
Serving All Your Heroin Needs - romefort
http://www.nytimes.com/2015/04/19/opinion/sunday/serving-all-your-heroin-needs.html
======
rcarrigan87
Having grown up in suburbia with a number of friends who have gone the heroin
route, from my experience the biggest issue is young kids don't associate
their Mom's painkillers in the medicine cabinet with heroin.

Oxycontin is viewed like a fun drug. It's legal, so it must be okay...

Once they're addicted and out of money they eventually turn to
heroin(something they would have never touched prior).

~~~
soberhacker
Opioid addiction is an insidious series of compromises. At 16 years old, I
would have laughed off any notion of trying heroin as absurd. _" No, I would
never do that!"_ But having recently tried marijuana, and open to exploring
drugs I thought of as "safe," the 5mg Vicodin I found in the medicine cabinet
didn't seem like such a big deal.

Well I tried it, and boy did I like it. Slowly, over time, I ran the gamut of
different strength pharmaceuticals, administered orally, intranasally, and
even rectally.

Eventually, you develop a physical addiction. One day, you can't afford the
$40 for an 80mg oxycontin that you need to get well, and you're staring down
the barrel of a long night of withdrawals. But a small bag of heroin might
cost $10 and last you a couple of days. And so it goes.

~~~
hn_
Thanks for sharing your story.

A while back I saw something about heroin addition on the TV. There was an
interview with a doctor. She basically said the same thing as you - none of
her patients just decide to start heroin one day, they start on prescription
opioids. Then their supply runs out...

Then they show videos from pharmaceutical companies from the 90s directed at
doctors telling doctors to prescribe their opioids to all their patients
(basically). It was basically like "30 million Americans have chronic pain...
give them Oxycontin. It's totally safe."

~~~
ddmf
I remember reading something similar about the pharmacy companies telling
their doctors that oxycontin didn't cause addiction and therefore it was safer
to prescribe than codeine etc:

[http://motherboard.vice.com/read/how-big-pharma-hooked-
ameri...](http://motherboard.vice.com/read/how-big-pharma-hooked-america-on-
legal-heroin)

------
darawk
As a former heroin addict who used to buy from these guys, this article is
spot on. They were always polite, fair and non-threatening. They were usually
(relatively) on time. They really did have a great customer experience
relative to the alternatives (which I also used from time to time). The thing
about them keeping business hours is also accurate and was amusing to me at
the time, except of course when I ran afoul of the deadline.

As I recall, they even engaged in some network marketing. The group I bought
from had a standing offer of a free balloon in exchange for bringing them a
new customer.

~~~
soberhacker
This is my experience as well. The "runners" (as the delivery persons were
called) were always friendly, and usually didn't speak English. They would
tell me, _" Tengas cuidado,"_ (be careful).

------
facetube
In the US, Methadone also keeps people tethered to a daily drive to a
Methadone clinic, followed by a relatively long wait in line. When someone is
trying to hang on to a job and get their life back together, this can be a
significant drag on the process. Buprenorphine (with or without added
naloxone) has no such restriction, and can be dispensed from a normal pharmacy
in 30-day supplies. However, the DEA limits the number of patients a
buprenorphine-licensed physician can take on, which leads to shortages of
available care (or very high prices) in a lot of areas of the US.

The article seems to blame the drug, and the delivery service, and the people
selling it. But many of the people in the bottom 20% income bracket in the US
are sick, isolated, have no access to health care (at least without winning
their $6,250 out-of-pocket maximum on a lottery ticket), are poor enough to
have to prioritize rent over food, and have little to no opportunity for
social or economic advancement. As the
[http://en.wikipedia.org/wiki/Rat_Park](http://en.wikipedia.org/wiki/Rat_Park)
guy said, "severely distressed animals, like severely distressed people, will
relieve their distress pharmacologically if they can."

~~~
wdewind
> The article seems to blame the drug, and the delivery service, and the
> people selling it. But many of the people in the bottom 20% income bracket
> in the US are sick, isolated, have no access to health care...

From the article:

> "the victims — mostly white, well-off and often young"

> "A result has been a rising sea level of prescription painkillers that
> continues today, of opioids such as Percocet, Vicodin and OxyContin. Sales
> of these drugs quadrupled between 1999 and 2010. Addiction followed. And
> this has given new life to heroin, which had been declining in popularity
> since the early 1980s."

I think your point is valid but not relevant to the article. It's not claiming
the things you said.

Also Rat Park is highly controversial and has failed to be reproduced and,
obviously, is a rat study, so I wouldn't really rely on it as a robust
narrative for what's going on with drug addiction in humans.

~~~
wanderingstan
I didn't realize that Rat Park was controversial. Can you point me to some
scholarly articles or discussions around it, or the latest addiction research?

The wiki page indicates that there was some success in replicating the
results. Searching the web is impossible, as it's mostly hype popsci articles
in th vein of "you didn't know this about addiction!"

~~~
facetube
There are almost certainly some issues with the Rat Park experiment, but even
exercise alone has been shown to reduce binding availability at the mu opioid
receptor in humans, probably as a result of beta-endorphin being released:
[http://www.ncbi.nlm.nih.gov/pubmed/18296435](http://www.ncbi.nlm.nih.gov/pubmed/18296435).
It wouldn't be a huge leap to hypothesize that this could decrease exogenous
opioid consumption.

Interestingly enough, there's also a genetic mutation that's at least loosely
associated with alcoholism, a possible increased response to naturally-
produced beta-endorphin, and a need for more opioids to achieve equivalent
pain relief:

[http://www.pnas.org/content/95/16/9608.full.pdf](http://www.pnas.org/content/95/16/9608.full.pdf)

[http://www.snpedia.com/index.php/Rs1799971](http://www.snpedia.com/index.php/Rs1799971)

------
ljd
I have a very close friend who this article described perfectly. None of us
grew up in a great environment, so when his friends suggested Oxycontin it
wasn't abnormal or even strange to do it. But it's been 9 years since and
after being homeless, a methadone patient (it's hard to call it treatment when
they themselves are so predatory), and endless amounts of family support he is
slipping into the harder street drugs that are cheaper and more abundant to
find.

Growing up in that world has given me an appreciation for the very slight
difference between obsession, which drives us to be great and addiction which
drives us into the ground and I wonder why I got one and he got the other.

------
dionidium
Let's not forget about the shameful inclusion of acetaminophen (at least
partially, explicitly) as a harmful deterrent against opioid abuse. Serial
abusers mostly know about this (and have strategies to mitigate it), but kids
popping their mom's Percocet with a Bud Light have no idea how harmful that
combintaion is. That it's unnecessarily, intentionally harmful is, again,
shameful policy.

[http://healthland.time.com/2011/01/13/fda-cuts-
acetaminophen...](http://healthland.time.com/2011/01/13/fda-cuts-
acetaminophen-dose-in-opioid-painkillers/)

~~~
roma1n
This was done on purpose? I have seen paracetamol/tramadol combinations to get
a synergistic effect (not sure that it works though). But what is the
rationale here? "You got an addiction problem, so we're going to fuck your
liver while we're at it" ?

~~~
vidarh
Paracetamol/acetaminophen does appear to have synergistic effect with codeine
as far as I'm aware, and the combination is often prescribed for severe pain
(the prescription-only variation - at least in the UK - has a far higher
codeine to paracetamol ratio), but the _requirement_ that they are combined is
clearly to deter abuse of the codeine.

The irony is that paracetamol overdoses are far harder to treat and far more
likely to lead to death or severe long term damage than opioid overdoses...

In the UK, codeine on it's own is still a controlled substance to the point
where if you extracted the codeine from a single pill (possibly two, not sure
of the exact limit) of the combination products, possession ould get you
arrested, while you can go and buy packets with a total of 64 pills (32 each
of ibuprofen and paracetamol combined with codeine) at the time from your
local pharmacy no questions asked.

Basically there seems to be a bizarre belief that addicts will act as rational
actors when faced with the knowledge of this mix, despite the fact that most
_other_ drug policy is based on the assumption that drug users - addicts or
not - are incapable of making decisions about harm on their own.

This becomes even more bizarre in places like the UK, where there have been
restrictions on the number of paracetamol pills that can be sold per
transaction because of the amount of harm caused by accidental or intentional
paracetamol overdoses.

------
sithu
There should also be some discussion about why the US uses more prescription
narcotics than any other country. Some interesting data and charts here on
global consumption and how it's changed over time.

[http://www.painpolicy.wisc.edu/global](http://www.painpolicy.wisc.edu/global)

------
BorisMelnik
Interesting business model for sure. Very impressed to hear they actually did
customer surveys and follow ups. The next step is an app over SSL. Choose the
quantity you want and your unique customer identifier and you will be SMS'd a
Google Maps link to a pickup location.

What a horrible problem this is. I was hooked for a very long time on this
stuff and have had many friends die as a result. It is a nasty habit to kick.

~~~
gwern
It would be interesting to compare this to the Silk Road model: the Tor black-
markets are more robust against surveillance (LE pulls countless cell records
every year) and more systematic about feedback (every order) but the delivery
mechanism is much slower (mail is never faster than overnight and
international orders take weeks or months) and it's unclear whether it's more
or less secure (individual vendors can be profiled and their packages
intercepted reliably; on the other hand, driving around is pretty darn
insecure).

------
stplsd
I hate when heroin is described as some terrible extremely dangerous drug,
when in fact it is quite the opposite - it is very gentle and relatively
harmless drug. Of course I am talking about medical grade pure heroin, not
that Mexican black tar shit or white heroin mixed with god knows what. Even
with street shitty heroin, 90% overdoses can be so easy avoidable: just don't
mix with it alcohol or benzos, and have someone in your shooting gallery with
shot of Naloxone.

I am not even talking about medical grade morphine/heroine, which is gentle
and safe as milk (I mean constipation and some temporary hormone imbalance is
the worst you can get, compare it with side affects of otc NSAID, which
includes renal failure, myocardial infarction, Gastrointestinal bleeding).

And the solution is so simple - just provide addicts with pure heroin, other
countries, like Switzerland do this with great success.

~~~
soberhacker
While I agree that the dangers of heroin are severely compounded by its
illegality, it is intellectually dishonest to describe it as "gentle and
relatively harmless."

Speaking as an ex-user, opioids are a horrendous class of drug. They steal
your motivations, your desires, your dreams—your very soul. They turn you into
a shell of your former self.

Do not fool yourself into thinking that opioids are gentle and harmless just
because they are technically non-toxic.

~~~
stplsd
I don't know, while I never used opiates or any other "hard" drugs (except
nicotine and alcohol), I had/have gambling addiction, lost a fortune of money
(myself and parents), now have huge debts, caused a huge emotional pain to my
parents, now have to live very frugal, because have to cover my debts, etc,
etc. So I think I imagine that full blown heroin addiction does to you, but
the way you describe it sound like some virus, which affects your brain and
make your a zombie (like some wasps do this to cockroaches). But in reality in
just simple chemical with well understood action mechanism. Of course if you
high all day, there is no motivation to do anything, but I think, we as humans
beings, have to take responsibility for this and not blame some chemical.

When I said "gentle" and "harmless" I meant their psychical properties to
human body. A roulette or deck of cards is also harmless to body, but they can
ruin lives too.

But the main tragedy is when people lose health, money, commit crimes,
prostitute themselves, etc. An as heroin is relative safe and harmless to
body, legal heroin supplies to addicts would solve so much problems.

~~~
amagumori
you still aren't getting it though. drugs that cause huge dopamine release
like opiates or meth are literally tampering with your motivational/reward
system directly, in a way that's much more harmful than other addictions. _you
can 't will yourself out of a fundamental change to your intrinsic will
system._ you can't say that people have to "take responsibility" and "not
blame some chemical". the chemical is literally altering the motivational
behavior of the person. this is not something the person can solve themselves.
they should not be expected to be able to.

let's say you can place everything you've felt in life on a scale of good to
bad feelings from -10 to 10. shooting heroin is like suddenly having an
experience rated at 100 on that same scale. the entire scale has permanently
shifted. everything else in your life has completely paled in comparison to
that experience whether you like it or not. you will have to deal with that
changed perspective for the rest of your life.

~~~
laichzeit0
I like your scale analogy. Is it really that bad as you say that it will
change your perspective for the rest of your life? Does that mean that former
heroin addicts will never really experience a good/happy life post addiction?

~~~
amagumori
in terms of the changed perspective, you're never going to forget that
feeling. it will forever be an "option" that has to be staved off with will.
the memory of a feeling like doing heroin is different from, say, the memory
of a fact. it forever pulls you towards it in the most primal, low-level way,
the human desire to feel good. emotionally trying times, in particular, are
the worst because you know you can spend $10 to be yanked into bliss.

a good 30-40% of my friends were addicts and from talking to them i think
they'd all agree that it's a long, slow climb back to emotional normalcy. i
think it's healed only by time. a lot of time. and i think it's a half-life
sort of curve where you get 50% better after the first 5 years, then 25%
better after the next 5, then 12% better.. etc. more than anything you're
trying to reorient yourself towards a life where the joys are small and
fleeting, and waiting for those potent memories of having your bliss-button
chemically held down to fade.

------
b6
Parts of this story are not ringing true to me.

Do dealers really drive around with balloons in their mouths, prepared to
swallow them if stopped? Do buyers really receive calls from dealers asking
them whether they're satisified? Do buyers really announce their intention to
quit using or switch dealers, and get free heroin?

I don't have a lot of experience with stuff like this, but it sounds so bogus.

~~~
soberhacker
I'm 4 years sober from heroin now, so I can speak from my experience using in
Los Angeles from ~2008-2011.

Balloons are typically sold in .1 gram quantities, with lower quality heroin.
I do recall buying balloons wet with saliva, but only some of the time. An
acquaintance told me that it used to be standard practice for dealers to use
young Mexican children to sell dope by this method on foot in Skid Row, but
that the city had really cleaned up downtown. With the popularization of cell
phones, the delivery system described in this article became the standard.

Higher quality heroin was usually sold by the half gram. Instead of being in a
balloon, it would be wrapped in plastic torn from a grocery bag, tied off or
melted to close and seal it. I don't recall these ever being spat out. They
would often hide it under the hood in their beat up trucks or minivans.

I never got customer satisfaction surveys from dealers. I'm sure that the
dealers had customers or friends from whom they got feedback on their product,
but I was never one of them.

A dealer's number was quite a hot commodity. You couldn't just call the dealer
up and expect to get served—you had to be introduced. And the dealer would
often throw in a free bag if you bought x number of them.

The result of this was that one user would have the dealer's contact
information, and would make a buying run for other users who didn't. If they
bought enough they could keep the free bag, or otherwise pinch off the bags
that they acquired for the other users.

~~~
BorisMelnik
Thanks for your experience also. I am also clean from heroin. I never got
"surveys" either but your dealer never asked you how a new batch was?

~~~
soberhacker
The runners delivering it usually didn't speak much English. I spoke with them
in my broken Spanish, which humored them. They were indistinguishable from
your average, friendly migrant day laborer.

Phone calls with the operator (el jefe) were brief and to-the-point. Code
words were often used, e.g., "I need 2 pairs of pants." There was certainly
never any in-depth discussion pertaining to the product.

I'm sure they had users with closer relations that they used for feedback.

------
MichaelGG
"But instead of pursuing more complicated pain solutions, which might include
eating better, exercising more and, thus, feeling better, too many saw doctors
as car mechanics endowed with powers to fix everything quickly."

And what's wrong with that? Opiates have a _very_ low side effect profile,
compared to other popular medications (like mood stabilizers,
antidepressants). Why should someone unfortunate to have a pain issue also
need to change diet and exercise if there's another option?

As far as doctors being mechanics -- eh, almost. This unfair system of
medicine licensing means that you need to get paid approval before taking
medicine of your choosing. And even then, unless you're wealthy enough to
demand service, you're entirely left to the doctor's personal whims. Many of
which include an anti-addict narrative influencing their decisions.

This story is rather Luddite in its views. Don't use medicine, find your inner
strength; be _American_!

------
king_magic
This is why I tend to roll my eyes when people advocate legalizing all drugs,
no matter what. All the talk about giving up on the failed war on drugs starts
to matter a whole lot less when it's your loved ones who you're not sure
you're ever going to see alive again on a day to day basis.

I'm completely willing to grant that keeping certain drugs (like marijuana)
illegal isn't effective or necessary from a public safety standpoint compared
to legalization/regulation. But for dealers of heroin and other hard drugs
like these, I support extremely, extremely harsh penalties and much stronger
enforcement. Far harsher and much stronger than what we currently have.

At least that's my (likely unpopular) opinion.

~~~
tmp-20150107
See
[http://en.wikipedia.org/wiki/Drug_policy_of_Portugal](http://en.wikipedia.org/wiki/Drug_policy_of_Portugal)
for an example of decriminalisation of posession of _all_ drugs, even heroin.
Dealers are still prosecuted, but users are not. This seems like a sane
solution.

~~~
vidarh
It still fails to address many of the worst problems of criminalisation of
drugs, namely the level of other crime associated with production and
distribution, and the sale of contaminated products.

The biggest risk from heroin, for example, is contamination and varying
strength, not the drug itself. E.g. street heroin is often mixed with all
kinds of other drugs or stuff like brick dust. Clean medicinal heroin is a
quite safe drug (safe enough to be used for e.g. post-op pain relief as an
alternative to morphine in some cases in the UK, for example - if you are ever
prescribed "diamorphine", that's heroin).

Decriminalisation of possession is basically a halfway step where politicians
don't have to admit to how horribly criminalisation have failed, but can
instead "sell" the change as caring about the addicts. But if they really
cared about the addicts they wouldn't keep leaving them in a position where
they're injecting drugs contaminated by brick dust and where they are still
left dealing with criminals for their supply.

