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Norway to test free heroin for drug addicts (afp.com)
44 points by smaili on Aug 10, 2018 | hide | past | web | favorite | 57 comments

Excellent idea.

In the U.S. we commonly see waves of "heroin" overdose deaths over the course of a single weekend. I use quotes because it's usually not diacetylmorphine, it's a fentanyl analog. While they're both illegal, fentanyl doesn't require large poppy fields to manufacture, and it can be more easily concealed for smuggling due to the significantly higher potency by weight and volume.

And the cause of those overdose deaths is typically a new illegally smuggled batch of it showing up in a specific area that may or may not be diluted correctly, and even if it is diluted correctly, it may or may not be significantly more potent than the batch that was being sold the day before.

The "normal" fentanyl that we use to control chronic and postoperative pain, and for anesthesia, is active and easily felt at the 12.5-25mcg level. Some of the fentanyl analogs, including some we use in hospitals, are active at less than 1/100th of that. You simply can't see that or handle it safely, so illicit "heroin" is dry mixed with other, ideally inert, powders.

This works fine for things like a cake mix, where the whole thing is going to be further processed with liquids added to it, but for a potentially lethal drug it's extremely dangerous.

As a result, people accidentally take 50x or more than they thought they were taking, and first responders like police and EMS are at serious risk of overdose themselves, simply from touching a surface or a plastic bag that looks empty.

There is virtually nothing we can do to prevent that unless we move the demand into a regulated channel like a pharmacy.

A nice side benefit to distributing the drugs for free, as long as it isn't overly restrictive, is that it can potentially destroy the blackmarket by eliminating the profit motive as well.

This is such a ridiculous idea that would work very well, because we're talking about addicts (and ignoring the possible moral hazard - government giving a drug out).

No intervention is going to motivate a dope-sick zombie to get to a hospital as much as the promise of being relieved of it - "can I talk you into coming in for counseling? there's going to be heroin and a nurse with steady hands."

And you entirely cut off the illegal sales market, because the government is never going to provide this service to a non-addict - there's no price at which a dealer survives this market and sells to your kid.

An addict should prefer it to the black market, because they don't have to worry about a fentanyl overdose.

If addicts are being produced out of legal opioids and switching to heroin, then this catches them before they are entirely beyond help.

All in all, this is excellent fiscally as well, because it prevents money flowing out in the dark out of the country (instead, legal imports to doctors) - and possibly, cheaper than ambulances every other week until the inevitable happens.

The only argument that you missed that some people may argue is that their taxes (Especially in Norway where taxes are very high) are now going to helping drug addicts get their next hit for free. Some people don't want that to happen, no matter how much good it does otherwise. The rest of your post is spot-on, it's just important to consider arguments from every side.

I know there are a lot of good responses to this argument ("you'd be paying for a jail cell anyway", "it's a net benefit to society", etc), but you have to remember that there is a very large portion of society that think drug users are inherently terrible people unworthy of help and won't listen to any logic beyond that. Although HN is made up of people who are willing to think through arguments fully and recognize why this program would result in a net-benefit to society (at least, in theory - it hasn't been tested yet), it's important to remember that people exist outside the HN bubble. To these people, the idea of helping someone obtain drugs (especially the government helping someone obtain drugs) is a terrible idea, hard stop.

Considering that the alternative is to have your taxes pay for free boarding in jail buying drugs is actually a bargain.

What if it reduces the disincentives to becoming a heroin addict?

Sending them to jail doesn't work. I think we have learned that during the war on drugs. Maybe send them to therapy or just let them do their thing? I used to know a heroin addict who made enough money to afford his heroin and he held a job successfully. He would sometimes disappear for a few days but I have seen that with heavy drinkers too. I think most drugs can be managed as well or badly as alcoholism.

I have a distant relative in Belarus who is a heroin addict for 25 years. Periodically he is thrown into a jail for stealing stuff. When he is released his close relatives have to watch for their stuff as he tries to still from them. But he only still to pay for heroin. If he will be provided free heroin, he will be harmless and may even do something useful as his mental and physical health AFAIK is still OK.

Being a heroin addict already sucks - the main disencientives are that you will probably die, that you’ll get dope sick, that you’ll lose friends and family. People who get into heroin don’t do it because of some cost benifit analysis, but because they are truely desperate.

Good point, it's an issue of optics really, regardless of the actual costs involved.

It's certainly not the drug itself that is so expensive; the unit cost of an individual dose of any of the common opiates, when purchased through a pharmaceutical channel, is going to be less than a rounding error.

Distribution and consumption details would both be political nightmares, even if a legislative body agreed on the core principal being important and the public at large was on board.

Those people need to realise that more of their taxes would go to apprehend, try and imprison the same individuals.

I know some people will still prefer punishing others to helping them, but at that point I don't think their opinion is worth much.

If 'free' is the problem then just legalise/decriminalise it, and sell it at a pharmacies like any other drug. The retail cost of heroin would be pretty low if legalised (around the cost of alcohol or tobacco?), so you can still solve the problem without subsidising the costs.

If I recall correctly, the Canadian equivalent has a longer term rehab upstairs from the area where the drugs are given out. The staff makes people aware it’s an option. People who may otherwise never interact with medical professionals.

Any experiments on how to help drug addicts is great. It's been obvious (in hard data) for decades that wagging our finger and throwing people in jail is not doing anything.

The Rat Park experiment (1981) shows an increase in the standard of living decreases drug use among addicted and non-addicted mice.

Hmm but Norwegians have probably the highest standard of living in the world already. It's a super rich country with a generous welfare state.

> If addicts are being produced out of legal opioids and switching to heroin, then this catches them before they are entirely beyond help.

I'm unsure if anyone is 'entirely beyond help', but if people suffering from opioid user disorder have a point of no return that point is well after switching to heroin. Many people have recovered from a heroin habit.

Slightly less eye-catching, but the actual news seems to be

> The Norwegian Directorate for Health and Social Affairs has been tasked with proposing an experimental project to identify patients likely to benefit from the programme, to examine the implementation method, and to calculate the costs...The first treatments under the project will begin in 2020 at the earliest, the health ministry said in a statement. The initiative could benefit up to 400 drug addicts, according to the daily Aftenposten.

So it is a small-scale, but still radical, experiment that may begin in a few years. This addresses my first immediate question, which was "why wouldn't this just attract heroin addicts from around Europe and beyond?".

This was tried in the UK before with generally positive results eg In 1982 in the Wirral, 400 addicts

>...93 per cent drop in theft and burglary. ‘You could see them transform in front of your own eyes,’ Lofts told a newspaper, amazed. ‘They came in in outrageous condition, stealing daily to pay for illegal drugs; and became, most of them, very amiable, reasonable law-abiding people.’ He said elsewhere: ‘Since the clinics opened, the street heroin dealer has slowly but surely abandoned the streets of Warrington and Widnes.’ https://www.spectator.co.uk/2015/05/the-case-for-prescriptio...

These people already suffer from addiction. Anything the government does to punish them just furthers their suffering and doesn’t help in any way as far we can tell. I think it’s time to paint lawmakers that imprison drug addicts as uninformed at best and immoral and evil at worst. The same goes for other drugs which could potentially end suffering of people (MDMA, Cannabis) but are currently dismayed. The war on the war on drugs needs to take up a notch.

> "Norway, which has one of the highest deadly drug overdose rates in Europe..."

This is the news to me. Anyone know why? My thought is that unlike the US they aren't use to dealing with this so Narcan isn't as prevalent (this is a throw it out there guess backed by no research). I would of guessed Eastern Europe/former communist states (Poland, Bulgaria, Hungary, etc.).

It's a pretty interesting statistics. #1 USA, #2 Estonia, #3 Sweden, #4 Norway, #5 Ireland. I don't really know what these countries have in common.

Excessively shitty grey weather?

US wasn't surprising.

Not sure why I got down voted for a simple statement but ok.

could something like this work for California?

I hope they try just so we can hear from Fox News.

Please don't do this here.

Sorry. Mere jest.

Universal basic income is so 2017. Universal basic stash is clearly the way forward.

Wholly under rated.

What happens when people start claiming to be drug addicts so they can sell the free heroin to real drug addicts?

Why wouldn't the real drug addicts go get the free heroin?

I was assuming there was some limitation on the amount you could get for free and that some addicts would want more than their allotment.

Big assumption. It might be the case, but it might not be.

The first batch of patients start in 2020, with a max size of 400. Let's see if we can help those people, who are probably chosen more carefully then a full program would be, before thinking about the issues scaling up will cause.

Models for opioid based opioid addiction treatments already exist, such as methodone

Or treat it like methadone where you must consume it on site. Not that hard.

Why would real addicts buy it if it is available for free?

Like needle exchanges, this will be an idea that progressives will eventually realize is outrageously naive and stupid. Sorry.

Norway will slowly collect addicts just as SF and LA have collected homeless. They aren't as dumb and helpless as you think, they will gravitate to places where their situation is condoned and supported.

Norway should expect a minimum of 50k Americans to scrounge together for a one-way trip...free heroin? That is a fantasy for any addict.

Needle exchanges are a great idea. They prevent the spread of HIV, hep c, and so many other diseases at a miniscule cost to society. What's stupid is not allowing addicts to get clean needles like a lot of states used to and likely still do. It puts the whole populace at risk of disease just to enforce some idiotic idea of morality or worse, what you suggest, to keep addicts from congregating outside the exchange. That's not even a serious concern when the alternative is to spread diseases and let people, both addicts and non addicts suffer and die from disease. I understand some people hate addicts so much they want them to die, but to spread deadly diseases throughout society because you hate addicts that much is beyond immoral and frankly, despicable.

> just as SF and LA have collected homeless

SF conducts a sort of census of their homeless population. One of the questions asked is where the person lived when they became homeless. The majority are from SF[1]:

> Sixty-nine percent (69%) of respondents reported they were living in San Francisco at the time they most recently became homeless. Of those, over half (55%) had lived in San Francisco for 10 or more years.

The idea that SF "collects" homeless people (from elsewhere) is a myth not supported by data.

[1]: http://hsh.sfgov.org/wp-content/uploads/2017/06/2017-SF-Poin...

> The idea that SF "collects" homeless people (from elsewhere) is a myth not supported by data.

It is, actually, supported by the data you just posted to refute it, which indicates nearly a third of SF homeless were not in SF when they became homeless.

31% of homeless in SF came from elsewhere. This evidence may actually go against your opinion...

What are the numbers like for other cities?

That actually seems a good deal less than the ratio of non homeless folks that are not from San Francisco (much larger than 31%)

> What are the numbers like for other cities?

Those numbers aren't collected in a national and standardized way. Even if other cities collected data about this question, please don't compare the numbers without also comparing survey methodology.

Absolute numbers matter too.

SF and LA have higher absolute numbers of homeless because both cities tolerate it.

> Like needle exchanges, this will be an idea that progressives will eventually realize is outrageously naive and stupid. Sorry.

This program is working for more than 20 years in many European countries already. Why would it all the sudden fail in Norway?

If Norway can rehabilitate those addicts, then great.

What’s the problem with needle exchanges?

What sort of alternative strategies do you have in mind?

I don't think the plan is to rehabilitate them. I think the plan is to mitigate the consequences of addicts taking harmful actions towards others (robbery, assault) in order to get their fix. The theory is it's cheaper and safer to society to just give addicts what they need so their addiction doesn't harm others.

I think this is program could help their chances of rehabilitation.

If they need to commit crimes to get more drugs, then I imagine that they're likely gaining criminal records and "falling into a bad crowd". This kind of stuff makes it hard to rebuild their lives when/if they choose to.

This is out of my wheelhouse and am just speculating. I would love to see data or research on this, though, if it exists.

How does free heroin rehabilitate anyone?

When did Norwegian taxpayers sign up to fund a global heroin haven?

It's pretty simple...if you are a heroin addict anywhere in the world who can afford a one-way ticket to Norway...

Of course much of the free heroin will end up being resold elsewhere, and causing misery elsewhere.

Norway could end up causing a heroin epidemic as their high-quality drugs flood Europe. This is like Christmas for organized crime...a government manufacturing a potentially unlimited supply of quality drugs.

> Norway could end up causing a heroin epidemic as their high-quality drugs flood Europe

From a quick wikipedia search: Heroin assisted treatment is fully a part of the national health system in Switzerland, Germany, the Netherlands, Canada, and Denmark. Additional trials are being carried out in the United Kingdom, and Belgium.

^I feel like you missed the boat on this one.

> How does free heroin rehabilitate anyone?

I don't know if you've noticed, but the current norms of tackling addication aren't working well at all. Countries that have experimented appear to be achieving good results. See https://www.theguardian.com/news/2017/dec/05/portugals-radic...

On portugal (from https://www.independent.co.uk/news/health/norway-parliament-...):

The Norwegian Health Committee is planning a trip to Portugal in February, which decriminalised personal possession of drugs in 2001. The country made the move following a heroin epidemic and the highest drug-related Aids deaths in the European Union (EU).

It now has the second lowest drug-related deaths in the EU.

> When did Norwegian taxpayers sign up to fund a global heroin haven

Here (ignoring the other part of your loaded question): https://www.independent.co.uk/news/health/norway-parliament-...

The GP asked for alternative strategies, which you have not provided, and which would be helpful.

So lets get this straight. The whole world of heroin addicts will flood to Norway, but then the people nearest to Norway (who likely don't have to fly) are going to be impacted by this illegal trade?

Selling something that is free is not a lucrative business for the Mafia. I think you have to make up your mind about the exaggerated scenarios you're imagining.

Here's two straightforward policies that would ameliorate these concerns:

1) Dole out the drugs on site. This is done already all over the world all the time. No take home doses.

2) This is a last resort of Norwegian citizens who have tried other methods of recovery. If you read the article, you'd see it will affect about 400 people. This is a good start, hardly a global heroin empire.

> Selling something that is free is not a lucrative business for the Mafia

It can only be considered truly free if the supply is unlimited per person, as in an "all-you-can-eat" model.

If I gave you 100 milliliters of milk per day then you could technically make the claim that you have milk for free, but you won't be able to drink even a full glass of it.

That’s fair, and I happen to agree with you. I just don’t think this particular concern is realistic given some very basic regulations in place.

How does free heroin rehabilitate anyone?

They stop spending all their time doing whatever it takes to get heroin. They can do other things with that time. Get jobs, for example. It's basically opening the door to rehabilitation.

If by "rehabilitated" you mean "not addicted to heroin", sure, not so much. If you mean "no longer a danger to society", very much so.

You clearly have no idea what you're taking about or how these programs work. You really think they just hand you a bag of heroin and bye, bye go do whatever you want with it? Addicts administer or are administered heroin at the clinic under supervision. They don't walk out with the drugs. These programs are already in place in multiple places on Europe and they are not flooding anything with drugs except addicts' veins.

As for the notion of heroin addicts being able to afford plane tickets... That's hilarious and incredibly ignorant bordering on delusional and downright stupid.

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