
H - The surprising truth about heroin and addiction - dangeur
http://reason.com/archives/2003/06/01/h
======
robbiep
As someone in the medical field, this article does a very good up job of
restoring the balance and correcting some preconceptions regarding substance
dependence and addiction - ie. that not all substances are going to lead to
lifelong dependence and addiction, and in fact it only occurs to a small
percentage. This is established medical fact and is taught in all medical
schools now. However I worry that it might make people consider heroin as
something that will be okay to have a crack at... There are very real
psychosocial dangers of heroin should you end up being dependent and addicted
- and the depths of despair that users end up in should not be ignored. No-one
can predict ahead of time if you will be okay on it, or if you will follow the
stereotypical pattern with which we are familiar with from popular culture.

The article also fails to mention that once addicted, and then having returned
their lives to some base level where they are able to seek help (assuming they
have not died of an overdose), 90% of patients that start on the methadone
program are still on it 10 years later- in Australia the methadone program
grows at about 4-6% per year, representing new people coming on and no-one
really leaving. Not cool, and not a good lifestyle!

~~~
refurb
A couple comments:

1\. Is chronic methadone usage really that bad? It's never great to be
dependent on a substance to function, but if all it takes is a trip to the
methadone clinic for your daily dose, but the rest of your life is relatively
normal, is that so bad considering the alternative?

2\. I've heard methadone withdrawal is much worse than withdrawal from heroin.
Heroin WD symptoms are very intense, but last about a week. Methadone WD
symptoms aren't that intense, but they last for months. It take an impressive
amount of willpower to put up with being tired, weak and "sick" for months.

~~~
robbiep
Chronic methadone usage has a number of problems associated with it, the ones
I am most familiar with (From my experience working with D&A specialists) is
poor teeth - easily chipped and broken, cavities etc (? related to bone
mineral density changes? I am not entirely sure) as well as the significant
hassle of going to a methadone clinic and having to deal with the social crowd
and second hand drug market that usually exists just outside a hospital
dispensary (In aust many pharmacies don't dispense methadone because of the
crowd they think it attracts, and those that do charge for it, which can be a
couple hundred a week, vs. free from a govt-provided system) However I did
meet some people during my time at the methadone clinic that had what you are
saying - a steady job, etc - but if you have a job and have to be at a clinic
every day, which opens only from 8-1, and only serves 1 at a time, you better
have an understanding boss...

with regard to 2, I don't know about methadone withdrawal being worse than
heroin; worse here is perhaps relative; you are exactly spot-on regarding the
aspects of both of them in terms of length - heroin withdrawal only lasts
around a week, and incredibly you can't die from it, although it may feel like
you will! \- as an aside, the only drug you can withdraw from that can kill
you is Alcohol (Delirium Tremens causing convulsions and death)

\-- EDIT -- This image <http://img546.imageshack.us/img546/9791/422a.jpg>
shows the biochemical effect of opiate withdrawal. This image shows enzyme
activity levels in a specific part of the brain associated with perception of
pain - Pain relief is correlated with the initial decrease in cAMP formation.
However within a short period AC increases leading to cAMP returning to normal
levels, and thus the return of pain; amplified by sudden withdrawal of the
opiate - now AC acts uninhibited, there is a massive increase in cAMP and thus
the 'pain' of withdrawal is experienced as physical pain, as real as being cut
open

------
cletus
Addiction is a weird beast. As I understand it is has two parts:

1\. Physiological dependence as evidenced by tolerance and withdrawal
symptoms; and

2\. Psychological addiction.

(2) can manifest itself in many ways that go well beyond drugs--gambling,
adrenalin junkies, even Farmville.

The danger of some hard drugs is that they can, for some unfortunate segment
of the population, be a potent mix of (1) and (2).

Further to (1) is that genes seem to play a role [1]. My personal view is that
like many complex "traits", genetics will give certain people a predisposition
to addiction.

The real danger of certain hard drugs (IMHO) is that you often don't you're
predisposed to something until it's too late. It's almost certainly the
exception rather than the norm but (I believe) you can get addicted to certain
drugs very very quickly.

You may be able to use them just fine and not get addicted. Or you may not. Is
it really worth the risk in case you turn into one of those people who spends
the rest of their (much shortened) lives chasing that initial high?

[1]: <http://learn.genetics.utah.edu/content/addiction/genetics/>

~~~
blackhole
And yet, the exact same argument applies to alcohol and alcoholics. So, why
take the risk of drinking and becoming an alcoholic? For some people who _are_
genetically predisposed to alcoholism, this is exactly what prevents them from
drinking, even though it's still legal. Yet, this small chance of being an
alcoholic doesn't prevent anyone else from drinking alcohol, so why should it
prevent people from doing drugs? It seems as though we run under the foolish
assumption that being an alcoholic "isn't as bad", without realizing just how
bad alcoholism can get. Double-standards like this are the entire point of the
article.

~~~
slurgfest
Of course everyone knows that alcoholism is garden variety addiction, and
cigarettes are addictive as hell.

Nobody is actually saying that being an alcoholic is any good at all; that's a
straw man. But we do have some level of cultural accommodation to and
regulation of alcohol. By now we have nearly the same level of facility in
dealing with marijuana, which is also a drug of abuse which is not that hard
to use safely.

But every compound is unique. Taken in the ways they are almost always taken,
alcohol and marijuana are pretty mellow and easy to dose and don't have wild
side effects like immediately blinding you or shutting down your lungs if you
screw up slightly. But they are not the same as each other and neither is the
same as datura or belladonna. Many psychoactives are blow-your-head-off
powerful tools that should never be used in the casual, vacuous party-time way
that our culture likes to do for the last 60 years or so. And many, it's just
prudent never to use at all.

Heroin is (or was) legal for UK hospitals to use in killing pain and I believe
in its usefulness for that reason. But I am not going to defend high-dose,
party-time heroin use as a reasonable and prudent practice any more than I am
going to defend promiscuous, unprotected sex with many HIV+ individuals (which
also has a very surprisingly low per-instance probability of doing anything -
yet that is exactly how it continues to spread and ruin people's lives).

In any case, saying 'alcoholism is also bad' is certainly not a reason to
suppose that heroin addiction is not bad.

~~~
ZoFreX
> Of course everyone knows that alcoholism is garden variety addiction

Really? Try doing a straw poll of everyone over the age of 50 in a British pub
at the weekend, see how many of them think alcohol is addictive. Then ask how
many of them drink every day.

I think you are repeating the party line boogey man mantra regarding "hard
drugs", alcohol does far more harm than any other drug, so how do you draw the
line for "hard"? Not based on harm, clearly, not based on lethality, but
instead based on... what?

------
papaver
i think this quote really sums it up, "I try very hard not to use when I'm
miserable, because that's what gets me into trouble."

it all depends on your personality. if you can get high and be responsible you
can probably cope with using in moderation. unfortunately, i imagine a
majority of people are not like that. i know several friends that have very
addictive personalities and getting into junk would have ruined their lives.

a lot of it depends on how its taken as well. mainlining vs snorting vs
smoking are all significantly different experiences, the amount taken as well.
one can function when its only a small amount taken, increase the dose and
you'll be lying around not being able or wanting to move.

i've tried everything under the moon though and i consider heroin pretty
dangerous. i would not advise anyone to try it unless they have a very strong
head. it is also one of the most amazing experiences i have ever had. the
singer of sublime thought he could jump in and get out when he wanted, he
overdosed, quite a sad story.

~~~
learc83
>i imagine a majority of people are not like that.

The studies cited in the article seem to challenge that assumption.

~~~
sverige
So then the analysis becomes the calculus of whatever benefits there might be
as a function of the odds of use 'without serious consequences' whilst
considering the potential outliers of serious negative physical and
psychological consequences, including death, all the while ignoring the
consequences of the realities of the present legal environment, as though
disagreeing with the moral rightness of what actually exists is sufficient to
make it go away?

~~~
learc83
I'm not sure who you are arguing with. OP said this: "if you can get high and
be responsible you can probably cope with using in moderation. unfortunately,
i imagine a majority of people are not like that."

The article specifically refutes that. It cites studies that show the majority
of heroin users are able to use heroin in moderation.

Also you should edit your post to make it a bit easier to read. It's quite
long for just one sentence.

~~~
sverige
I understand papaver's statement is contrary to the article's assertion that
the majority of heroin users are able to use in moderation.

My response is challenging the implicit assumption in the article (and in your
reply) that the moderate use of heroin is worthwhile in light of the real
risks that are entailed in that use. In other words, is the high really worth
the chance of becoming dependent and/or possibly dying from overdose? At what
point does that risk become so suboptimal that deciding to go forward with a
decision to use for the first time (when the individual cannot know for
certain how he or she will react) is considered folly?

And I would try to edit that long sentence, but I cannot figure out a way to
break it up without losing the intent. If only there were some symbols I could
use to express the same thing mathematically in a way that would be more
easily understood . . .

~~~
learc83
>My response is challenging the implicit assumption in the article (and in
your reply) that the moderate use of heroin is worthwhile in light of the real
risks that are entailed in that use.

Oh I don't think that moderate use of heroin is worthwhile--I simply think it
is possible.

I don't disagree that for most people the inherent risks of using heroin
outweigh the benefits, but that doesn't preclude from believing that the risks
of using heroin are still exaggerated.

For instance, I believe that it would be optimal if the majority of 10th
graders didn't have sex, but I don't believe we should tell them sex will
likely result in death.

Present the actual risks, not exaggerated propaganda.

I'm not sure if you're from the US, but here we have an anti drug program
called D.A.R.E where police officers talk to young kids about the dangers of
drugs.

The dangers presented are so ridiculously exaggerated, that when kids
inevitably learn that smoking marijuana doesn't necessarily lead to death and
destruction--they begin to question everything else they learned from the
program. Lying in order to persuade children is almost never a good option.

------
abruzzi
Never tried heroin, but I had to come off oxycodone cold turkey (from about
40mg a day). My pain doctor was trying to slowly bring my down from a peak in
the hospital of 150mg of Demerol every 4 hours. It was going too slowly for my
patience, so (out of the hospital) I just stopped. The withdrawal sucked--
about 4 days of sweats, shaking, tachycardia, and a real hard time sleeping. I
ended up using pot to help get me through it.

But ultimately, despite the physical dependance, it was easy to quit because I
wanted to. Most people that fail to get off opiates fail because they don't
entirely want to get off. They may think they want off, or think the need to
get off, but at some level they still want the drug, and that is the essence
of addiction.

~~~
slurgfest
40mg oxycodone is on a different level from 300mg of heroin; although the
mechanism of action is pretty much the same, you are talking about radically
different doses and time courses. As well as a prescribed, regularly taken
drug vs. one taken ad lib for pleasure, building up a self-driven habit.

When drawing conclusions about why people have trouble getting off opiates,
I'd suggest taking the same care comparing your experience to heroin addiction
as you would take comparing your weird dreams to a schizophrenic's psychotic
episodes.

------
alrs
Of my two friends who started using heroin as teenagers, both destroyed their
pancreas by their early thirties. As of now (age 37), one of them has died
from an overdose. The other is intermittently homeless.

~~~
andrewfelix
Good friend died of an OD at 26. Three others I know who used to use struggled
in life while on it. I know nobody who handled it well.

~~~
learc83
Selection bias can easily account for that.

------
gee_totes
According to this article[0] the street price of a dose of heroin is $10-$25
dollars. However, that street place is suffering 40-50 times inflation[1]. If
heroin were relieved of price inflation, a dose would cost between 20 cents
and 63 cents.

Compare that to cigarettes. I once heard from a foreign cigarette manufacture
that the cost of manufacture for a pack of cigarettes if 50 cents. A pack of
cigarettes contains 20 doses of nicotine and costs around 14 dollars (in New
York City, American Spirit Brand). Each dose (cigarette) costs 70 cents
inflated and took only two cents to produce. Nicotine suffers from a 35 times
price inflation due to legalization.

These look like two industries that are ripe for disruption.

[0]<http://heroin.net/about/how-much-does-heroin-cost/>

[1]<http://reason.com/archives/2003/06/01/h/1>

~~~
GuiA
>These look like two industries that are ripe for disruption.

Please go on— how would one disrupt these industries?

~~~
slurgfest
By competing with piles of incumbents. Who are already comfortable with
illegal, armed action outside the free market...

------
sverige
Having struggled with addiction off and on for more than half my life, I would
say that the opiates are some of the more enjoyable drugs, though they can be
quite difficult to kick, and the legal and financial risks are very high.
Cigarettes are far harder to kick. And pot isn't nearly as harmless as most
make it out to be, since it literally makes people stupid with regular long-
term use.

I kicked everything except cigarettes for nearly 20 years, then went back to
some of them during a difficult time. I was hooked again for longer than I
intended, and it was much harder to kick again when I was older. (I've been
abstinent again for some years now, including cigarettes (after 30 years ...
finally!!).)

The vast majority of those who experiment never become addicted. But for those
who do, it is very costly, and fatal frequently enough that it is not worth
the risk, at least from my minority experience perspective. There are lots of
other ways to relieve stress and/or alter your consciousness.

I have a libertarian bent, and think drug laws have mostly accomplished the
militarization of the police forces in America. They certainly have not
reduced the availability of high-quality drugs. But that does not mean I agree
with the idea that using heroin is just some harmless fun to be had from time
to time. Reserve that category for things like skydiving or working out in a
gym or getting a massage or writing some code.

(What's that? Writing code isn't fun, it's something you have to do? Maybe
it's time for you to kick the habit then.)

~~~
john_flintstone
>The vast majority of those who experiment never become addicted. But for
those who do, it is very costly, and fatal frequently enough that it is not
worth the risk

Are you talking about heroin, or alcohol?

------
andrewfelix
Had a good friend who was educated, healthy and ran his own business. He died
from an heroin overdose shortly after selling off most of his business assets
to pay for his addiction.

Yes, this is one anecdote. But I bet you my anecdote is a fuck load more
common than that of the successful New York business man cited in the article.

~~~
lincolnq
Selection and availability effects should account for this, though.

~~~
andrewfelix
It might, but there are thousands of people with awful stories about Heroin.
Negative effects extend far beyond the individual user, entire communities can
be crushed by it's use.

~~~
ZoFreX
Most of the effects that extend beyond the user are more a facet of
prohibition than the drug use itself, no?

~~~
andrewfelix
That is another point in entirely. But yes you are quite right. That is true
for most drugs and how they are consumed.

------
Deestan
Disregarding the pro/con heroin issue, this article also illuminates that
anti-drug campaigns are having a "facts crisis". If you say "x drug is bad for
you", you should also be able to say why and how.

To memory-quote from a pregnancy leaflet we got a few years back:

\- You should avoid drinking alcohol during pregnancy, because it can cause
harm to the child's nervous system in the early stages.

\- You should avoid smoking tobacco during pregnancy, because it can cause
oxygen deficiency and low muscle mass in the child.

\- You should avoid smoking hashish during pregnancy, because _it is illegal._

I'm not exaggerating - that was literally all the evils of hashish they could
list.

~~~
shin_lao
That's very likely because there are many serious studies about the effects of
tobacco and alcohol on the fetus, but not that many for hashish.

~~~
Deestan
I agree that's probably why - for all the studies not showing any concrete
harm from hashish use, I've yet to meet an avid hashish user who can count to
100 without assistance.

But still, they should at least say _that_. "The effects of hashish on the
fetus are not well studied, and doctors heavily recommend abstinence."

------
stratos2
I think addiction has less to do with the 'drug' and more to do with the
person. Be it heroin, pain killers, sex, gambling, smoking, or alcohol
segments of society are able to use these in a way that does not interfere
with their own life or those of people around them.

There are also people who use these as a means of escape or have limited
coping resources. It is not that the cigarette is bad, or the pain killer is
bad, or sex is bad.

In saying that, having a methadone dispensary four doors down from where I am
sitting, I see first hand the obvious effects of drug addiction and how people
struggle to escape it's grasp.

~~~
andrewfelix
Addiction is a physiological dependence. It has much more to do with your body
than your personality.

~~~
chii
sure, physical addiction. But what drove those people to try the drug in the
first place? its a set of circumstances - such as poverty, lack of other
leasure activities etc.

~~~
andrewfelix
I was responding specifically to... _"I think addiction has less to do with
the 'drug' and more to do with the person."_.

------
shin_lao
I wonder how this business man was doing with his teeth, pancreas and kidneys.

I also wonder how his control of heroin would hold should he lose his job or
his wife.

Isn't the danger of such drugs in the things they whisper to your ears when
you're beholding the abyss?

~~~
ZoFreX
> I wonder how this business man was doing with his teeth, pancreas and
> kidneys.

Would uncut, correctly dosed heroin have an effect on those?

~~~
sverige
Where are you going to find uncut heroin? Are you going to join the Taliban?

~~~
ZoFreX
Wasn't planning on it, was just wondering whether uncut H would have those
effects or not. If not, then if anything it's an argument in favour of
regulation.

~~~
sverige
I had a good friend whose first taste was uncut or nearly uncut China white
while he was in Viet Nam. He kicked when he got back stateside in 1970, then
used again for a time in the late '70s. He drank a lot and used cocaine at
different times, too. He died of liver failure this spring at the ripe age of
62. I tend to believe the alcohol did most of the damage, but he thought the
powders contributed a lot to it too. Hard to say without some kind of
controlled study on a large population, I suppose. My scientific curiosity
doesn't extend far enough to make such a study worth it.

------
gadders
Theordore Dalrymple, a prison doctor that writes under a pseudonym, has long
maintaind that a) heroin isn't as addictive as people claim, and b) withdrawal
symptoms are minor.

<http://www.manhattan-institute.org/html/_wsj-poppycock.htm>

------
nikatwork
If you'd like a deeper look into this issue across a wider variety of
substances, I highly recommend the book "Saying Yes":

[http://www.amazon.com/Saying-Yes-Defense-Drug-
Use/dp/1585422...](http://www.amazon.com/Saying-Yes-Defense-Drug-
Use/dp/1585422274)

------
ilaksh
I can't see any good reason why someone would go to so much trouble to defend
heroin, other than to assume that this is some kind of PR requested by
establishment and/or intelligence groups which profit from heroin grown in
places like Afghanistan (or, in the previous era, India).

~~~
dinkumthinkum
Reason has an agenda they are trying to spread to you. They don't want to live
in a world where something the government regulates, actually is dangerous.
They want to have their cake and eat it to. "People should be able to destroy
their bodies if they want. Oh yeah, and since that is not very convincing to
you, here's some statistically insignificant reasons why heroin doesn't hurt
you anyway, neener neener. Oh, and now the government can just get rid of the
regulations."

Maybe libertarians sometimes feel silly telling people "I know this would
destroy people's lives and society would decay but it is immoral for the
government to do anything about anything." I don't know why ... :)

~~~
learc83
Libertarians believe that ending drug prohibition would _reduce_ the harm to
society--that the problems caused by drug use are exacerbated by prohibition.

You can argue with libertarians all you want about whether you think their
proposed actions will help or hurt society, but stop acting like libertarians
are monsters who don't care about the welfare of others.

>"I know this would destroy people's lives and society would decay but it is
immoral for the government to do anything about anything."

You seem to have fallen for the reddit caricature of libertarians. Again you
can argue with the methods, but stop acting like libertarians are heartless
bastards. As a group they believe that reducing regulations and limiting
government will _help_ society.

~~~
dinkumthinkum
I haven't fallen for any Reddit caricature, I just actually know what
libertarianism is. I'm not saying any libertarians are monsters. Apparently
some just want their cake and eat it to. L) Actually, you're wrong, a pure
libertarian view has no judgment about whether or not people do better on
heroin than people normally think, or that heroin only has bad effects because
of the big bad government. It's like libertarianism provides no view about
whether duck-typing is a good thing.

It is a convenient ploy to pretend all these things in the article or simply
make counter-intuitive statements. I think a libertarian should be more like
"Oh, so heroin actually makes you more productive and a better person? Well, I
don't really care but the government should stay out of it."

A true libertarian view is that the government should just stay out of it,
whether it harms or not. I am not making a judgment about that basic position.
I think that people that proclaim to be libertarians don't want to state their
true beliefs because they know they are going to be made fun or at least not
taken seriously in practical society.

~~~
learc83
You have fallen for the Reddit caricature--you have _no_ idea what you're
talking about.

The closest thing you could get to a "pure" libertarian philosophy is that
libertarians are against coercion.

Whether that coercion is public or private has no bearing. You seem to have
distilled libertarians beliefs down to "government bad"--a clear caricature.

Many (in my experience most) libertarians support the existence of government
to provide services they believe the private sector can't--some don't. And
yes, Most libertarians want to limit government and supplement it with
voluntary association, but only because they believe that is what's best for
mankind, not because of some irrational hatred of government.

"Government bad" is not the central tenant of libertarian philosophy, that you
think it is.

But you seem to know more about what libertarians think than libertarians
themselves. Let's take a look at some of your wording.

>I just actually know what libertarianism is

> I think a libertarian should be...

>A true libertarian view is...

>I think that people that proclaim to be libertarians don't want to state
their true beliefs...

The beliefs that fall under the term _libertarianism_ are so varied that
libertarians themselves can't agree on a definition--How can you possibly come
here and decide what is and isn't a libertarian view? Libertarian beliefs
range from anarcho-capitalists to libertarian socialists. Everyone from tea
party protesters to Noam Chomsky call themselves libertarians.

Libertarians haven't been able to agree on these issues for decades, so it's
very kind of you to come here and clear it up so nicely.

------
pchivers
>If heroin really is "so good," why does it have such a tiny share of the
illegal drug market? Marijuana is more than 45 times as popular.

One possible reason is that people are squeamish about needles and
uncomfortable consuming drugs intravenously.

~~~
slurgfest
I am not a fan of marijuana (or any street drug) but it is incredibly hard to
mess it up. It has a fantastic 'therapeutic index' - a big fat window between
the dosages where it starts having useful effects and those where it starts
potentially harming you.

(anecdotally I would wonder about impact on lifestyle, but killing yourself
with pot would be pretty tough, and expensive)

This is a big contrast from serious downers which put the happy zone right
next to the off switch, and build up tolerance...

~~~
tsahyt
> killing yourself with pot would be pretty tough, and expensive

As far as I know there's not a single death directly caused by the substance
yet.

~~~
sverige
Other than those inconvenient people who have died as a direct result of the
errors of drivers under the influence of the substance, of course.

~~~
tsahyt
To be more specific I was talking about dying from pot itself, not from
extended effects.

------
tacoboye
Heroin is so awesome but so profoundly bad for your life. Please be careful
with your opiates.

------
asdfsdfsdfs
Yes, some people can have functional lives on heroin.

But almost none of them stop using, ever.

~~~
nn2
Did you actually read the article? It quoted studies that contradicted exactly
what you said. Most studied people stopped using it at some point.

