19 May 2014: Helping Heroin Addicts

Category: General
Posted by: Dr. H
NaloxoneSusan Svrluga wrote a very interesting article over at the Washington Post, 5 Ways to Help Heroin Addicts. When I saw the headline, I felt like Vladimir at the end of Waiting for Godot, "Off we go again." In general, the media establishment is a big part of the drug problem in this country. Reporters are generally clueless and they spread misinformation in a sensationalistic way. And when they talk about "recovery," they are usually even worse—promoting 12-step programs and other quack therapies that do more harm than good.

My theory about drug addition is very simple. People generally get clean after a period of time. The reason is fairly simple: being a drug addict sucks. So if society thinks that drug addition is something that it wants to reduce, it should do as much as it can to help drug addicts who want to get off drugs to do that. All the work of throwing people in jail does almost nothing other than making drug addiction even more sucky—and that's hardly necessary. So there are two critical things that we can do to help drug addicts: keep them alive until they decide to stop using and provide easy access to effective treatment.

And that brings me to Svrluga's article because it really surprised it. Mostly, it was right in line with my thinking. She suggests making the opioid antagonist naloxone more widely available. The fact that it isn't proves my point that most of the society just wants heroin users to die. Naloxone is nothing short of a miracle drug: it stops overdoses almost instantaneously. She also suggests "good Samaritan" laws where drug users don't get arrested because they try to get help for another user.

After years during which I had a libertarian approach to drugs, I've come to a very practical place. I think methadone treatment is probably the greatest tool we have for fighting against the harm caused by opioid addiction. Just in the simplest way, it allows an addict to stabilize his life and think clearly about the future. And a future on maintenance is a whole lot better than many alternatives. One of Svrluga's ways to help is to make methadone and buprenorphine more available. Hear, hear!

I would go further. We should make methadone maintenance free to all addicts who want it. To put every addict in the United States on maintenance would cost less than $3 billion per year. That might sound like a lot, but it is only 0.02% of the size of our economy, and I'm sure it would be more than offset by increases in productivity and decreases in crime. Of course, not every junkie in America wants to get clean at any given time. Many people qualify for treatment through Medicaid, but it depends upon the person and most of all on the state. The point is to make it easy for addicts to get help when they decide to. As it is now, there can be weeks to wait to even start a program. And if the addict has to come up with hundreds of dollars, the chances that he will still have the resolve to start the program are greatly reduced.

The rest of Svrluga's ideas are not as good: more long-term treatment and more "talk" about addiction. Long-term residential treatment is generally a bad idea because it just reinforces the idea that the patient is an addict, forces them to spend all their time around other addicts, and delays the time until a new life can start. But there is a bit of truth in what she said. She quoted a doctor saying, "It's not simply the medicine, but a package of services that need to be provided for most patients." That I agree with. General counseling can be helpful. But most of all, many addicts need job training. They need some way to make it in the world if they don't already have one.

One of the big problems we have in our society is the way we treat people who are struggling. We plop people from jails onto the streets and then wonder why there is a high recidivism rate. The same is true of drug addicts. Of course, those two groups have a very big overlap. And in addition to everything else, being labeled a felon (and people are so labeled for crimes as simple as having a joint on them), effectively eliminates any chance the drug addict has of changing his life.

This is not the first good article I've seen on this subject. Over the last five years, there has been a lot more reasonable discussion of drugs in this country—although it is still a great minority. And even Svrluga is not above the typical sensational story, Fairfax Mother of Young Heroin Addict: "There Were Clues. But We Had No Clue." It's part of a genre: Oh my God, nice white suburbanites are turning into heroin addicts! But the trend is good. And the 12-step juggernaut seems to be weakening as people begin to see that prayer is not the best approach to drug addiction. Of course, we have so far to go. But Susan Svrluga's article is a good sign.



Cross-posted on Frankly Curious.
Category: General
Posted by: Dr. H
I just got the following email, "Im 13 and need a quick fix. How do i extract Codeine from TEC-3 pills? I dont have access to pipes and hoses." Oh my God!

There are several problems with this. First, I don't believe in kids doing drugs. In fact, I'm not an advocate for anyone doing drugs. I just don't think that the society has a right to destroy the lives of those who choose to do drugs. I'll come back to that in my response. But the second problem is that I'm a fairly paranoid person. If someone tells me they are 13 years old, I can only assume they are trying to set me up. After all, anyone who has read my work would know that I think of my work as minimizing harm—not adding to it. So I think there are people out there who don't know what I do and just want to attack the whole harm reduction movement, "See: he just wants to get kids addicted to smack!"

Anyway, I wrote back:

Are you kidding me?! First, if you have read my site you know how much I hate this kind of stuff. Second, 13 year olds should be out having their hearts broken and struggling with basic algebra, not looking for a "quick fix"! Third, you are far too young to be doing any drugs at all. It is bad for your development. Trust me, you will have plenty of time later to destroy your life!

PLEASE, if you need help, get it. And regardless of what your age is: it is stupid to try to extract opioids from pills. It takes a lot of time and few people have the skills to do it. Here's my advice: get good grades, go to college, get a chemistry degree, and become Kid Charlemagne. THAT would be cool. What you're doing now is not.

Too harsh? I don't know. I've seen too many kids have their lives effectively destroyed by drugs because developmentally it is a curse. And for all you cannabis smokers, that's the drug they've mostly done: the "safe" and "harmless" drug. Anyway, it is better to dream of becoming a drug chemist than a junkie poet:


17 Jul 2013: Nonviolent Junkies

Category: General
Posted by: Dr. H
It isn't the case that junkies are necessarily nonviolent, anymore than that is the case for any group—including Quakers. And it is certainly true that during detox, junkies can be cranky. But in general, the drug makes people, if anything, less violent. It often annoys me that all drugs are lumped into one group as though the effects are the same. And as though illegal drugs have anywhere near the effect as alcohol.

Anyway, I was pleased to read this in an article by Kevin Drum:

A trio of authors identified three major "drug eras" in New York City, the first dominated by heroin, which produced limited violence, and the second by crack, which generated spectacular levels of it.

I'm not sure about crack—it isn't my thing. But I'm glad to see someone acknowledging that heroin doesn't turn people into violent monsters.
Category: General
Posted by: Dr. H
I've decided to try to integrate all my drug related writing (the politics anyway) over on my main site. Then I'll post links here. I'm also going to turn off comments here. The site is a spam magnet with 100+ spam comments for each real one.

Today, I posted the following article that I think readers here will be interested in:



It is about Sheff's new book Clean.

16 Feb 2013: American Heroin

Category: General
Posted by: Dr. H
American Heroin - George Henry BorawskiA photography friend of mine, George Henry Borawski has an ongoing project of documenting "American Heroin." In fact, he is trying to get me to hit the road with him to do a book. That isn't a bad idea, but I have a lot of questions and concerns. My main concern is how we manage to not get arrested and murdered.

You all may have an answer to my big question: what would said book be about? The problem I see is that a simple chronicling of American heroin users would not be that interesting all on its own. What's more, I wouldn't want such a book focused on just the most intense of users. I am, as I always have been, most interested in infrequent users. Those are the people who the culture as a whole thinks not only don't exist but can't exist.

Anyway, check out George's newest batch of photos on his site. I'm sure he would be interested in any thoughts you might have.
Category: General
Posted by: Dr. H
I was directed to an interesting website, Points: The Blog of the Alcohol and Drugs History Society. They had an article about Victorian Women on Drugs. It reminded me of much of my writing about drugs during that period (probably in Little Book of Opium). You might want to check out the site.

I wrote to my friend:

That's interesting. I've written a lot about this, of course. A common myth says that heroin was claimed to be a cure for morphine addiction. Similarly, morphine was said to be a cure for opium addiction. This isn't true of course. But opium was looked down upon as dirty—thanks in large part to its association with the Chinese, but also because it was a natural (herbal) drug. Morphine was seen as scientific and thus "western." Thus, many people in the Victorian period were glad when someone got off opium and onto morphine. What it shows above all else is that the biggest effect of these drugs is on other people in how they color their perceptions. Look at Long Day's Journey into Night. Long before I had any experience with drugs, it seemed to me that it was the rest of the family that had the real problem. So mom wanted to live life in a quasi-dream state? You would think by the reactions of the rest of the family that she was dragging them with her.

Taking matters up to today, I have heard any number of conservatives claim that maybe cannabis is a useful drug. But certainly if it were to be acceptable, doctors would put it into a pill form. You know: pill = good; smoke = bad. It would be hilarious if it weren't so evil.

If anyone has video of anyone talking about how we have to turn cannabis into a pill, please post it!

27 Jan 2013: Murder in Bali

Category: General
Posted by: Dr. H
The BBC reported last week, Bali Drugs: Lindsay Sandiford Death Sentence Criticised. I'm sure most of you have heard about it. I have not wanted to write about it because it is so vile. As the report says, "A death sentence handed down in Bali to a British grandmother found guilty of drug trafficking has been condemned by the UK government." I'm just not sure what the Bali government thinks that it is accomplishing with this.

In general, people don't traffic in 5 kg of cocaine if they have an option. It makes a lot more sense to just be an executive at HSBC, where you can work for drug dealers without the worry of even losing your job, much less going to jail or being murdered. Of course, I don't have much sympathy for the United Kingdom. Most of the drug war hysteria of the last many decades is a direct result of the actions of western powers (the US primarily). Not that I think that Indonesia isn't capable of their own homegrown oppression.

I always think that something like this travesty is a direct result of the people I see screaming on the TV that drug dealers are like serial killers. We're all culpable—every fucking one of us. But some are far more so, and I'm not thinking of anyone in Bali right now.
Category: General
Posted by: Dr. H
This really has nothing to do with this site, but I'm very pleased with it. It is a parody of a TV spot for Zero Dark Thirty. It isn't funny, it's political. And if you don't pay attention, you won't even notice. All the quotes are real:


10 Jan 2013: Bread and Heroin

Category: General
Posted by: Dr. H
This is very funny. But on a serious level: it is really difficult to distinguish food from drugs. It is all metabolism.

Category: General
Posted by: Dr. H
Dylan Matthews over at Wonk Blog reports, The Economic Case for Decriminalizing Heroin. It talks about an economic model that finds that drug use would be no higher if they were legalized but taxed up in price. This is not exactly a new idea, but I'm glad it is getting to coverage.

Just the same, I think it is largely bullshit. I accept that heroin purchasers are as rational are broccoli purchasers. But I don't accept is that either are all that rational. What's more, it is only academics and highly paid reporters who think that the only cost users face are found in the street price of the drug. The potential of three years in prison, for example, greatly adds to the price of a gram of dope.

The other side of this is that much of the benefit of allowing users to have their drugs at the fair market (cheap) price would be gone in such a situation. The point with opioids is it is the price alone that stops users from having otherwise normal lives. But really, do we as a society forbid drugs because we want to limit addiction? I don't think so. Providing government supplied drugs to be done in government supplied rooms would not increase addiction. In fact, it might reduce it. But we don't do that.

Don't take this to mean that I'm against legalization (or decriminalization as proposed in the article). But this discussion treats drug users as nothing more than a problem to be solved. I think we can go a lot further looking at the problems that drug users face. What I would like to see first is methadone maintenance on demand for anyone of any income level. Such program would cost a pittance. Even assuming a worse case scenario, it would cost no more than a hundred million dollars per year. It is a sane policy that no reasonable person would be against. Thus, I'm sure it would never win support in the United States.

Our society does not approach drugs in any kind of reasonable way. So any reasonable argument to improve the situation is useless. I'll be happy to be proven wrong.