H - The surprising truth about heroin and addiction

http://reason.com/archives/2003/06/01/h

by dangeur • 14 years ago

78 88 14 years ago

robbiep3• 14 years ago

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!

shousper• 14 years ago

This is really good to hear from someone in the field, thank you.

Those numbers for the methadone program could be purely from population growth, but then considering the state of the world its probably not entirely either. (Not that I'd know)

robbiep3• 14 years ago

yes you are right about the population growth, I thought this too - but think of it like a school year or something like that (i.e. there are, in most industrialised countries, pretty much the same number of people going into a year of school as the year before - we have a rectangular (as opposed to pyramidal) population tree. Most people experiment with drugs in the same age groups, and In australia over the last 15 years heroin use has been falling (although slight bump last year or 2) - thus the 'cohort' or number of people trying heroin is not increasing, certainly not at the rate of population growth. cheers!

refurb2• 14 years ago

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.

andrewfelix8• 14 years ago

Russell Brandt has an interesting take http://www.guardian.co.uk/culture/2012/aug/12/russell-brand-...

robbiep3• 14 years ago

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

pkulak• 14 years ago

I just listened to this, which made it sound like there's something out there substantially better than methadone:

http://www.npr.org/blogs/money/2012/07/31/157665908/episode-...

papaver2• 14 years ago

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.

refurb2• 14 years ago

I think the problem that a lot of people get into is that your ability to maintain moderate use is not static.

If your life is going well and your not under a lot of stress, I could see certain people who could use heroin recreationally. Now have those same people lose their job, get divorced or have a depressive episode and watch their drug use spiral out of control. I've seen it before.

learc838• 14 years ago

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

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

sverige6• 14 years ago

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?

gee_totes• 14 years ago

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

thucydides• 14 years ago

Cigarettes are expensive because of local, state, and federal taxes.

Heroin is expensive to compensate for the high risk of government punishment at each stage of the manufacturing/retail process.

Synaesthesia2• 14 years ago

Not to mention the demand!

lamby• 14 years ago

You seem to be implying that markup applied above production cost (for any product and for whatever reason) is immoral.

("Inflated" or "inflation" is the wrong term anyway but it makes no difference here)

chii2• 14 years ago

> You seem to be implying that markup applied above production cost (for any product and for whatever reason) is immoral.

its not immoral (for an entity should be allowed to price their product at any price they want to), but i want to believe that a free market _should_ control abnormally high markup, so that all produce will cost only slightly more than it takes to produce it.

GuiA• 14 years ago

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

Please go on— how would one disrupt these industries?

tedunangst• 14 years ago

Sell heroin for $1, just like in American Gangster.

slurgfest5• 14 years ago

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

corin_• 14 years ago

Worth noting that your 14 dollars varies widely by location. Here in the UK most brands are between $10 and $11, in Germany it's more like $6, and in countries like China, Egypt, Greece (or indeed on a flight between UK and USA) they can cost $3 or less. Even within America prices vary greatly, for example I think $10 is a pretty typical price in Chicago.

nikatwork• 14 years ago

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...

asdfsdfsdfs• 14 years ago

Yes, some people can have functional lives on heroin.

But almost none of them stop using, ever.

nn2• 14 years ago

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

stratos2• 14 years ago

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.

andrewfelix8• 14 years ago

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

chii2• 14 years ago

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.

chimeracoder• 14 years ago

Empirical evidence supports your first two paragraphs: http://en.wikipedia.org/wiki/Rat_Park

This experiment was not well-received in its day, but in recent years, the line of thought is becoming popular, as people who work in drug treatment realize that the paradigm is very helpful when treating people in recovery (ie, you have to identify the reason why people feel compelled to seek external relief, be it anorexia/bullemia/marijuana/alcohol/heroin, or else you're just patching over the symptoms).

As for your last point, I'd point out that what most people don't ever see are the people who use drugs responsibly and without any problem - there's a selection bias afoot which causes society to overestimate the harms associated with drugs (and underestimate the harms of the policies associated with them, since they also never see the people locked away).

pchivers• 14 years ago

>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.

rgbrgb• 14 years ago

Seeing as you can totally smoke heroine, I think it has less to do with the needles and more to do with the fact that it is one of the most addictive substances in the world and people regularly die from overdose.

Also, nearly all "normal" tasks can be done stoned on pot but you can hardly talk when you're on heroine.

slurgfest5• 14 years ago

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...

learc838• 14 years ago

"but killing yourself with pot would be pretty tough, and expensive"

It seems to be impossible to actually overdose from the THC contained in marijuana. No one has actually managed to kill a large mammal with THC, but they have managed to kill small rodents.

Extrapolating up it seems that you might be able to obtain a lethal dose of THC by consuming somewhere between 1/3 of your body weight and 1500 lbs of marijuana (all at once).

tsahyt2• 14 years ago

> 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.

alrs• 14 years ago

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.

andrewfelix8• 14 years ago

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.

learc838• 14 years ago

Selection bias can easily account for that.

tacoboye• 14 years ago

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

cletus• 14 years ago

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• 14 years ago

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.

slurgfest5• 14 years ago

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.

slurgfest5• 14 years ago

Addiction is a valid folk concept: everyone is aware of someone who can't get off cigarettes or booze, for example, or gambling, or occasionally heroin or meth or crack - to the impairment of their life, past the point of ongoing pleasure. So there are real phenomena to study, of some social importance. And I don't dispute that many people lose control and mess up their lives in various ways, in addition to running afoul of the law. So be careful with drugs, not even once, blah blah blah.

But the term 'addiction' does not correspond to any natural scientific category. Because unless it is made impossibly rare and unlike our folk concept, any definition will drag in all routine motivated behavior to the point where a lot is included which we all like and find healthy and normal.

There is no actual distinction between 'physiological dependence' and 'psychological addiction.' The relevant phenomena are all psychological and all have biological basis - just as one's behavioral responses to hunger, dehydration, embarrassment or sexual arousal do. Avoiding withdrawal might be more or less motivating depending on the drug - for example, cocaine doesn't really have much of a withdrawal compared to heroin. But the fundamental reason people use heroin isn't because of withdrawal, it's because they love it. The situation where one takes heroin simply to avoid symptoms is just not the primary mechanism of heroin addiction. And since heroin is the paradigm case for this kind of explanation, it is just generally not a good one. We have confused the different phenomenology of the cravings with a spurious major distinction between physical and ghostly causes, when we should really be considering the specific neural systems which are engaged by the different drugs.

I appreciate that what I am saying sounds controversial. If what I say is true, why do people keep talking about addiction? Because the word has an important function OUTSIDE of science - it applies a specific kind of pressure, an important feature of which is the appearance of being scientific. It is an implicit value judgement said in a scientific tone of voice, making it more legally and secularly palatable.

Addiction is nothing more than the pathologized version of desire or enjoyment. If you wish to cast shadows on anything people enjoy doing, simply call it an addiction. In particular if you wish to conflate social disapproval of an activity with a scientific judgement of unhealthiness, call the activity an addiction.

Suppose, for example, that a certain person goes to a bondage club on a weekly basis... so easy to make this into an addiction. Doing the same thing with 'normal' sex is just significantly harder. (Though still possible - in a situation where someone has an interest in pathologizing sex)

shin_lao3• 14 years ago

Withdrawal symptoms make it harder to quit.

abruzzi• 14 years ago

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.

slurgfest5• 14 years ago

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.

ilaksh• 14 years ago

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).

lincolnq2• 14 years ago

Reason.com is a libertarian blog, generally promoting reduced regulation in all forms.

EiZei• 14 years ago

In my opinion the funny thing is that when it comes to drugs libertarians are trying to promote some kind of reasonable fact-based regulatory approach rather than the current moralist view which pretty much is all about punishing people just for punishment's sake. Too bad they can't apply it on other issues as well.

dinkumthinkum3• 14 years ago

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 ... :)

learc838• 14 years ago

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.

njs123452• 14 years ago

There are plenty of people who aren't libertarians at all who disagree with the War on Drugs. I don't think it's inherently immoral for the government to regulate hard drugs, but pragmatically I think as a policy it's a failure, with negative consequences for everybody..

jamesbritt• 14 years ago

Isn't this sort of begging the question?

Sounds like no one should defend H because no one defends H.

ngkabra• 14 years ago

The love of truth, maybe?

andrewfelix8• 14 years ago

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.

lincolnq2• 14 years ago

Selection and availability effects should account for this, though.

andrewfelix8• 14 years ago

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.

ZoFreX6• 14 years ago

How would you possibly know how many of your friends use heroin responsibly and in secret with no effect on their lives (a la NY business man in the article)?

andrewfelix8• 14 years ago

That argument is a logical absurdity. You cannot assert a proposition is true because it has not yet been proven false.

njs123452• 14 years ago

Would your friend have died of a heroin overdose if heroin was easily available to maintain his habit and regulated? See http://en.wikipedia.org/wiki/Heroin_assisted_treatment

vidarh• 14 years ago

I used to work with someone who was a responsible, successful business man who nobody suspected might use heroin until a substantial change in heroin prices left him in panic chasing money to pay for his addiction. Had the drastic price change at the time not happened, chances are nobody would have found out. In other words:

You see the ones that ends up fucking up for one reason or another. You don't see the ones that manage, so you don't know whether nobody manages to deal with it, or if lots of people do.

(the other aspect of this is that his personal ruin, while facilitated by a heroin addiction, was triggered by the legal regime surrounding heroin that made it impossible for him to get at a low, predictable price; I've gradually come to believe that outlawing most drugs is ethically indefensible)

shin_lao3• 14 years ago

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?

ZoFreX6• 14 years ago

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

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

sverige6• 14 years ago

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

Deestan2• 14 years ago

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_lao3• 14 years ago

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.

Deestan2• 14 years ago

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."

sverige6• 14 years ago

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• 14 years ago

>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?

gadders• 14 years ago

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

H - The surprising truth about heroin and addiction

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