
How a nation of junkies went cold turkey - krakensden
http://www.newrepublic.com/article/113051/georgias-war-drugs-how-its-subutex-addiction-ended
======
girvo
Normally, on topics like this I post under a throwaway. Now, I don't see why I
should.

I'm an ex-heroin addict, and am on Suboxone Opiate Replacement Therapy. I've
been clean for 9 months, after 6 years of opiate addiction (starting with
Oxycodone, and moving quickly to Heroin). I'm 22 years old.

This article has a few factual inaccuracies, which I want to correct.

First: Injecting Suboxone is NOT safe. Not even close, especially with the
method described in the article: unless you are a fan of Talcosis (which will
kill you), you need to get a micron filter. Even then, it's not worth it. The
high is minimal, tolerance builds rapidly, and it's dangerous. There are
numerous complications that come from injecting pills, and it's never worth
it.

Second, and this is a small nitpick, heroin users don't have "eyes like
saucers" - you have eyes like pinpricks. Opiates constrict pupils, not dilate
then.

Third, heroin withdrawal IS torture, at least if you have a sizable habit.
Yes, Burroughs did say it was "overrated", but I can tell you from experience,
it's absolute torture. It's not like fever. It's an entire body ache, down to
your very bones; it's your mind crying out for relief. It's something I
wouldn't wish on my worst enemy.

Just thought I'd add my two cents.

~~~
nullymcnull
There were a number of annoying factual inaccuracies in the article,
particular with respect to heroin:

> ..time-killing properties of opium or heroin, but with none of the
> likelihood of it stopping his heart

Opiates do not stop your heart. The notion that every single usage of opium or
heroin is like a game of russian roulette, that might stop your heart, is
fantasy. Opiates are actually quite safe, as drugs go. It's not until you take
far too much or mix them that you are screwed. And that's true of any opiate,
prescription or otherwise.

> Heroin kills, and OxyContin, unless badly mishandled, does not.

Basically not true; injected oxy requires no more 'mishandling' than heroin to
kill. Both will happily shut down your respiratory system and kill you if you
administer too much. Of course one could argue that the pharma is of a
consistent manufacture and dosage, whereas one batch of too-strong street
opiates could kill someone used to weaker stuff, but the author of this piece
seems far too clueless about the subject to be making such distinctions.

Then we have comparison of marijuana's 'addictiveness' to that of opiates. The
difference between psychological dependence and physical dependence is one of
kind, not degree.

~~~
girvo
Injected OxyContin is worse, actually. Being 2/3rds the strength of heroin,
but being in pill form, means you're running the gauntlet with talcosis, and
causing other terrible and fatal medical conditions due to the nature of what
is put in the pills themselves.

Heroin and pure opiates are actually "safe" as far as drugs go. I'm clean, and
even when addicted held down good jobs, earning good money, and no-one was the
wiser. My vitals are still perfect to this day.

It's the addiction that gets you, unfortunately.

~~~
omegant
As a child I was once in a english class for people in rehab from heroin. This
was Spain in the early 90s and most of them had been addicts fOr more than 10
years. They were definitely affected neurologically, they were like a bit in
slow motion and could disengage from their sorroundings quite easily. They
were in the last part of the therapy, almost ready to go home, but I can't
tell if that was an effect of a substitution therapy( at the time it was
methadone), or they had a permanent cognitive damage.

~~~
girvo
Methadone, at least in my experience, really does "zombify" you. It has really
pronounced CNS depressant effects. It's basically no different from Heroin in
how it affects your state of mind: that's why I personally chose Suboxone as
my ORT drug.

~~~
jnbiche
I've done high-level cognitive activities like programming for 5 years of
methadone therapy with little to no problems. I took the GRE on methadone
therapy and did better than when I was on no opiates 10+ years ago. Used
properly, methadone's side effects can be minimized to almost none in most
patients. I tend to get sleepy after lunch, but I honestly can't tell if
that's the methadone.

Most of the "zombified" methadone users are way overmedicated, usually because
this is the state they are seeking.

~~~
girvo

      > Most of the "zombified" methadone users are way overmedicated, usually because this is the state they are seeking.
    

I agree entirely :)

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Wintamute
Around 1 in 20 people have personalities such that they're prone to addiction,
to the extent that it can cause them to make questionable decisions. Drinking,
smoking, sex, heroine, gambling, porn, work, party drugs, Subutex, anti-
depressants, whatever, you name it. We need to stop prohibiting whatever
activity/substance people actually get addicted to because its essentially
arbitrary, and start compassionately treating the root psychological causes.

~~~
tokenadult
_start compassionately treating the root psychological causes_

How? Couldn't limiting access of an addicted person to the substance or
activity the person is addicted to be one part of compassionate treatment?
What research is there on this?

~~~
Falkon1313
Limiting access to a substance or activity doesn't address the problem, which
is the behavior. If the person in question ends up replacing it with a safer
substance or activity, that may be somewhat better, but they may instead end
up replacing it with something even more dangerous. It's a gamble and it
doesn't even address the problem. Blaming inanimate objects for the actions of
humans never really helps. It would be better to address the actual humans,
their actions, and the causes instead. We just don't know how to do that yet.
As a society, we aren't smart enough.

------
jnbiche
As an opiate addict on methadone for 5 years, I have a problem with this
article because of several major factual inaccuracies.

First, and most notably, heroin withdrawal, like withdrawal from any opiate
worth its cost, is absolute torture. It's ironic that Burroughs was quoted
here, since he's written some of the most accurate descriptions of the utter
pain of withdrawal. It's far, far more serious than something like swine flu
(which I had during the pandemic), and people can and do die from opiate
withdrawal on a frequent basis, usually from the accompanying cardiac issues.

Second, having dosed in methadone clinics across this country, I've never seen
one with an armed guard, or even an unarmed guard. I've dosed in a clinic in
Gary, Indiana, and one in a rough spot near Orlando. Both were clean, safe,
well-run places with no guards necessary. In my 5 years on methadone, I've
only seen the police called to a clinic on one occasion, when a disgruntled
patient got a little verbally abusive toward a counselor. But never physical
violence, and never a need for armed guards. It's possible that there is a
clinic somewhere that has an armed guard, but saying methadone clinics in
general have armed guards is incorrect.

Others with far more experience in issues like this than the writer have
commented on other inaccuracies, like the "saucer-like" eyes of heroin users,
and the exaggerated desirability of Subutex to IV drug users.

Because of inaccuracies like this, I have to doubt the other "facts" reported
in this article. The whole piece seems to have been written to support a pre-
existing idea the writer has about drug policy. Good journalists do this the
other way around.

~~~
corin_
I've never been near one of these clinics, but is it not possible that 95% of
them do have armed guards and the two you went to are in the 5%. Not saying
you are or aren't wrong, just that both ways are possible.

~~~
girvo
None that I know of (and go to) in Australia do, mainly because you can dose
at any pharmacy that participates in the program.

------
GigabyteCoin
Note to self, never visit Georgia. This is how they did it:

>If you think New York’s stop-and-frisk rule is invasive, try Georgia’s: Cops
can stop anyone at any time for no reason and force him to urinate into a cup.
Fifty-three thousand people were stopped on the street in 2007, or about one
in 20 of the young men in Georgia.

------
uptown
WAY off-topic, but I think this is the first mobile-theme I've seen that
renders the site completely unusable on a mobile device. (iPhone 4s - doesn't
scroll at all)

~~~
lelandbatey
I was hoping it wasn't just me. I'm using a galaxy s3 and I'm experiencing the
same issues.

------
Symmetry
Honestly the cure seems worse than the disease here, if what they were saying
about Subutex is true (I'd never heard of it before this article). Heroin is
horrible stuff that can easily kill you. For that matter so is alcohol. I
really don't see the point of cracking down on something that is displacing
far more dangerous drugs.

~~~
conroe64
It wasn't displacing heroin. Heroin didn't make a resurgence. Krododil did,
but its use was not nearly as prevalent as the use of Subutex was. The point
is that the society got a lot safer and more productive after the Subutex
problem was fixed.

~~~
girvo
"Krokodil" (which just by the way, barely creates trace amounts of
Desomorphine; the chemistry just isn't correct. No-one really knows WHAT it
creates) is guaranteed to kill you. Suboxone (while possible) generally didn't
have that sort of guarantee. I'm not sure which is better.

~~~
raverbashing
Yes

Note to readers: don't google pictures of Krokodil effects.

~~~
johnward
Unless you want to see rotten flesh and exposed bones

------
raddoc
FYI- Suboxone is actually buprenorphine combined with naloxone whereas Subutex
is only buprenorphine. When Suboxone is taken sublingually as indicated, the
buprenorphine is absorbed and naloxone is not. Thus, if taken as prescribed,
Suboxone can be an effective detox/maintenance drug. However, if it is
injected, the naloxone becomes bioavailable, binding as an antagonist to the
opiod receptors and inducing withdrawal if the user was taking methadone,
heroin, or buprenorphine (theoretically). Clever.

------
revelation
Yes, there is no drug abuse in dictatorships. It can also fix crime, obesity
and all kinds of problems. But it's certainly not worth it.

~~~
dmm
The US has had its dictators too. FDR was given almost absolute executive and
legislative power. He openly admired european facists, describing himself, in
the presence of journalists, as a blood brother of Stalin and Mussolini. He
imprisoned citizens without trial.

I think a similar argument could be made about Lincoln. He too siezed
unprecedented executive powers.

I'm not saying they were good or bad. I'm just trying to point out that we
have had presidents that have taken extreme measures to deal with percieved
crises. And we have, for the most part, interpreted this as a-ok.

~~~
smacktoward
_"FDR was given almost absolute executive and legislative power."_

Um, no. This is incorrect. Roosevelt's plans and projects were repeatedly
frustrated by opposition in the other branches of government. That doesn't
happen in dictatorships.

Much of the New Deal, for example, ended up being struck down by the Supreme
Court. Roosevelt tried to prevent that from happening again by "packing" the
Court with friendly justices
([http://en.wikipedia.org/wiki/Judiciary_Reorganization_Bill_o...](http://en.wikipedia.org/wiki/Judiciary_Reorganization_Bill_of_1937)),
but Congress shot that plan down. He desired for years before Pearl Harbor to
get the US to join with the Allied powers in opposing German and Japanese
expansionism, but the Neutrality Acts
(<http://en.wikipedia.org/wiki/Neutrality_Acts_of_1930s>) made it nearly
impossible for him to provide any US support for the Allies at all. Even in
1941, after the fall of France and the Battle of Britain, Congress only agreed
to extend the military draft instituted in 1940 by a _single vote._

You can argue whether Roosevelt was in the right on any of the policy
decisions he made, but you can't argue that he was operating without checks
and balances, because he wasn't.

------
gailees
Interesting. This really got me thinking:

"Dependence on pot isn’t a minor thing—imagine stalling the careers of a tenth
of the U.S. workforce for a year—and we should certainly consider it in the
negative side of the ledger when contemplating reform in drug policy."

~~~
ralfn
Because the purpose of life is to work, produce as much as possible?

Talk about an addiction, an unhealthy dependence, obsession with a metric that
has nothing to do with either happyness or fullfilment.

Almost as if we're actually craving enslavement. As if chasing promotions, or
wealth as if we're gaining XP or coins in a videogame, is a better way to
spend our time, health and energy on.

Im not saying there is no pot abuse, or working is evil, or other hippy logic,
i just wanted to point out that this particular argument is flawed.

~~~
droopyEyelids
I'm with you on the whole enslavement and false idea that the purpose of life
is to work, my personal pet peeve is how "passion" is used as a word that
means "slavish devotion to enriching a company"

However, we live in an imperfect world and the career disruptions that can
ensue from a devotion to TCH reduce people's quality of life in no uncertain
terms.

~~~
milkshakes
I'm skeptical of your broad, unsubstantiated claims about a drug that you
can't even spell correctly.

------
chrislloyd
For those interested in Krokodil, there's an excellent, harrowing and _very_
NSFW documentary on it by Alison Severs:
<http://www.youtube.com/watch?v=JsUH8llvTZo>

~~~
mauvehaus
An interesting video, but fair warning before you watch: it gets pretty
graphic about halfway through. They show some clips of people with the side-
effects of krokodil: the skin drying out, falling off, and parts of bodies
getting pretty raw.

I don't have a particularly weak stomach, but my dinner started getting
restless.

~~~
tetha
Yup, even after seeing to many weird videos, this is one of the 5 worst I
know.

------
coldcode
I wonder what the actual affect on people is of Subutex. If the effects
generally are similar to pot, why bother regulating it? 30,000 people per year
in the US die of alcohol related accidents and other issues, and 250,000 or so
die of smoking related cancers. Yet they remain completely acceptable legal
"drugs". I don't know off hand the number of deaths from illegal and
misdirected drugs including violence but I am sure it's not a small number
either. The inconsistency of treating each mind-altering substance is what
makes little sense to me.

~~~
coldcode
I found this: "The most common reported side effect of Subutex and Suboxone
include: cold or flu-like symptoms, headaches, sweating, sleeping
difficulties, nausea, mood swings. Like other opioids Subutex and Suboxone
have been associated with respiratory depression (difficulty breathing)
especially when combined with other depressants."

Sounds like a hangover.

~~~
girvo
The effects are a feeling of pure (blissful) apathy, and warmness. Suboxone is
very light on the side-effect front, compared to other opiates.

------
rammark
The article didn't really explain the justification for the crackdown on
Subutex except for the usual "drugs are bad, mmmkay". It seems like Subutex is
a good cure for misery without serious side effects.

~~~
shabble
There are plenty of undesirable side-effects:

 _can induce mild withdrawal symptoms in patients dependent on opioids; also
diarrhoea, abdominal pain, anorexia, dyspepsia; vasodilatation; dyspnoea;
paraesthesia, asthenia, fati- gue, agitation, anxiety; less commonly
flatulence, taste disturbance, angina, hypertension, syncope, hypoxia,
wheezing, cough, restlessness, depersonali- sation, dysarthria, impaired
memory, hypoaesthesia, tremor, influenza-like symptoms, pyrexia, rhinitis,
rigors, muscle cramp, myalgia, tinnitus, dry eye, and dry skin; rarely
paralytic ileus, dysphagia, impaired concentration, and psychosis; very rarely
retching, hyperventilation, hiccups, and muscle fasciculation_

    
    
        --British National Formulary 59
    

As well as all the complications that come from self-injecting with
potentially non-sterile equipment, and of things not intended for IV use
(crushed pills have a number of inactive different binders and fillers that
don't dissolve and get lodged somewhere in the body, typically the lungs[2])
It's metabolism can be pretty hard on the liver as well, which is a major
concern if users have hepatitis from needle sharing/reuse.

Another big problem is that since it operates as an opioid receptor anagonist
(rather than an agonist, as practically all other opioids), the usual
treatment for overdose -- Naloxone -- won't work very well. Buprenorphine also
has a fairly hard effectiveness ceiling at ~32mg/day (although it would be a
lucky/rich addict indeed who could afford that at €300/8mg quoted in the
article)

Finally, if an addict ends up in hospital or requires strong pain-relief,
there's not a lot of options because the blockade effect will prevent (afaik)
virtually all other opioids from working.

[2] <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1276621/>

------
inDigiNeous
Is it just me, or is this article praising Subutex ? If you want to know what
subutex does to people, watch this Finnish Documentary about Subutex,
Reindeerspotting, Escape From Santaland:
<http://www.youtube.com/watch?v=Q8O_Ot-wCIg>.

Subutex misuse is a big problem in Finland, and it seems to create more
problems than solve them, at least to the information I've read about it.

------
joyeuse6701
In summation, tough policy cleans up the majority of the drug addicts, but the
diehards resort to a worse substitute that is , for lack of a better word,
grotesque. I wonder if they reintroduced subutex if the old drug addicts would
come back, or if just the die hards would return and be free of krokodil?

------
cnp
I wish more people were familiar with Ibogaine. It's expensive, but it's
helped two friends completely return to life with no withdrawal symptoms or
desire to use again.

It has properties that break opiate withdrawal almost instantaneously, as well
as other psychological effects that tend to reset senses such as smell, touch,
etc, back to an almost childlike state. Very mysterious and beautiful
substance.

<http://en.wikipedia.org/wiki/Ibogaine>

This is also a must-watch documentary:

Ibogaine, Rite of Passage: <http://www.youtube.com/watch?v=dPDIH9WODnk>

------
equilibrium
Cycle of addiction <http://visual.ly/cycle-addiction>

