No doubt that there’d be some injectors and smokers and snorters, but snorting wouldn’t have to remain the normative route, like it is now, and neither would smoking among lower socioeconomic classes. As it stands currently, among all who started using cocaine in 2000-2001, less than 1% injected, and 14% smoked; the rest 86% only snorted, with a small minority trying swallowing as well. Heroin injecting didn’t really pick up as a dominant method until after heroin was made completely illegal in 1929. And in modern times, as heroin purity increased, smoking became more common.
No doubt that there’d be some injectors and smokers and snorters, but snorting wouldn’t have to remain the normative route, like it is now, and neither would smoking among lower socioeconomic classes. As it stands currently, among all who started using cocaine in 2000-2001, less than 1% injected, and 14% smoked; the rest 86% only snorted, with a small minority trying swallowing as well. Heroin injecting didn’t really pick up as a dominant method until after heroin was made completely illegal in 1929. And in modern times, as heroin purity increased, smoking became more common to the point that 70% of all new heroin users from 2000-2003 claimed to have never injected it.
I’ve always heard this, but when you get right down to it, methadone withdrawal is a lot less unpleasant than withdrawal from the shorter-acting opioids. Maybe the people I’m most familiar with are atypical, since they claim not to be addicts but to be pain patients seeking cheap treatment, but generally they’ve described vaguely flulike symptoms and hot flashes/night sweats rather than the more severe symptoms associated with, say, morphine or heroin withdrawal.
It does last longer, though. So perhaps in some ways [length of symptoms] it is harder to stop.
Yes, this part is ridiculous, although since opiates in general tend to give a lot of people a “sweet tooth,” you can end up doing serious damage to your teeth if you don’t exercise a rigorous program of oral hygiene. Still, it’s not the fault of the opiates per se; anybody who doesn’t practice rigorous oral hygiene could suffer the same problems. And it’s certainly not the fault of methadone specifically.
This wasn’t true last time I checked (which, granted, was about four years ago, and it’s possible that regulations have tightened, which is idiotic, but whatever). At the clinic I did the the largest portion of my interviews at, you got one take-home a week (Sunday) right from the start. After two months you got Saturdays as well. After six months you only had to go in three times a week, nine months twice a week, and after a year once a week. After 18 months you only have to go in once every two weeks, and after two years once a month. I understand that this has been changed so that it now stops at once every two weeks.
In exchange for going in to a certain place every day, you get a safe, cheap, pure source of molecules to plug into your opiate receptors.
That’s the big problem as I see it. Not enough availability.
In my experience, buprenorphine is hated by most addicts because (they say) its antagonist properties are strong enough that you don’t really feel any different than you would going cold-turkey. A few have done it, though most of the people I know who found it useful were short-term addicts who hadn’t been using very long.
You walk to a local DEA office, and declare yourseldf an addict. You then get two options:
- receive a license to purchase a certain dose of heroin every week. this license stipulates that if you sell or transfer any of the dope you buy, you go to jail.
-2) surgery at a local hospital; you get an implant 9into the pleasure center of your brain., with a wireless control. when you want pleasure, you merely pres a button.
This ougta take care of the problem!
There is only one constant in this debate; that people will always do drugs. You can try to prohibit them but demand is far too great to have any success. I think the war on drugs is about a successful as a war on sex outside marriage would be. It’s never going to work.
The way I see there are many positives for legalizing all drugs. Given that there will always be sellers of "drugs’’, whether legal or illegal, why not have the ability to limit and regulate their consumption? Right now illegal drugs are not tested for safety, are sold to minors (drug dealers don’t care who they sell them to but a profitable company would not risk selling to minors if they had to deal with hefty fines and lawsuits) and are not taxed.
That being said, I think people are slowly waking up to this and there will be a gradual shift in public opinion that will lead to an end on the War on Drugs™. I don’t think there is anything we can do to hasten this change however.
I’ll have to look at that article; perhaps it’s the population I’m working with. Most of them have not injected - they’ve been insufflating it. Same with prescription opiates … lots of snorters out there.
It’s also interesting that heroin became popular way back when as the tax on smokable opium was increased, creating a black market and making the smuggling of high-potency heroin profitable. Depending on how you look at it, you can say that the “war on opium” created the black market for heroin.
From a symptom severity perspective, absolutely right. But the clients I’ve tried to taper (just with a methadone taper) absolutely hate it.
Try arguing that point sometime 
It’s like arguing faith with science.
But still, it’s out of your control. You have to submit to someone else telling you where to be and what to do and how to do it.
A number of my clients would also report missing the thrill of the “hustle”. If you’re going to the evil methadone clinic with the evil Dr. Slip, you’re not getting that either.
Are these people getting it legitimately prescribed or buying off the street? If you take “bupe” with a substantial habit, it can induce withdrawal or at the very least not seem effective, given its partial agonist properties.
I’ve had some real success stories with bupe. And then some others, not so much 
That’s similar to the British model, I think.
I haven’t looked up heroin for opiate maintenance (it may be in my review book in the near future). I would be curious as to how well it works, given Dole and Nyswander’s concerns that it was too short-acting and didn’t give enough stability.
That’s is a VERY bad idea. At least opiates (even injected or smoked) take a few seconds to hit the brain (and hence, the reward systems). Picture pressing a button, and having an instantaneous orgasm. As long as you like. As often as you like.
Stimulating that area of the brain (between anterior bed nuclei and the ventral tegmental area, for those anatomy buffs) is one of the most powerful rewards known. It rivals cocaine or methamphetamine for reinforcing properties.
The few studies where physicians triggered these areas in humans produced responses like orgasm or religious rapture.
Controlled trial of prescribed heroin in the treatment of opioid addiction (Spain)
Heroin-assisted treatment (Switzerland)
Central Committee on the Treatment of Heroin Addicts(Netherlands)
Patients receiving a prescription for diamorphine (heroin) in the United Kingdom (UK)
Yeah, they tell me it’s pretty miserable. On the other hand, with the patients I’ve spent the most time with (the purported pain patients) who have stopped taking methadone, it’s miserable, but not nearly as miserable. Which is actually one reason I tend to believe them when they tell me they’re not “real” addicts: they seem to have a much easier time coming off. I suspect it’s because addicts have psychological cravings and wish they could be using to cope with life and whatnot, while the pain patients are actually happy to be getting back to a normal life.
Oh, man, that’s for sure. The clinic patients I’ve spoken to are … um … well, let’s just say that as a group they have an excess of superstition and a deficiency of critical thinking.
See, I just don’t understand that kind of thinking. Surely submitting to somebody else bossing you around and not having the thrill of the hustle is more than balanced out by the fact that you no longer have to worry about getting arrested, getting HIV, getting ripped off, getting beaten up or killed, having to steal or prostitute yourself to make money for drugs, etc.
Oh, these are people in a real treatment program rather than just getting it off the street. The few people I know who’ve admitted tried it off the street (some while already methadone patients) have really hated it. Nothing like being on methadone for a few years and then kicking yourself into withdrawal with a pill.
Methadone may have a bad reputation among addicts, but its long half-life and excellent oral availability sure makes things easy as far as dosing goes.
You know, that’s what I always thought, but then I read (in my wife’s Psychology 101 book) that the depressed patients who actualy had the surgery (for obvious reasons this hasn’t been tried in may people) said that it produced a mildly pleasant feeling but nothing too great, and they didn’t have any great overriding desire for continuous stimulation. Nothing like I was lead to believe from the way the rats behave, or from reading Niven stories about tasps and wireheading and the like.
I think they must have botched the surgeries, if that’s the case; obviously there are SOME places you can stimulate to produce orgasmic feelings, or we’d never have orgasms (and I’ve heard a few stories from addicts describing “whole-body orgasms” lasting 20 minutes or more after injection of relatively large amounts of heroin mixed with cocaine). And those were the very first such surgeries. Maybe they did it again and got it right with other patients? You know, as transcranial magnetic stimulation becomes more widely available and more people start experimenting with it (heck, check out the OpenStim project, where people are attempting to create an open-hardware TMS device to experiment on themselves!) I suspect more and more people will get a chance to find out what it’s like.
And I suspect that ralph124c was saying that this should be done precisely becaue it will quickly, quietly, and painlessly remove the addict from society for good. (Although if I’m wrong about that, please correct me, ralph). Personaly, if I had to die, I’d prefer to do it with the wire in my brain going full-blast. 
The war on drugs will never end. It’s too much of a money maker… Period.
If you think anything different you are fooling yourself.
But that would still be de facto prohibition. Employers and employees do not play on a level field; consider the impact on an average large company if a person decides to quit–‘firing’ the employer so to speak–in comparison to the impact on the person if the company decides to fire him. They’re not even in the same ball park. Drug testing is a standard feature of employee life now, just like a standard 40 hour week (or whatever). Granted, in-service testing is rare and usually for cause, but I see no reason it would stay that way, especially if the statutory prohibition was repealed.
Furthermore, not everyone has a great idea for starting their own business, or the wherewhithal, so escaping the status of employee just isn’t possible for everyone.
You got that right.
(adding it to the large pile of board review stuff) 
Thanks!
That’s the difference between physical dependence and “addiction”. It’s unfortunate that DSM-IV codes it in such a confusing way.
Can a pain patient be physically dependent on opiates? Most certainly. What’s missing (and where they’re not using the products in a compulsive, out of control fashion - AKA “addictively”) are all the environmental cues and triggers to relapse. It’s a pretty reasonable way to to think about it, there, IMHO
That’s more of that critical thinking that is wanting in this population; the cravings (and subsequent drive to use) can easily trump them.
They have taken rats, trained them to self-administer drugs by running across a grid and pressing a level, and then electrified the grid. They still run across and endure the shocks to get to their drug.
Transitioning from methadone to buprenorphine is difficult. I’ve done it a few times for clients. They’re generally not happy campers for a few days.
Since methadone hangs around for so long, the dose has to be tapered (to 30mg or less), then has to be stopped for at least 72 hours before starting bupe. It’s not an easy transition; the two times I’ve done it in recent memory, both clients got pretty “dope sick”.
I wonder if they got the electrodes in the right place. In the “Big Red Book” (the ASAM “Principles of Addiction Medicine”) and in a recent lecture, he says it’s much stronger than a mildly pleasant feeling. It’s a very specific myelinated tract - I wonder if the surgeons were merely stimulating other parts of the reward pathway?
Heaven help us all if it can effectively get there. Although at least, once you have all the hardware and figure out placement, you wouldn’t need to do anything else except buy batteries or make sure to pay the electric bill 