - while most opiates don't have any detrimental health effects (obviously other than addiction,) there are occassionally caveats such as this one.

          Resuscitate investigative journalism! Reality-Based does NOT mean investigations are wrong - it means investigations are essential.

          by nephalim on Mon Jan 17, 2005 at 05:43:25 PM PST

          [ Parent ]

  •  Good on you (none)
    Thank you for the hard work you've put in, both in your diaries and in your healing.
  •  A few disparate comments (none)
    My ideas/opinions are based on my work as an addictions specialist social worker currently working at a tertiary hospital, and I did one of my internships at a methadone clinic...

    1. Thanks for the diary. I agree with you that different people get clean different ways. No one approach (self-help, group tx, individual tx, med maintenance, cold turkey, acupuncture, religion, etc...) works for everyone. IMHO, a multi-faceted approach tailored to each addicted person's individual situation has the best chance of helping.

    2. Crystal meth is very much present in the Northeast. Growing exponentially here in Boston. Tends to be shipped in, but it's totally here. HUUUUGE public health problem heading our way.

    3. Legalization of anything except maybe pot would be a big mistake; again, IMHO. Alcohol's "addiction curve" is much less steep than any of the illicits except for pot. It takes much longer for a human body to become physiologically addicted and damaged by EtOH than by the illicits. And while opiates and hallucinagens have been available in various cultures for millenia, only in the past few generations have these substances been manufactured and available in such purified form - you really can't compare them to EtOH.
    The government giving you pure clean heroin and clean needles to inject it with will not protect you from tolerance. It also will become and remain your #1 relationship. Your substance - government sanctioned or not - will be between you and everyone and everything else in your life. Also, people with opiate tolerance can pretty much kiss good pain management goodbye.

    1. Just bein' picky here: group tx and self-help tx are TWO DIFFERENT THINGS.

    2. While you can be compulsive about food and sex, you cannot be "addicted" to food or sex. Our brains are wired to get pleasure from food and sex - it's normal and healthy. Those pathways get "hijacked" by EtOH and illicits and can be ruined by heroin/coke in particular.

    Thanks again for the great diary
    •  Thanks, let me respond.. (none)
      There are only two comments I want to respond to. Thanks for the reply, and sharing these things, and if I might disagree strongly regarding one or two things, don't get the wrong idea.

      Legalization of anything except maybe pot would be a big mistake; again, IMHO. Alcohol's "addiction curve" is much less steep than any of the illicits except for pot. It takes much longer for a human body to become physiologically addicted and damaged by EtOH than by the illicits. And while opiates and hallucinagens have been available in various cultures for millenia, only in the past few generations have these substances been manufactured and available in such purified form - you really can't compare them to EtOH.

      Sure, it's very comparable, you can't say just because they are somewhat new (about 100 years) they are incomparable, I am sorry but I strongly disagree there. They are clearly different things, but very comparable.

      As for the "addiction curve" you mentioned, I am not sure you are correct. I do believe it's relatively similar, if not virtually indentical. You also have to consider the fact that alcohol is socially acceptable and used as such, and people don't start drinking 4+ times a day for mainly that reason.

      On top of that, you said "damaged." The topic here is heroin, and heroin does not, itself, damage the body. Many other "hard" drugs don't either - but many do, and far worse and much quicker than alcohol - such as crystal meth.

      I will look for some evidence regarding this, and get back to you, whether I am right or wrong.

      However, I find it a bit irrelevant. It matters little exactly how quickly it takes for physical addiction to set it. And the reasons for this I argued throughout my diary.

      I do, however, find your insinuations that alcohol is OK (relatively speaking) whereas drugs (except pot) are not to be quite troubling, and I adamantly disagree, even if you didn't say that outright.

      The government giving you pure clean heroin and clean needles to inject it with will not protect you from tolerance. It also will become and remain your #1 relationship. Your substance - government sanctioned or not - will be between you and everyone and everything else in your life. Also, people with opiate tolerance can pretty much kiss good pain management goodbye.

      I never said otherwise, and do not disagree. But the bad needs to be taken with the good - and we are not talking about everyone here, either.

      I do disagree that it will be your #1 relationship. Quite a bit, in fact. Having been down the road of being a heroin addict and having a sky-high tolerance personally, I can tell you that while my #1 concern was having a supply of heroin, my life otherwise was virtually unchanged. I described this pretty thoroughly, I think. However, that's not to say that government sponsored heroin means that heroin is OK, and I think I made that pretty clear.

      You can kiss pain management goodbye in just about any situation where you are abusing opiates, a big problem, save the much softer ones. No tolerance is completely insurmountable, however, if the doctor is willing.

      Thanks for the info on crystal meth - I know, virtually for a fact, it has yet to "take" like other drugs in New York - it's just not on the streets like the others. I am sure it will, however, and sure it has in many other places in the East - as I said, it's definitely a growing problem. A big one. I said in a comment it warrants it's own diary, but I don't think I am really the one to write that diary.

      Resuscitate investigative journalism! Reality-Based does NOT mean investigations are wrong - it means investigations are essential.

      by nephalim on Mon Jan 17, 2005 at 05:25:55 PM PST

      [ Parent ]

  •  Wow, check this out, (none)
    An article I found while googling at the Free Republic, deriding the "War on Drugs."

    Freeper Article

    This is one issue I think there is consent from everyone. The problem is no one knows what to do about it.

    Resuscitate investigative journalism! Reality-Based does NOT mean investigations are wrong - it means investigations are essential.

    by nephalim on Mon Jan 17, 2005 at 05:31:15 PM PST

  •  Thanks again! (none)
    For those of us who have never known a heroin user (as far as we know), thanks for writing these.  Your articles are really eye-openers, and the first person perspective is so much better than what we hear from the media and the government.
  •  IBOGAINE (none)
    should be thought of as just another psychedelic.  You could use LSD or Mescaline et al, but Ibogaine is legal in Holland, Mexico and Israel so the principles involved maintain clinics there.

    There has been at least one death attributed to the therapy but it seemed to involve a young woman who smuggled heroin into the treatment facility.

    Keep posting. Hope to welcome you back into the world of the used-to-be-addicted soon. Good luck.

    A democracy that is fixed, is broken.

    by Brother Artemis on Tue Jan 18, 2005 at 09:39:07 AM PST

    •  2 deaths following Ibogaine treatment... (none)
      both involving ingestion of modest doses ofg heroin subsequent to treatment. The 2nd, Rob McDonald, was a friend and codefendant from protests at 1996 Democratic National Convention.

      This vastly increased sensitivity to Opiates by itself proves that the Ibogaine effect is not "just another psychedelic" but is active in the dopamine circuit as well.

      I am not currently Licensed to Practice in this State.

      by ben masel on Sat Jan 22, 2005 at 06:19:13 PM PST

      [ Parent ]

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