
The Heroin Business Is Booming in America - pmcpinto
https://www.bloomberg.com/news/features/2017-05-11/the-heroin-business-is-booming-in-america
======
smogcutter
Anyone else notice that a common theme in the recent wave of handwringing over
heroin and opioid addiction is that the victims we're asked to consider with
compassion and understanding are almost always white? The tough on crime drug
war rhetoric disappears so easily when the victims are "regular people" who
fell prey to the pharma industry, not "junkies".

I'm not saying that we shouldn't treat these people with compassion -- exactly
the opposite. The LA Times series in particular is a fantastic piece of
reporting. Rather, I'm saying we should consider why the portrayal of this
particular drug epidemic is so different than others, and how we can extend
the same compassion to others who have also had their lives and families
destroyed by drugs. We hear about these people because they're white.
Meanwhile, what's happening to the people we don't hear about?

~~~
baldfat
I agree with your point 100% BUT there is one point to be made. Prosecute the
Pharm Execs, Doctors who broke the law.

There is a smoking gun! Look at West Virginia and the pills that were
prescribed. I am talking about 780,000,000 pain meds. In a state of 1.84
million residents, the shipments amount to 433 pain pills for every man, woman
and child in West Virginia.

The death toll for this 5 year time between 2007-2012 is 1,728 West Virginians
died from overdoses of hydrocodone and oxycodone.

[http://www.nbcwashington.com/news/local/Drug-Wholesalers-
Shi...](http://www.nbcwashington.com/news/local/Drug-Wholesalers-
Shipped-780M-Pain-Pills-to-West-Virginia-407331135.html)

So you are 100% right about public perception. I live in a large city in PA
and my In-laws come to visit from W.Va and I always tell them I see more
people high in W.Va then in my Center City neighborhood and they always roll
their eyes like I am crazy.

~~~
msmm
It is not going to happen, because they have politicians in their pockets and
nobody will investigate that.

~~~
baldfat
I sadly also agree with you 100%

------
throwaway2016a
This is probably pop psychology but it always struck me that if you legalize
marijuana you go a long way to solving the problem. My thoughts are...

1\. It is reportedly a better pain killer in some cases than opioids so it
keeps people off of the prescription opioids

2\. It is nowhere near as addictive (possibly not addictive at all)

3\. When people are already criminals (because they smoke weed) I think they
are more likely to say "screw it" and try a harder drug. In the vein of, "I'm
already doing something I can go to jail for, what's one more thing?"
Legalizing keeps people out of the criminal class (increases barrier of entry
to it)

I'm actually for legalizing all drugs like several other posters but I don't
think society is ready for that.

I got in a argument with a close relative (a retired police officer) and
another close relative (a doctor) about this on Easter. There arguments were
entirely based on emotion and lot so logical fallacies. And understandably,
they have both seen the darkest sides of what drugs can do. But criminalizing
doesn't help those people.

~~~
slapshot
> if you legalize marijuana you go a long way to solving the problem

Well, Colorado tried that. Recreational weed has been fully legal in Colorado
since January 1, 2014. You can walk down any major street in Denver or Boulder
and pass multiple outlets selling marijuana. And they've sold lots of it,
according to the tax receipts raised.

The result has not been the sudden reversal of opioid addiction that you had
hoped for.

In 2015, opioid overdoses in Colorado continued to increase at the same rate
as prior to legalization of marijuana. That year, opioid overdoses killed more
Coloradans than homicide. [0]

In 2016, the total number of opioid deaths dropped 6%, but the number of
heroin overdoses continued to increase. [1]

Personal experience in Portland Oregon suggests that in that city, legal
marijuana has not made a dent in the meth and heroin issues that are still
affecting the city.

Maybe recreational marijuana laws have helped. Nothing in this data can
disprove that maybe more people would have died without it. But it hasn't been
a magic bullet. It hasn't yet gone "a long way to" solving the problem of
heroin overuse.

[FWIW, I'm in favor of recreational marijuana legalization, but the problems
of heroin have different roots and we can't expect legal marijuana to
immediately solve those issues.]

[0] [http://www.denverpost.com/2017/01/03/colorado-opioid-
heroin-...](http://www.denverpost.com/2017/01/03/colorado-opioid-heroin-
deaths-outnumbered-homicides/)

[1] [http://www.denverpost.com/2017/03/07/colorado-opioid-
heroin-...](http://www.denverpost.com/2017/03/07/colorado-opioid-heroin-
deaths/)

~~~
throwaway2016a
> The result has not been the sudden reversal of opioid addiction that you had
> hoped for.

I didn't say "sudden". I think it would take time.

Addiction doesn't happen overnight. I am open minded and I am not going to
ignore research if the research doesn't support my view. But my hunch is, it
is too soon or too much damage has already been done and we need to take other
steps to reduce usage not just legalization.

Incidentally I thought I saw some research that showed the opposite effect but
I can't find the link right now... I'll take a look for it later and see if I
can find it.

~~~
baldfat
When ANYTHING is used to escape from emotional pain be it heroin, pot or food
it is wrong and causes problems.

------
diogenescynic
The drug war has failed. Legalize all drugs and tax them. Spend the tax money
on rehab, schools, and public universities. We are just propping up drug lords
in Latin America to feed our insatiable demand for drugs.

~~~
meddlepal
How does legalizing fix or reduce addictions? I understand it makes
acquisition less taboo, and perhaps makes treatment a less taboo subject too,
but it's not like legalization is a pancea for addiction. Booze is legal and
we still have a massive alcoholism problem.

~~~
mmjaa
Legalization doesn't fix addiction. It fixes the sub-culture, the underground,
the dark layers in society where addicts lurk in order to be able to continue
their addiction.

Legalization brings these people into society, by removing the stigma
associated with drug use, and makes it less of a problem to be swept under the
rug. It makes it easier to contact addicts and get them into effective
treatment programs. Right now, there is a huge wall between addicts and
treatment: that wall is an entirely fictitious legal construct.

~~~
kogepathic
> It makes it easier to contact addicts and get them into effective treatment
> programs.

Who do you expect will fund these treatment programs? I seriously doubt most
addicts are equipped to pay for it.

You're talking about a country where a major political party actively works to
remove funds from women's healthcare. [0]

I fully agree that these substances should be legalised for the reasons you
mentioned, but I think it's laughable to think present-day politicians give a
shit about these people. If anything, they'd probably face substantial lobby
from police unions concerned legalisation would lead to job cuts.

[0]
[http://www.idahostatesman.com/news/business/article145926149...](http://www.idahostatesman.com/news/business/article145926149.html)

~~~
prbuckley
You know who cares about these addicts, their families, who are the voting
constituents of these politicians. The heroin epidemic is the worst in many
traditionally republican states. I think you may find there is more bipartisan
support for fixing the heroin problem than there is consensus around hot
button topics like abortion.

~~~
kogepathic
> You know who cares about these addicts, their families, who are the voting
> constituents of these politicians.

You're making the assumption that their families have the resources to pay for
their treatment. Nearly half of Americans are one pay cheque away from not
being able to make ends meet. [0] [1] [2]

Here's a poverty map of America:
[http://www.nytimes.com/newsgraphics/2014/01/05/poverty-
map/](http://www.nytimes.com/newsgraphics/2014/01/05/poverty-map/)

[0] [http://www.marketwatch.com/story/half-of-americans-are-
despe...](http://www.marketwatch.com/story/half-of-americans-are-desperately-
living-paycheck-to-paycheck-2017-04-04)

[1] [http://money.cnn.com/2017/01/12/pf/americans-lack-of-
savings...](http://money.cnn.com/2017/01/12/pf/americans-lack-of-savings/)

[2] [http://nypost.com/2016/09/27/why-even-half-the-middle-
class-...](http://nypost.com/2016/09/27/why-even-half-the-middle-class-is-
living-paycheck-to-paycheck/)

~~~
prbuckley
I am suggesting people will put political pressure on the government to help
pay for treatment as part of the solution. As others here have suggested that
if drugs were legalized the tax revenue could fund things like this.

------
Digory
Russ Roberts' Econtalk podcast had a stunningly good interview with Sam
Quinones about the opioid epidemic.

I am fairly libertarian on many things, but this is not a simple case of
prohibition run amok. Heroin/opioid addiction is close to a loss of free will,
aided by screw ups from big pharma and Government healthcare policies.

Really fascinating, sad, and difficult stuff.

[http://www.econtalk.org/archives/2017/01/sam_quinones_on.htm...](http://www.econtalk.org/archives/2017/01/sam_quinones_on.html)

~~~
egwynn
I think it’s rather generous of you to call them “screw ups” from big pharma.

~~~
Digory
The interview goes into the history of pharma's search for a non-addictive
opiate. I assume that started with decent motives, even if not altruistic. The
research critically failed a lot of people. Among other things, says
Quinones's, it "transformed football into a gateway to heroin addiction..."

The more recent big pharma position of "we never thought to ask why West
Virginians are such good customers" deserves scorn, lawsuits, and prison time.

------
weeksie
Maybe I'm crazy but I feel like the US goes on this uppers/downers cycle. Of
course I'm probably seeing patterns where there are none, but we had heroin in
the seventies, cocaine/crack in the eighties, heroin was back in the 90s, meth
in the 00s, heroin in the teens.

~~~
sosuke
I'm just pulling ideas out of thin air but I wonder if it connected with how
good the economy is doing for the people buying drugs.

------
SurrealSoul
Cincinnati was my home town, and its bad. People joke about it but I know at
least 3 people on my friendslist that overdosed.

I'm glad the punishment for selling the drug is so high, often even sometimes
receiving murder sentences for people that overdose but that isn't going to
prevent people from buying / selling

~~~
imroot
One of my good friends was rear ended by someone on heroin this week.
Cincinnati police didn't even bother stopping to do a police report. Less than
20 minutes later, he hit a parked car in St. Bernard and was arrested for DUI,
Driving under suspension, and no insurance. The guy has a felony charge
pending (and an arrest warrant out for him)...and CPD just drove off without
even taking a second look.

I don't want to say that CPD has taken a blind eye to it, but, it seems that
way.

~~~
mywittyname
CPD has been like this for as long as I can remember. I'm not sure if
Cincinnati is a shit-hole because the police don't care, or the police don't
care because the city is a shit-hole. I imagine it's a little bit of both.

------
hourislate
>Millions of Americans got hooked on pain pills during a prescription binge
that started in the 1990s and peaked around 2011. As states have tightened
monitoring and doctors have reduced dosages, it’s become harder for addicts to
get prescription painkillers, driving many to get their fix off street drugs.

I feel like the legalization of Marijuana years ago could have saved a lot of
folks while helping them manage their pain. The Government found it easier to
prosecute and jail people who struggled with chronic pain and mental illness
than try to help. Now we have folks at the federal level who have never
experienced an enlightened moment in their lives or have a shred of empathy
for the sick. All they understand is how to help their friends in the Prison
Industry, Law Enforcement and Pharma Industry.

Sad....

------
cletus
I'm not convinced that straight legalization of everything is the answer. It's
clear however that what we're doing now isn't working. Unfortunately to those
in favour of it it doesn't need to work. It's just a tool to be "tough on
crime" and take a moral probably religious stance for the benefits of donors
and constituents.

None of this will really change until those in favour of dismantling what is
mostly the mass incarceration of African Americans are willing to exercise
sufficient political force to get people elected.

But whatever the case, there are some clear problems that need to be fixed:

1\. End this regime of stigmatizing felons. Stripping them of the right to
vote, the scarlet letter "are you a felon?" question on job applications and
so on. At some point, having served their time, the stigma should be gone.

2\. End mandatory drug sentencing.

3\. National legalization of recreational cannabis use. The arguments against
cannabis are pretty thin. The war on marijuana that began in the 1970s made
marijuana harder to get and more expensive such that when crack cocaine came
along it and heroin were both more readily accessible and cheaper, which is
crazy.

4\. Decriminalize drug possession and start treating it as a medical rather
than legal problem.

5\. This is tricky but tackle the over-prescription of opiates in the US. This
can easily go wrong as some people really do need opiates. It's clear that
overall they're over-prescribed however. A lot of people addicted to
prescription drugs or heroin began with a legal prescription.

6\. Raise the bar required for drug trafficking charges. It's ridiculous how
low the requirement can be in some jurisdictions. For example, possession of
more than 6 grams of pills in Florida IIRC allows a charge of possession with
the intent to distribute. That's approximately 60 pills and the actual dosage
doesn't matter (60 5mg Oxy pills are treated the same as 60 80mg Oxy pills).
This is particularly hypocritical as Florida has essentially legalized the
dealing in opiates through loosely-regulated "pain clinics".

7\. This is also difficult but we need to end the plea bargain culture, which
usually means overcharging by prosecutors to extract a plea. Judging
prosecutors based on conviction rate seems to be at the heart of this problem.

I honestly wonder how many hard drug addicts could be avoided by simply having
ready access to cannabis.

------
S_A_P
This is a tough problem with no easy answer. Ive 2 friends with heroin
problems that I fear may never fully stay clean. I don't think that jail is
the right answer though.

~~~
kingkawn
If jail was structured around rehabilitation of the roots causes that led the
individuals into the anti-social behavior that requires their isolation then
it would be the proper place for someone who has been overcome by problems
like this. Instead jail is punitive hell, meant to further isolate and
devastate the individuals it consumes to intimidate the rest of the
population.

~~~
tyingq
And it's punitive forever. Your employment prospects once you have a felony
conviction are severely limited.

------
ada1981
Legalize and tax/regulate production, purity, etc. Outlaw all marketing.

Invest all profits in the following:

1) Ensuring all children have an attuned attachment figure / parents have free
(or even incentivized) training to learn how to attune emotionally.

2) Psychedelic therapy centers to help heal the underlying addiction along
with support and integration.

3) Community gardens / organic food production & affordable housing.

~~~
krapp
> Legalize and tax/regulate production, purity, etc. Outlaw all marketing.

Why outlaw marketing? If all drugs are legal and regulated, there should be no
issue with advertising them like any other legal and regulated product. The US
already allows advertising for pharmaceuticals, it should allow advertising
for every other drug.

And why should drug companies have to invest their profits in the programs you
describe? No one forces beer companies to invest all of their profits in
Alcoholics Anonymous, or MacDonalds to invest in weight loss programs.

Your comment implies that you believe certain drugs would present a societal
harm if legalized, and that extraordinary efforts should be taken to mitigate
that damage. But if so, why legalize them to begin with?

~~~
mgce
I firmly believe alcohol marketing is a major contributor toward alcohol
continuing to be one of the most destructive drugs in our society. It's
glamorized in a a savvy and well-funded way that puts an incessant haze in our
understanding of it as a a powerful, poisonous, and potentially debilitating
substance.

You can find billboards that make bottles of liquor look like royal treasure
passed down from the gods. It's ultimately poison in a bottle. This kind of
glorification of it hurts people who don't have the ability to enjoy it
without consequence (i.e. millions of people in the U.S.).

~~~
rm_-rf_slash
On one hand, who can forget this wonderful slice from South Park:
[https://m.youtube.com/watch?v=WrVLB3MtUjo](https://m.youtube.com/watch?v=WrVLB3MtUjo)

On the other, alcohol use is highly cultural. In Italy, everybody drinks. A
glass of wine or two with lunch and dinner is totally normal. Yet I never have
seen a sauced Italian.

Compare it to the Brits, who drink like fish. In fact, the ancient Romans
repeatedly tried and failed to replace the local binge drinking culture with
their own casual Mediterranean cafe culture.

The reason Americans drink too much is simply because American culture values
getting sauced. Even responsible adults remember their adolescent years with
some fondness and so there isn't much of a cultural impetus to stop drinking
or to drink less.

------
egwynn
I generally hear people saying two things:

1\. “The gov't isn’t/wasn’t able to competently police big pharma, so
addiction will only get worse if we legalize drugs.”

2\. “The gov’t is policing citizens too much, so addicts’ lives will get
ruined if we don’t legalize drugs.”

I’d like everyone to consider the very real possibility that we’ll need to fix
_both_ problems before we reach a good place.

~~~
pixl97
Or you should realize both problems cannot be fixed and we need to choose the
option that will do the least harm. Reducing the abusive police state and
treating increased numbers of abusers is likely a much better problem than the
one we are currently experiencing.

------
parkeragee
I think a lot of it comes down to the pharmaceutical companies. Instead of
legalizing drugs and getting into some infinite loop of creating new addicts
and spending the tax money to rehab & educate them, etc., we need to regulate
the pharmaceutical companies. Shocking: In U.S. real estate, service providers
(title companies, home inspection companies, etc.) are not allowed to give
"kick-backs" to Realtors. But, we have pharmaceutical companies providing HUGE
kick-backs to doctors for prescribing their patients meds they don't need.

------
knownothing
We invaded Afghanistan--the world's largest producer of poppies for heroin and
opium--in 2001. Production has also been on the rise since then. An
interesting correlation.

~~~
Fricken
Opium production was virtually eliminated in Afghanistan before we invaded, by
the Taliban, whom we thanked for doing such great work. We also granted
Afghanistan $43 million to help farmers no longer profiting off poppy fields
through a drought.

[http://www.nytimes.com/2001/05/20/world/taliban-s-ban-on-
pop...](http://www.nytimes.com/2001/05/20/world/taliban-s-ban-on-poppy-a-
success-us-aides-say.html)

~~~
knownothing
Right. Which is exactly what I said. Production has been on the rise since
2001.

~~~
Fricken
I wasn't disagreeing, I was embellishing.

~~~
knownothing
Ah, I assumed the most pessimistic reading possible. Thanks for adding that!

------
jcmoscon
Read the "Red Cocaine" book to understand this war. It's an old book but the
players didn't change.

------
danschumann
"It's one molecule away from heroin" I heard people say about oxycontein(sp?).
If marijuana were legal, fewer people would be prescribed oxy, and therefore
less gateways to heroin. The real gateway is the bad law of prohibition on
marijuana.

------
jostmey
Isn't it possible to create poison genes using CRISPR that are always dominant
and will lead to a species extinction?

Why not apply this technology to completely eliminate Opioid plants?

P.S. I am sure there are many reasons why this won't work, but let's think
big, okay?

~~~
pixl97
Um, you're not thinking big enough, and there is a large number of failures of
imagination you are experiencing.

First, opioids are actually really good when you don't abuse them. Just go
break your leg and you'll see why.

Second, you are suffering from the sci-fy show "use space age technology yet
still have modern problems" thing you see. If you can 'extinct' poppies, I can
just as easily use CRISPR to stick those genes in anything else. _It 's not
corn, it's my cash crop!_

If you have supertechnology don't fix plants, _fix people_.

------
madengr
So is there anything stronger than carfentanil?

~~~
ridgeguy
Not clear. I seem to remember reading of a stronger fentanyl derivative within
the last month or so, but can't immediately find the reference.

If you're interested in the status of fentanyl and its derivatives, as well as
the directions being explored for their pharmaceutical use, here's a well-
written, chemistry-heavy article [1]. Not paywalled.

[1]
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4137794/pdf/nih...](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4137794/pdf/nihms591772.pdf)

~~~
madengr
Interesting that the lethal dosage for rats is 100x higher than monkeys.

------
toymachiner62
Maybe i'm an insensitive Mofo, but let the dumbasses OD and educate how
dangerous these drugs are. Then maybe the next generation will be smarter.

~~~
sctb
Please make your point civilly and substantively or don't post.

[https://news.ycombinator.com/newsguidelines.html](https://news.ycombinator.com/newsguidelines.html)

------
chris_7
Heroin, LSD, etc. use really doesn't affect me. I don't care if people use it,
and don't want the government to waste money fighting it or whatever they do.
I don't care if people manufacture it, as long as they follow all the usual
regulations for dangerous chemical plants (like, don't have one in an
apartment building). Anyone should be able to grow weed wherever they'd grow
lettuce or whatever, no danger there. I also don't care if they sell it, as
long as they collect sales tax and pay income tax, so that we can pay for
welfare and healthcare and such.

Let's have a war on smoking instead. I live in New York, and people think it's
perfectly acceptable to light a cigarette while walking down the sidewalk and
spew their fumes all over everyone walking behind them. Let's punish that like
we'd punish them for punching random people on the sidewalk. Hey, if someone
hits me and they're not a trained boxer, I'll probably feel fine a few minutes
later, but that cancer smoke builds up over time.

Then we can move on to exhaust-producing vehicles, and so on...

~~~
koolba
I don't recall any incidents of junkies robbing people to buy a pack of
Marlboros.

~~~
jjawssd
Junkies wouldn't need to rob people of as many things if these drugs were
cheap as dirt

~~~
koolba
They'd still rob people. Heroin is already very cheap. That's one of the
drivers of people moving to it from prescription opiates.

Dropping the price further isn't going to make much difference.

