At the suggestion of georgia10, I am writing this diary. I didn't think there would be much interest, but hopefully there will be, we shall see. I shall try to focus on the legal and political aspects and implications.
As a few people know, I am a former heroin addict. I have been in maintenance for 4 1/2 years - but not with methadone. There has been an alternative around for about 2 years now [in America], yet few people know of it. It's called buprenorphine, a drug that has been around for many many years, but now is available for maintenance purposes in a high-dose form under the brand names of Subutex and Suboxone. If you don't know what maintenance is, keep reading.
First of all, a plug: The Drug Reform Coordination Network (DRCNET)
They were founded in 1993 and have both a lobbying arm and a non-profit arm, similar to the ACLU. They release a weekly newsletter, and at the least I suggest you subscribe - you will learn alot about something that has fallen to the back burner in recent years with the massive issues created by the Bush Administration.
Much more below the fold
Let me provide a link to the ACLU for ease here:
American Civil Liberties Union
I strongly urge anyone who isn't a member to join the ACLU, it is of my opinion that nothing is more important than our civil liberties, and I am worried that the "PATRIOT" Act has barely a mention at all - nevermind "PATRIOT II", which is downright disgusting. It's THESE things that could
destroy this country - not the end of Social Security [although that is certainly not something to be ignored, don't get me wrong.]
Finally, one last shameless plug. A FAQ I wrote on buprenorphine, the maintenance medication I am taking Buprenorphine FAQ (in need of updating) by Nephalim(27)
It contains just about anything you would want to know about buprenorphine, a large amount of info on methadone, and the current law. I will reiterate much of it here. It also contains a bit about me, as well. If you read this and want more info, that's where to go. It's written as a FAQ - a format that is much more readable.
Anyways, enough with the plugs. Onwards and upwards.
There is another reason I am writing this, and that is because heroin, as well as other hard drugs, are about to become a major problem again. I will get into this later.
Everything I will say here will be as much in layman's terms as possible as opposed to technical terms, so don't jump on me for not getting something "technically" correct. This isn't the place for such things.
Let me end by saying this will hopefully be part of a series, assuming there is enough interest. Tell me what you want to see, and I will deliver.
UPDATE (day 2): (sorry, haven't figured out how to use update tags yet.) I have written this from the perspective of someone who is an advocate of maintenance treatment. Let me make it as clear as possible: there are people who feel this is not the best way to deal with heroin addiction. And while I strongly disagree, and am not going to un-bias my diary, as it is my personal opinion, I am going to show you the other side of the coin. Look towards the bottom of this diary to see what I am speaking of.
A Personal Statement
Let me get one thing out of the way: heroin has been stigmatized to no end, largely due to the needle use involved. However, due to the great increase of potency that heroin has had in the past decade or two, needle use is no longer necessary for those who aren't hardcore addicts. There is large growth in suburban sniffers and smokers, as well as large growth in use of prescription opiates (properly known as opioids, except for codeine and morphine, but I will use opiates anyway,) especially Oxycontin [generic name oxycodone], which spreads out to rural areas as well as suburban areas, and it's a HUGE problem. It's even hitting the rich - just look at Rush!
Now, back to what I was saying: is heroin (and other opiates) bad? Hell yes! I am not, nor will I EVER, advocate heroin use. But it's bad for one reason and one reason alone: the addiction/tolerance. Every single other reason is due to the drug war. Every last one. This is my opinion, and you are free to disagree. Let me also make clear that I am not downplaying the problem of addiction and tolerance: it's a HUGE, HUGE problem - as you will soon learn about. Now, a large group of street addicts are worthy of the stigma - there is no doubt there - just go to a crummy methadone clinic if you have any doubts. But there are also large groups of opiate addicts you have no idea existed. If you are so inclined, visit alt.drugs.hard [where mostly current users are], on usenet, and speak to some of these people. They are intelligent, thoughtful, friendly, and to some extent, as much as is possible, in control. Unfortunately that's still very little.
If you limit heroin to sniffing and smoking, let's just say that I would rather that than be an alcoholic. Alcohol causes permanent bodily harm, and even death. Heroin does not [overdose is a problem but could largely be controlled with legalization(at least for addicts) - by knowing what you are getting, and giving the cure for overdose out freely - and doesn't occur very often in those who aren't shooting. Yes, there is a CURE for overdose. The most common is naloxone, an opiate ANTagonist, which means it blocks opiates from working. You will feel like the worse kind of shit imaginable after getting a shot of that - but your life will be spared.] What else does alcohol do? It causes violent and other nasty behavior, for one. Opiates do not, except perhaps to those desperate to get what they need to feel normal. It causes far more deaths in car crashes, heroin doesn't impair your driving ability to THAT much of an extent - although it surely does - unless you are "nodding" (falling asleep.) It also has life threatening withdrawals - as do tranquilizers - heroin does not. It's just as addictive as smoked or sniffed heroin, and ALMOST as hard to get off of, in the long term. I just want to make the point that just because something is legal, doesn't mean it's "OK".
Let me say something again: I am not advocating opiate use! You WILL regret it! I promise you. You will be chasing that "virgin" high for the rest of your life, and might wind up unable to experience the pleasure you were once able to. It's not a fun life, and it's surely not glamorous. Let me also make it clear that there is no "soft" opiate (except, perhaps, opium.) Everyone starts, that is the people who aren't on the street, with "soft" opiates. It doesn't last - and even if it does, the differences between them and heroin are minimal at best. The thing that makes heroin so much different than other opiates is the so-called "rush" - it rushes your brain faster than any other opioid, and causes great feelings of pleasure, even after your tolerance is sky-high. Maintenance meds are different, and I will explain.
Alright, let's start with the basics.
The Basics
Well, in that personal statement, I have explained very much about the non-legal and non-political aspects of this, so I will largely try to keep this on topic. But there are many concepts I need to explain, first. I hope I am not boring you too much, and thank you for taking the time to read it. I promise I will get into something interesting.
I didn't tell you what maintenance is, for those who don't know, and it's a very fundamental concept to all of this. Maintenance is when you take another opioid instead of heroin, "maintaining" your addiction. At face value, that doesn't sound very productive. But it is, and I will now tell you why. At the current time, there are two maintenance medications: methadone, and buprenorphine[Subutex/Suboxone]. There was a third, LAAM, legally no different than methadone, which worked for a whopping three days, but it was pulled from the market (in the USA) because of lack of interest and the potential for heart attacks it causes (one of the few opiates, if not the only, to have such problems.)
So why is maintenance important, and a very necessary option for heroin and opioid addiction treatment? Why isn't it "trading one addiction for another"? Because depending on the study you are looking at, nevermind anecdotal evidence, your chances of success at long-term abstinence are anywhere from 5-15%. No one knows why this is, at least not yet, but even after the withdrawals are over, "the easy part" according to just about anyone, the hard part begins - long term abstinence. "Willing it" just doesn't seem to work - believe me, I have tried. Your brain seemingly gets rewired to treat heroin like the most basic of your biological needs, lasting anywhere from 6-12 months to the rest of your life. It's like trying to "will" yourself not so sleep, or eat, or fuck. Over the long term.
So that's why it's important, because your chances of abstinence are so low, and people just want to live normal lives (and buprenorphine is a HUGE step towards that goal, as opposed to methadone, I will explain.) The important question many must be asking themselves is what makes it any different than heroin? There is a world of difference between methadone/buprenorphine and heroin/other opiates. The first and foremost is the duration of action and the time to peak effects. They both prevent withdrawals for 24 hours (or more), meaning you will not be constantly running around looking for a fix, and you won't have the ups and downs of heroin - once stablized, you will essentially just feel normal - not high, not low. Your body will adjust to the drug and make itself work as if it wasn't there. Ideally, at least, there are some very unique people out there. The fact that it takes nearly 2 hours to reach peak effects means you just simply don't get high from these drugs - unless you are "niave" to opiates, that is, in which case you wouldn't be going into maintenance. As I said, it let's people live normal lives - people on methadone, undetectable, are lawyers, engineers, even doctors. You would be amazed.
Buprenorphine is different than methadone, and it's vital. I will get into the legal differences and implications in a minute, but let me get the final bit of basics out of the way. Buprenorphine is a "mixed opiate agonist/antagonist," well, actually, it's better described as a "partial opioid agonist." Describing this is beyond the scope of this diary. Let's just say there are several things about buprenophine that make it very different pharmacologically than methadone, which I will describe:
#1 - It is a much weaker drug. It won't leave you with a sky-high tolerance to opioids.
#2 - Following that, even though it's weaker, it has an antagonist effect - meaning it blocks other opioids from working (i.e. heroin.) - quite well in fact, but not as well as was originally believed
#3 - Following THAT, It seems to fix what heroin broke, and anecdotal evidence clearly implies that you are often more sucessful getting off buprenorphine than methadone.
#4 - Finally, the withdrawals of buprenorphine are mild at best in relative comparison to other opiates, especially methadone. Methadone withdrawals are a month of utter, utter hell.
There are two major downsides to buprenorphine, which I will also list for you.
#1 - As I said, it's, simply put, "weaker." This means that it can't satisfy all addicts - although the specific tolerance and level of addiction of the addict seems to play only a small role in this.
#2 - Due to it's opioid-blocking effects, the transition of getting on to buprenorphine from heroin or other opiates can be quite painful, especially if it's not done properly - and most doctors have no idea what the hell they are doing in this regard.
One final thing to say about buprenorphine - poorly understood, but it seems that it helps greatly with cocaine addicts. Getting into this is beyond the scope of this diary.
Well, I hope that's about it for the technical mumbo-jumbo. I hope you are sticking with it. On to some more relevant stuff.
The Law
So what is the law regarding maintenance treatment, and how has it evolved? When and how did buprenorphine come into the picture, and how is it different?
Let me start by saying methadone maintenance treatment has been around since the 1960s. It has very much proof as to it's effectiveness, as well as something very important: it is far cheaper, for society, to have an addict on methadone than on the streets on heroin. That's some food for thought for conservatives.
Methadone has some very strict laws regarding it's use. These laws vary from state to state, but under the Federal CSA (Controlled Substances Act, as amended, which is the federal law controlling almost all of prescription and illegal drugs,) only doctors with special certification, working in special clinics, can prescribe methadone. In most cases, "prescribe" isn't really the word. The users need to show up, every day, sometimes within as little as a one hour period, to get their methadone. Most clinics have a ridiculous rule that you must piss heroin positive in order to get on heroin - causing people who have been clean a few days but just can't take it to go out and get high needlessly. Only after testing clean and going every day for 6 months or more do you get any "takehomes." These takehomes start for weekends and work there way up, after several years, to monthly (in some cases.) Usually two weeks is about all you can expect. I don't know exactly how much of this is federal law, state law, or not law at all, unfortunately. I will look further into it if there is interest.
So the laws regarding methadone (and LAAM before it was discontinued,) are pretty harsh. It's hard to imagine anyone making it through that instead of just scoring a bag. Or getting screwed because of a momentary lapse of judgement. That brings us to buprenorphine, which comes in two forms - Subutex, which is just buprenorphine, and Suboxone, what is commonly used, which contains an extra ingredient - naloxone. This is added to prevent abuse. If taken normally, it does nothing. If injected, it causes massive withdrawals. This is what I am taking.
So what makes buprenorphine different? In 2000, under Clinton, the 106th Congress passed the Drug Addiction Treatment Act of 2000, otherwise known as the DATA. You can search Thomas for info on this, including the full text of the bill and the Yea's and Nay's. Unfortunately I can't link it, as it only keeps what is generated temporarily. The DATA amended the CSA (Controlled Substances Act) to allow normal doctors, who either meet certain qualifications or take an 8 hour class, and apply to the DEA and SAMHSA (Substance Abuse and Mental Health Services Administration), to prescribe Schedule III opiate agonists (opiate drugs), that are FDA approved for opiate addiction treatment (methadone is Schedule II - meaning this act doesn't apply to it.) You can get a regular prescription from a qualified physician, and fill it at your local pharmacy (alas, most local pharmacies, especially chains, are very reluctant to fill these prescriptions and in many cases will make up blatant lies.) The doctor is in full control of your treatment, and you can take home up to a month's supply as soon as he sees fit. This is a major step forward. Unfortunately, it has yet to spread to the streets, and only the upper-class drug addicts have been able to make use of the drug, and it's a real shame.
Methadone clinics are afraid to be put out of business, and have done everything they could to stonewall this and the FDA Approval of Buprenorphine for Opiate Addiction every step of the way. Now, even though this law was passed in 2000, there were no opiates that were Schedule III or above that were FDA approved for opiate addiction. Buprenorphine was in clinical trials for nearly two decades, being stonewalled every step of the way by everyone who had an interest in seeing addicts suffer or keeping the cash in the methadone lobby's pockets. It finally was approved by the FDA in October 2002, and available in pharmacies next January, 2 and a half years after the DATA was passed, despite ample evidence of it's effectiveness. Buprenorphine has been used in other countries with great success (although some abuse has been reported when heroin supplies ran dry, like in France,) for a long time. It is currently used in dozens of countries, including much of Europe, Canada, and Australia.
It's interesting to note that immediately before the FDA approved it, the DEA rescheduled it to Schedule III from Schedule V (the lowest.) Reading the petitions to the DEA was both fascinating and frightening, hearing misguided assholes demanding it be in Schedule II with things like Hydromorphone (Dilaudid) or Morphine. Luckily they decided not to put a stop to the whole thing by doing so, and they put it in Schedule III. They put both Subutex and Suboxone in Schedule III, which makes little sense, as Suboxone is specially formulated to greatly reduce any potential for abuse.
Now, let me finish this part off by saying that congress did something blatantly illegal when they passed this law - they delegated their powers to the executive branch, putting it into the law that the DEA can pull the plug at any time. While I find this unlikely at this time because this drug is used mainly for upper- and middle-class drug addicts, such as Rush I am sure (eventually at least,) it is still a scary thought. Even if they didn't put this little disclaimer in there, it would matter not, as the DEA could reschedule the drug at any time to Schedule II, putting it with methadone, and then the special provisions of the DATA would no longer apply.
Why this is important
Well first of all, we are going to see a huge resurgance in hard drug use - if we haven't already. Poor economic times lead to this - nevermind the HUGE crop in Afghanistan, which, luckily (for US,) will flood Europe and Russia and very little will wind up in the USA. The Heroin in the USA comes from Columbia (East Coast) and Mexico (West Coast,) and small amounts from East Asia, mostly on the East Coast. But it's still a matter of supply and demand, and I can tell you that scoring heroin on the streets of New York has never been easier.
So with a resurgance in drug problems, we have two issues - the first being getting the people that need help, help. The second being the "war on drugs" might return as it started - and that won't be pretty. With drug laws being toned down or outright decriminalized in many places, I am afraid of a backlash. The homosexual "acceptance" has had a backlash - that's for sure.
In fact, the drug war bears a great resemblence to the evolution of homosexual rights, only the drug war is further behind. First, it was a crime. Then, it was a disease. Now, (for homosexuality,) it is a right - yet still viewed as a problem by most in society. I am waiting for drug users to reach the next step.
Drug law reform needs to be properly framed, and treatment as opposed to incarnation needs to be the only option. Sending low-level non-violent drug users to jail is not only counterproductive, but a huge waste of money, and ruins many, many lives. Here in New York the Rockefeller Drug Laws were laxed - which is a big step for us here, but it is far from what can be deemed "reform." Somehow we need drug laws that will discourage new users, even though I personally believe it to be a civil right, many others do not. I think what I do with MY body is MY right. And if you disagree, I wonder why most feel that people can do what they want with their body when it comes to abortion, but not with drugs. If proper heroin maintenance is given to addicts, the problems of heroin addict to society would virtually dissapear.
Besides that, the drug war is a complete and utter failure. It causes crime, causes people to become homeless and poor, causes needless deaths, the repercussions are endless - and this is blatantly obvious. We cannot continue such a fundamentally flawed policy, whether you believe drug use is a right or not (the founding fathers seemed to think so, I might add.)
Why else is this important? Because as I said way up at the top, there is nothing more important in my mind than our civil liberties - and it is something that must be defended - it is the last door to full-blown tyranical fascism that needs to be crossed. We must fight tooth and nail to stop any futher incursions into our liberties as Americans. (BTW, look up "liberty" in the dictionary. Tell me if you can honestly say to me that currently applies to America.)
Perhaps in another edition I will write the history of the drug war and drug use in America - and how, seemingly, drug use wasn't really a problem until the government propagandized it and created prohibition, the correct word for the current situation. Alcohol prohibition didn't work, and drug prohibition is working far less. Ending drug prohibition would go a long way towards curbing crime on all levels.
Here are some links to wet your whistle with on the drug war, and why this is important:
An Open Letter to Judge Rufus G. King III - A nice summary on the problems with the drug war.
The current DRCNET "chronicle" (newsletter)
---------------------
Thank you for reading this. I know it was long and contained lots of boring info you probably don't care about. Tell me where you want me to take this and it will be done, assuming the interest is there. I can talk about other drugs, or (/and) talk about prohibition and the drug war throughout American History.
UPDATE: It seems I have finally made the recommended diary list. I want to thank everyone for their very kind words, and let them know it's a pleasure to be able to write something that people find interesting or helpful.
Finally, I have decided to continue this into a series, with the next diary being on the history of drug prohibition and where we are now in the "war on drugs," and how exactly it's a problem. I will continue with what should be done in the future - a topic for debate - and then write some diaries on other drugs as I have done with heroin here. Please give me your input, this certainly isn't set in stone.
UPDATE (day 2): Here's what I promised, the other side of the coin. Here is a very well written post by glibfidget, who is also a former heroin addict, along with my rebuttal, to someone who feels very strongly that maintenance is not a good thing, and that abstinence via NA/AA is the way to go. I strongly disagree, and you will see both his and my arguements.
I want to say first that both he and someone down below stated that there is virtually no success rate with methadone or buprenorphine, and that it has little proven value. This is simply completely bogus, and I will provide the statistics to back up my claims.
I also want to say something very important I should have said in the first place: methadone and buprenorphine are VERY different medications, and there are strong downsides to methadone which don't exist with buprenorphine. I will make a list of the downsides of methadone that I didn't mention. And this is the reason I feel very strongly about buprenorphine as opposed to methadone - but for some people methadone is the only option - and I can say with absolute certainty that I *HAVE* met these people.
Downsides to Methadone (and compared to buprenorphine)
#1 - You have to go to a clinic every day for a long time at the beginning, which I did mention, but I didn't mention the fact that you are surrounded by drug addicts while doing so, and there are usually drug dealers parked outside (especially the lower-class clinics, there are many different "types" of methadone clinics, some for street addicts, some for upper-class addicts, and the latter is far superior.) Buprenorphine doesn't have this problem.
#2 - It is extremely difficult to get off of methadone. You have, in most cases, withdrawals worse than heroin, and lasting over a month (as opposed to a week with heroin.) Buprenorphine has extremely mild withdrawals in most cases, but they are long lasting like methadone, about a month (compared to about a week with short-acting opiates.)
Well, that's really it. I think I mentioned everything else. But these two things are very important. Let me know if I am missing anything.
Finally I want to say that this diary has been misinterpreted that I was suggesting lifelong maintenance. I was not. While that is certainly a possibility, especially with certain individuals, the goal of maintenance treatment is that you will get off of it eventually, and that should be very clear.
The Post by glibfidget including my Response
You said alot, and I hope I do your post justice in the response...
Let me say first of all that it's fine that you disagree, and I realize that I wrote the diary from one specific perspective, and I even added an update at the bottom that I needed to make it less biased, even though I AM biased in this regard. I have to say though quite honestly I disagree with alot of what you said, and I do find it "disgusting" to a large extent - but much like you, I am not going to attack you, and respect your views. You had success with a certain route, and that is important. Everyone is very different when it comes to this, and anecdotes should not be ignored. But neither should the scientific statistics. Anyway, let me get to what you said.
I gave you a 4 for the diary. Politically, I agree with most of what you said. Personally, it was well written and thought provoking; however, I find the mindset you subscribe to disgusting. I don't mean that as a personal attack on you, though I suppose by nature it is, but keep in mind I certainly don't know you. And, perhaps disgusting is a strong choice of words. And while I try not to be judgmental on this topic when I run into guys like you, that sort of mindset evokes some fairly strong gut reactions for me. Your way of thinking kept me (and people like me, ergo you) sick for a long, long time.
It did? Most of the people I know that tried to go clean tried being clean many many times, always going back to heroin. (I don't know many real-life junkies, well...not very well. Most of the people I know have been in online forums, I was alone in my habit, at least for the most part.)
What I personally agree with is that people need to try being clean, if they feel it's their place. What I don't agree with with is that they should try it right off the bat.
Have you ever seen the look in a junkie's eyes, one who has tried to be clean over and over again and just keeps failing? I have seen it many times, and it's one of the most horrible things you can see. To have these people keep trying to get clean in futile attempts is nothing short of inhumane.
I did take pot-shots at NA/AA, and I do NOT subscribe to their "faith-based" approach. I think it's a solution, but I think that accepting god as a solution to a problem is nothing short of a "cheap way out" as I believe you put it. That doesn't mean that I don't believe in any type of counselling period. I don't believe in group therapy with other junkies - it's a ridiculous idea. If it worked for you, great, but I think overall it is so ineffective and it puts people in a position they shouldn't be in that I wouldn't recommend it for ANYONE...
I am getting ahead of myself. Let me try and address them as you say them.
So, while I can't say it without it coming off as a personal attack (as it's a personal topic for the both of us), I mean it generally. Again, I don't know you.
What I do know something about is addiction, and addicts of all stripes. Background on me, some of it anyway, I'm a recovering addict myself. It's pretty much ruled my life from adolescence on (I'm in my late 20s now, so say 15+ years). I've been in numerous inpatients, outpatients, detox wards, mental hospitals, jails, etc over the years. Believe me when I say I understand the issues involved intimately.
I see that your history is littered with the most horrible of places. What is so great about buprenorphine is it lets you go to your doctor, take home a script, and return to a normal life. Then, and only then, when you are completely into a normal life and a normal mindset removed from drugs does anyone really have a chance at success with abstinence that I feel they should try. I think the chances of abstinence right off the bat are so low, and the chances of severe harm with relapse - guilt, further self-doubt, even death from overdose which happens most often with the relapsing junkie, that it simply doesn't even warrant trying at that point - unless there is simply no other option. But that is my opinion, and everyone is different, and there are always unique situations.
I also know, for me, what works and what doesn't.
I also want to make it clear what works for you doesn't necessarily work for other and vice versa. I think I already made this clear. In this world, everyone is very unique, and there is no one solution for everyone. Your story is but one anecdote. I know several thousand. I am sure you know plenty as well.
Indeed, in the recent history of addiction treatment (last 100 years or so), psychiatry, psychology, criminal justice, certainly pharmacology, have all failed in providing effective and holistic treatment for the addict.
Agreed.
AA and NA have been, consistently and unequivocally, the constant form of treatment that has proven most effective for long-term sobriety. What's more, any psychiatrist, psychologist, parole officer, or even pharmacist who knows anything about this and isn't trying to sell you something, will absolutely tell you the same thing.
Sorry, I disagree. My first doctor, a doctor from overseas in France who was personally responsible to a large degree for helping Paris get off heroin (at that time) and bringing buprenorphine here, understood many of the things I said, and I was so lucky to have had him. He thought leaving yourself on your own was the worst thing you could do - but surrounding yourself with other junkies was the second worst.
I DO agree that AA/NA is the most effective group therapy available - period, and that's an important thing to say. It is a well-designed program that works well for alot of people - especially alcoholics where in their case alcohol isn't illegal and the situation is very different from a junkie. But as I said a while back, a large hunk of their success is due to people giving themselves to god, and doing so for convenience. I am an atheist, and I find it disgusting, for personal reasons. People need to learn that they have the power over themselves, not some invisible force has the power over them.
I don't want to turn this into a discussion on god. I will address the issues of group therapy (alone) vs. medical treatment with therapy (of any kind.)
In your diary, you stated simply that long-term abstinence isn't for you because...the odds aren't good.
I should have made it clear that I meant that it isn't for me right off the bat. It isn't for just about anyone right off the bat, unless they are extremely special. The potential benefits don't outweigh the risks, and their chances of success are the lowest of all. Your mind is simply too fucked up to just go cold turkey and be clean - it just doesn't work in 99% of people.
I will likely have a go at abstinence sometime this year. I am afraid, but I am ready. It took me longer than most wait, but I didn't want an exercize in futility, it simply wasn't worth it. Methadone has many hardcore downsides (including the most severe withdrawals imaginable), buprenorphine has virtually none, and I am going to make this clear in the diary.
What you don't mention are the odds of people getting "better" by any measure on maintenance drugs. If you look at methadone, the "success" rate is astronomically small. The success rate with buprenorphine is simply non-existent, as we have no measure of its long-term effects.< You're betting the farm on 0% or 5% (buprenorphine and methadone respectively) against 5-15% (the % you put to abstinence, which I promise is A. wrong and B. doesn't tell the whole story).
What in gods name are you talking about (no offense)? Your numbers are just plain wrong. The numbers are upwards of 50%, IIRC, in keeping people off of heroin and keeping people safe from AIDS and other related problems. I will find the studies to prove it to you. The fact that you would quote such totally bogus numbers makes me question the the objectivity of your information.
Even based on your logic, you're playing the wrong numbers. But the other question you have to ask yourself is: how do you define success? If "success" on buprenorphine's terms means taking a narcotic daily for the rest of your life because you can't live without it, versus the "success" of say a 12 step program--which is abstinence and living a better life--well, I'd say the pot of gold at the end of the rainbow for abstinence is a heckuva lot richer than with maintenance pharms.
Hell no. While I feel that lifelong maintenance IS a valid option, and one that works for many people - I have seen them - they are professionals in many cases. My trip to the upscale methadone clinic absolutely boggled my mind.
But as I said, hell no. The goal of buprenorphine is NOT lifelong maintenance, even though *I* feel that's a valid option. The goal is treatment through medication until you are ready to become clean. And with buprenorphine, getting clean is a heck of a lot easier than with heroin or methadone. It's about being able to get your life in order. You are incorrect, whoever has told you this information does not know their facts. Any clinical trial of methadone or buprenorphine has the people go clean at the end, and that is the stated goal.
The bottom line though, and why BOTH maintenance pharms and long-term abstinence have low success rates, is because it's hard. Simply put. If it was easy to get off drugs, everybody who had a problem would do it. It isn't, it's going to be tough no matter how you try to do it, and most people won't make it (remember, this goes for maintenance pharms also).
Absolutely! But being on a maintenance med is no comparison to abstinence, and if you think it is, no offense, you are simply misguided. Either way it is hard, and no matter what abstinence is going to be super hard. But it is my strong opinion that abstinence after maintenance is a far better shot, and really the only one worth taking in almost any case, than abstinence cold turkey from heroin.
The thing is, you can't decide what you're going to do based on what seems easiest, which is essentially what you're doing. You need to decide based on asking yourself the question "What do I need to do to be the person I want to be?" I tell you what, dieting and exercise regularly for life is pretty tough too, but if you have a weight problem and want to change, that's the best way to go, versus putting your faith in every new miracle pill that comes on the market promising to make you thinner. It was easy(er) for me to quit shooting dope if I just drank a case of beer and smoked a few joints every night, but guess what, that was pretty shitty too. The thing is, I might have even been able to live like that, long-term, and I could tell myself I was living a reasonable life (getting to work on time, maintaining a relationship, not getting arrested, etc). But I'd ultimately be lying to myself. I know, I've tried it. If that's what some people choose to do, hey more power to them, but I have a hard time believing that they're much self-actualized that way, just based on my own personal experiences and the personal experiences of pretty much every single person I've ever met that's tried to stop using drugs by substituting with other drugs.
I am sorry, but I have to strongly disagree with you here, and I have already outlined my case. Your analogy is very flawed.
That's the general stuff. Specifically on this post, you say that it's not an ideal situation for a person trying to get clean to surround themselves with other addicts or alcoholics. And yet, it's consistently the most tired and true method we know over the last 70+ years.
Not so. That would likely be methadone. It's been used since the early 60s with great success.
Look at every person in that room that's more sober than you; that's exactly what worked for them when nothing else did it. You're acting like it's a drug party you're walking into: what it is is group therapy and a fellowship of people who have struggled with the exact same problems you're struggling with and have come out the other side. Your psychiatrist who is prescribing you drugs has no idea what you're going through or even what works for the problem. He hasn't faced the same demons you've faced and prevailed. The guys in the rooms of NA have.
That's just the thing. In most cases they haven't. They are trying to prevail against the demons, but in most cases they haven't.
If there was group therapy where everyone was verifiably clean, that would be another story.
But this is what gets me most:
What if I believe in empowerment instead of helplessness? Teaching helplessness as a drug treatment strategy is poor to say the least, IMHO.
You believe in empowerment and not helplessness, by deciding that you are absolutely incapable of abstinence and the only way you can live a productive life is by ingesting a narcotic daily? How is that empowering? You've already decided you're helpless, it seems to me.
I have already addressed this for the most part. I am, for the most part, helpless. But for me to change that, empowerment is the only option. I am not going to give myself up to a higher power - and that simply won't work for me - period. As I said, everyone is unique in this case.
But, you share that with the folks in NA and AA. You said it yourself, you already know that trying to "will" or "empower" yourself clean doesn't cut it; the folks in AA and NA know it too. So instead of giving into that and saying "So fuck it, I'm helpless so I'll just keep taking drugs the rest of my life", the folks in those programs say "I'm helpless, I can't do it alone, but I know people who can help me and as long as I admit that I'm incapable of getting high anymore, I can figure out a way of life where getting high is no longer required."
I find it hard to believe you have ever been in NA, no offense, I am not questioning your truthfulness merely suggesting that your case is not like most. I have been to several NA meetings, though never have attended fully. I have scored heroin at NA meetings. Does that sound like it's going to work for anyone struggling to deal with their demons, as you put it?
I am not going to respond to the rest of your post. It is your personal experience, and your defense of NA, and I am not going to question it. In fact, I am going to put this entire post into the diary, to give people a full look at the options available - and hopefully find the studies to back up my claims of methadone and buprenorphine's success.
It was nice speaking to you, and even though we disagree - pretty strongly at that - I am glad we can keep it civilized.
Best of luck to you, and I am sure I will hear from you again soon.
The folks in AA and NA admit that they're powerless over drugs and alcohol so they're done trying to get on top of it. You admit you're powerless, but you`re embracing that helplessness and sitting in it. When you say the folks in NA and AA are trying to force a higher power on you, what they're essentially saying is "You are not God. You cannot control everything. Realize that and learn how to build a life around that very plain and self-evident truth."
And you're right, if you're just a statistic, you probably won't make it no matter WHAT you try. But I just can't imagine trying to live my life like that anymore, constantly trying to right myself with chemicals. If that's success, I want no part of it. I'd rather admit defeat and instead focus on being the person I truly want to be than wallow in my helplessness for the rest of my life. What's the longest you've been abstinent since you've been addicted? If you've just gone from one drug for another, are you sure you're giving it a fair shake? Shouldn't you try it first before passing judgement?
Finally, everybody has AA and NA horror stories. When you go in there looking for things to object to, more than likely you'll find them (guess what, that goes for anything else in life also). There are also more people for whom AA and NA has saved their lives than you'll ever find in line at the pharmacy or clinic. I know, on this site, Maryscott O'Connor is pretty open about her own experiences there, and I`ve heard a few others as well.
Finally, I hate how this post sounds. I hate coming off high and mighty and judgmental. So, my apologies, this is off the cuff and dreadfully early in the AM. But I just read a lot of posts about people who have family members struggling with addiction, and I can tell you based on what I know now that if my son or daughter is ever struggling with the problems I have, I will surely not recommend that they find a "better" narcotic to become addicted to. I've known people that have tried it both ways. I've never met somebody who long term has found a successful life by substituting one drug for another; I`d reckon that you haven`t either. Maybe it's possible, I don't know, but I've never seen a success story myself, and I've been around literally thousands of addicts. On the other hand, in my experiences in AA and NA, I've found some of the best, most self-actualized, and empowered people I've ever run across, anywhere, period, and nearly every person I've ever run into who has tried, HONESTLY tried, with willingness and an open mind, to work the NA or AA program, I've seen succeed, time and time again. REAL success.
Anyway, sorry for the rant. Like I said, it's a personal subject.
-----------------------
Thank you, glibfidget, even if I disagree with you. I sincerely apologize for not making it clear that not everyone believes the same as I do, although with all honesty most people in the heroin recovery community (who are addicts themselves) feel pretty strongly about maintenance. I can provide references to, for instance, the Advocates of Recovery through Medicine, who's hard work has been invaluable to people like me.
Update (day 2/part 2): I just realized this is a little unfair, my rebuttal without him being able to respond to my comments. If you want to see his response, as I am sure he will respond, as well as a post from someone who agrees with him, here is a link to his original comment:
glibfidget's post
Update (day 2): I promised to include other treatment options (besides maintenance and abstinence) and certain "harm reduction" policies (the current strategy today), and I am going to deliver.
Besides abstinence and maintenance, there are essentially two other treatment options. One is called "Rapid Detox." It is nothing new, and I have never heard a positive word about this method except from those trying to sell it to you. This is what I had to say about Rapid Detox, as well as a mention about the other new potential option, ibogaine:
"It's absolute quackery"
It's for people looking for miracle cures - and it just plain doesn't work. It's been around for quite some time now, it's no "breaking" treatment. It also costs ridiculous amounts of money. [Thousands of dollars]
Someone coming out of rapid detox has the lowest chance of success at abstinence of all - 5% at best. You just can't close your eyes and wake up cured. It DOES work in that you don't experience withdrawals - but if you ever see one of these things, up close or filmed, you wouldn't even consider it. It's downright horrible. They put you to sleep and force your body to go through what it needs to to be clean compressed into a 6 hour period. There have been deaths, and I wouldn't be surprized if it's shut down eventually. On top of that, you have protracted withdrawal symptoms, more minor nagging symptoms that continue longer than they should.
I have yet to meet anyone in the "loop" that had anything positive to say about rapid detox.
The only other treatment they have is this stuff called ibogaine. Well, that's not exactly true - they have plain symptomatic treatment for withdrawals, but NOTHING works to cure heroin withdrawals. Nothing - save one exception. There is a blood pressure med called Clonidine that depresses one area of the brain that heroin does - but far from all. So it does help - in some people - but others report no help or worsening of symptoms.
Back to ibogaine...it's this stuff that makes you have something resembling an unpleasant acid trip. Apparently some people think that when you take it, it does something to you that makes you look at your life and no longer want drugs. It has had mixed reviews, but there are some reports of success in clinical studies, which I need to catch up on.
------------------
I will look for some further info on Ibogaine, including a link to a site possibly with info about it, and hopefully provide that. My opinion on it is it might be worth a try, but it's no miracle cure. I think we are mostly seeing the power of placebo here. But I will investigate further, it's overdue on my part.
Harm Reduction
The current stragegy of the government, after much lobbying, is called "harm reduction." This means that while we still send people to jail, while they are using we will do what we need to reduce harm (to everyone involved.) This mostly includes:
#1 - Education and Addict Outreach
#2 - Needle Exchanges
Needle Exchanges have done extroadinarily well, at least here in New York (I am positive there are places that need to catch up on this.) They essentially allow addicts to trade used needles for old ones. The goal is preventing the spread of HIV - and there is plenty of evidence of it's effectiveness in this regard. Guiliani opposed the first needle exchange tooth and nail, but eventually relented. The other important thing needle exchanges do is take used needles - thus preventing, to a certain extent, spent needles in places they shouldn't be.
Many states, including now New York, have also taken the step of making needles over-the-counter, meaning you can just buy them without a prescription. They are fairly cheap, and this is an important step for the type of junkie who would rather not go to a needle exchange - or where there are none available (or available at the time the junkie needs the needle.) I hope the other states that haven't implemented this follow the lead.
As for addict outreach, it's not nearly what it should be. Street addicts, most homeless and have HIV, need to be hit on the head with a stick to really get through to them, and many are very fearful of going to jail. I hope to see improvement here in the coming years.
Well, that's it for now. Hope I have given you what you have wanted.
UPDATE: future additions to my series on the drug war
Drug Prohibition: a Primer on Drugs from my vantage point - This is an opinion piece about drugs, and an overall introduction and background information for the future.
Next to come: Drug Prohibition: Where we Stand [tentative]
