# Should Heroin Addicts Be Given Heroin? **URL:** \ **Category:** Great Debates\ **Created:** [November 28, 2012, 9:29am UTC](https://boards.straightdope.com/t/should-heroin-addicts-be-given-heroin/642359 "2012-11-28T09:29:52Z")\ **Posts on this page:** 20\ **Page:** 3
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [November 29, 2012, 8:25pm UTC](https://boards.straightdope.com/t/should-heroin-addicts-be-given-heroin/642359/41 "2012-11-29T20:25:57Z")
This was methadone for pain, or to manage opiate addiction? Or are they the same thing in this case - “pain” meaning the symptoms of withdrawal. Maybe I will do a search on your posts and try to bring my education about the topic up from 1970. Regards, Shodan ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [November 29, 2012, 8:40pm UTC](https://boards.straightdope.com/t/should-heroin-addicts-be-given-heroin/642359/42 "2012-11-29T20:40:09Z")
> [@Shodan](#): > > This was methadone for pain, or to manage opiate addiction? Technically it was to maintain an addiction. I’ve seen doses that high used for pain management too. And a lot of addicts enrolled in methadone maintenance programs for addiction insist they’re on the drug for pain, not for addiction. It can be difficult to sort out each case. ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [November 29, 2012, 9:00pm UTC](https://boards.straightdope.com/t/should-heroin-addicts-be-given-heroin/642359/43 "2012-11-29T21:00:24Z")
Thank you for the information. Regards, Shodan ---
**Author:** ![Stoneburg](https://avatars.discourse-cdn.com/v4/letter/s/df705f/32.png) [@Stoneburg](https://boards.straightdope.com/u/Stoneburg)\ **Post date:** [November 29, 2012, 9:15pm UTC](https://boards.straightdope.com/t/should-heroin-addicts-be-given-heroin/642359/44 "2012-11-29T21:15:27Z")
> [@James52637](#): > > I feel for what your saying, but what you seem to be supporting only works in theory and in a country with a small population. I’m not sure it’d work in USA. How do you come to the conclusion that it only works in theory, when the theory is based on experiece and research? And how does the population size of the administrative area effect it? I’m sorry, but your statements make no sense. Please clarify them. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [November 30, 2012, 4:08am UTC](https://boards.straightdope.com/t/should-heroin-addicts-be-given-heroin/642359/45 "2012-11-30T04:08:25Z")
> [@Qadgop\_the\_Mercotan](#): > > Even recently, I’ve had patients come in to see me on 120 mg of methadone a day for maintenance. Some clinics interpret the slightest craving as an indication of the need to bump the dose up. > > This is not an unusual approach to methadone maintenance. ☹ > [@Shodan](#): > > I assume 120 mg a day is a lot. Yes, it is. If I recall, for the unhabituated non-addict 70 mg could kill. Obviously, one can build up a tolerance to such a dose. When I was at the clinic they usually tried to keep people between 45-70 mg to start. Of course, there were exceptions - we had a couple people with daily doses in the triple digits. We also had some people we started their maintenance as low as 15-20 mg. Then again, we had an MD on staff who actually gave a damn about his job rather than just medicating people into docility, which can happen at some clinics. It’s more work to actually try to customize the dose to each addict. For the overworked, underpaid, disrespected addictions specialist working a chronically underfunded clinic, well, the temptation to cookie-cutter medicine is probably pretty strong. > [@Qadgop\_the\_Mercotan](#): > > Could kill a horse with it. A clydesdale. > > I’ve even seen one guy come in on 200 mg a day. > > Most science indicates that doses over 60 a day don’t give better pain relief than lower doses, and also raise the risk of dying by about a grillion percent. Folks on the higher doses just about need a dynamite charge to poo, too. ---
**Author:** ![Ambivalid](https://avatars.discourse-cdn.com/v4/letter/a/a5b964/32.png) [@Ambivalid](https://boards.straightdope.com/u/Ambivalid)\ **Post date:** [November 30, 2012, 5:01am UTC](https://boards.straightdope.com/t/should-heroin-addicts-be-given-heroin/642359/46 "2012-11-30T05:01:04Z")
> [@Qadgop\_the\_Mercotan](#): > > Technically it was to maintain an addiction. > > I’ve seen doses that high used for pain management too. > > And a lot of addicts enrolled in methadone maintenance programs for addiction insist they’re on the drug for pain, not for addiction. > > It can be difficult to sort out each case. How common are cases where pain patients being treated with methadone long term end up developing addictions? ---
**Author:** ![Speaker\_for\_the\_Dead](https://avatars.discourse-cdn.com/v4/letter/s/c77e96/32.png) [@Speaker\_for\_the\_Dead](https://boards.straightdope.com/u/Speaker_for_the_Dead)\ **Post date:** [November 30, 2012, 12:15pm UTC](https://boards.straightdope.com/t/should-heroin-addicts-be-given-heroin/642359/47 "2012-11-30T12:15:03Z")
> [@Ambivalid](#): > > How common are cases where pain patients being treated with methadone long term end up developing addictions? I can’t answer for him, but I do want to distinguish physical dependence (signs of physical withdrawal with cessation of therapy), which happens to every chronic pain patient, and “addiction,” which refers to the maladaptive pattern of behaviour associated with using a drug for recreational purposes. There is also “pseudoaddiction” in which patients with chronically under treated pain act like drug-seekers because they need better symptom management. ---
**Author:** ![Ambivalid](https://avatars.discourse-cdn.com/v4/letter/a/a5b964/32.png) [@Ambivalid](https://boards.straightdope.com/u/Ambivalid)\ **Post date:** [November 30, 2012, 1:37pm UTC](https://boards.straightdope.com/t/should-heroin-addicts-be-given-heroin/642359/48 "2012-11-30T13:37:28Z")
> [@Speaker\_for\_the\_Dead](#): > > I can’t answer for him, but I do want to distinguish physical dependence (signs of physical withdrawal with cessation of therapy), which happens to every chronic pain patient, and “addiction,” which refers to the maladaptive pattern of behaviour associated with using a drug for recreational purposes. There is also “pseudoaddiction” in which patients with chronically under treated pain act like drug-seekers because they need better symptom management. Yes, I was referring to these maladaptive patterns of behavior arising/developing as a result of legitimate long-term treatment for pain. I wouldn’t guess this is _too_ common but is it seen? ---
**Author:** ![Gary\_Kumquat](https://avatars.discourse-cdn.com/v4/letter/g/4491bb/32.png) [@Gary\_Kumquat](https://boards.straightdope.com/u/Gary_Kumquat)\ **Post date:** [November 30, 2012, 2:16pm UTC](https://boards.straightdope.com/t/should-heroin-addicts-be-given-heroin/642359/49 "2012-11-30T14:16:09Z")
> [@Stoneburg](#): > > Frankly I think that it would be a boon for society if there were NO drugs in the “illegal” category, although this may seem counter intuitive. There are some very convincing arguments against prohibition policies and a plethora of research that shows it not only to be ineffective, but actively counter productive. Basically the policies increase the very problem they are supposed to solve. Prohibition seem to increase both consumption and damage. Totally agree with you. A question for those of you who support TWOD: can you please give a rough idea how many decades & billions we let this run on for before we try a new tact? I mean, in 2019 we’ll have the centenary of the US Supreme Court ruling banning the prescription of maintenance narcotics to addicts. Is 100 years enough for us to reach the conclusion that prohibition isn’t working? ---
**Author:** ![ralph124c](https://avatars.discourse-cdn.com/v4/letter/r/8797f3/32.png) [@ralph124c](https://boards.straightdope.com/u/ralph124c)\ **Post date:** [November 30, 2012, 2:37pm UTC](https://boards.straightdope.com/t/should-heroin-addicts-be-given-heroin/642359/50 "2012-11-30T14:37:43Z")
How about fitting addicts with insulin-pump like devices 9that b dispense pharmaceutical grade heroin)? This would keep the addicts happy, end the market for illegal heroin, and save billions. Naw…can’t have that-it would put too many lawyers, judges, prison gurads, etc. out of work! ---
**Author:** ![LinusK](https://avatars.discourse-cdn.com/v4/letter/l/258eb7/32.png) [@LinusK](https://boards.straightdope.com/u/LinusK)\ **Post date:** [November 30, 2012, 5:26pm UTC](https://boards.straightdope.com/t/should-heroin-addicts-be-given-heroin/642359/51 "2012-11-30T17:26:01Z")
> [@Stoneburg](#): > > It is actually a bit funny how almost everyone assumes a lot of people will start using it if it is legalised, yet when you ask someone if they would… they wouldn’t. Yep. And everybody washes their hands when they go to the bathroom. [Illusory Superiority](http://www.brandumbxd.site40.net) ---
**Author:** ![Stoneburg](https://avatars.discourse-cdn.com/v4/letter/s/df705f/32.png) [@Stoneburg](https://boards.straightdope.com/u/Stoneburg)\ **Post date:** [December 5, 2012, 1:10pm UTC](https://boards.straightdope.com/t/should-heroin-addicts-be-given-heroin/642359/52 "2012-12-05T13:10:00Z")
Ah. So in reality, if it was possible to procure heroin without risking legal penalties, most or a lot of people would actually jump at the chance to try a drug that is well known to be incredibly addictive with no other incentive than it being possible to do so? I don’t think so. And since heroin has been legal it as actually possible to make comparisons. When we do, we find out that whe heroin is criminalised, consumption and abuse increases dramatically. Before criminalisation, England had a few hundred heroin addicts, a few decades after criminalisation, the they are counted in hundreds of thousands. Out of all policies that has been enacted in modern times, the prohibition on recreational drugs must be the most counter productive. And the fact that it is still largely unquestioned despite the massive scientific evidence that discredits it really goes to show that we have ways to go before we can call ourselves rational as a society. ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [December 5, 2012, 2:28pm UTC](https://boards.straightdope.com/t/should-heroin-addicts-be-given-heroin/642359/53 "2012-12-05T14:28:34Z")
> [@Stoneburg](#): > > Ah. So in reality, if it was possible to procure heroin without risking legal penalties, most or a lot of people would actually jump at the chance to try a drug that is well known to be incredibly addictive with no other incentive than it being possible to do so? I don’t know about “most” or “a lot”, but “more than now” seems pretty likely. For much the same set of reasons that people nowadays start smoking cigarettes rather than using heroin - cigarettes are legal, and therefore much more available. This despite the fact that cigarettes are at least as addictive, and probably worse for you, than heroin. Regards, Shodan ---
**Author:** ![ladyfoxfyre](https://avatars.discourse-cdn.com/v4/letter/l/ad7895/32.png) [@ladyfoxfyre](https://boards.straightdope.com/u/ladyfoxfyre)\ **Post date:** [December 5, 2012, 2:39pm UTC](https://boards.straightdope.com/t/should-heroin-addicts-be-given-heroin/642359/54 "2012-12-05T14:39:02Z")
Do you have any evidence that incidence of use would go up following decriminalization? Because the evidence seems to point in [the other direction](http://www.time.com/time/health/article/0,8599,1893946,00.html). > [@](#): > > The Cato paper reports that between 2001 and 2006 in Portugal, rates of lifetime use of any illegal drug among seventh through ninth graders fell from 14.1% to 10.6%; drug use in older teens also declined. Lifetime heroin use among 16-to-18-year-olds fell from 2.5% to 1.8% (although there was a slight increase in marijuana use in that age group). I don’t think people smoke cigarettes because they’re more accessible than heroin. ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [December 5, 2012, 4:03pm UTC](https://boards.straightdope.com/t/should-heroin-addicts-be-given-heroin/642359/55 "2012-12-05T16:03:52Z")
> [@ladyfoxfyre](#): > > Do you have any evidence that incidence of use would go up following decriminalization? Because the evidence seems to point in [the other direction](http://www.time.com/time/health/article/0,8599,1893946,00.html). It is not necessarily clear cut. From your cite - > [@](#): > > Portugal is a small country and that the cyclical nature of drug epidemics — which tends to occur no matter what policies are in place — may account for the declines in heroin use and deaths. > [@](#): > > Consider the Dutch experiment with commercialized marijuana: after “coffee shops” were widely promoted in the Netherlands, the rate of regular marijuana use among 18-to-20-year-olds more than doubled. [Cite.](http://www.americasquarterly.org/node/1915) And other researchers have noted a roughly comparable drop in heroin use without decriminalization - > [@](#): > > The annual prevalence of heroin use among 12th graders fell by half between 1975 and 1979, from 1.0% to 0.5%. [cite (pdf)](http://monitoringthefuture.org/pubs/monographs/overview2009.pdf). > [@](#): > > I don’t think people smoke cigarettes because they’re more accessible than heroin. Maybe I was not expressing myself clearly. People will tend to use (and abuse) drugs more if those drugs are available easily. Therefore more people use alcohol than heroin, because there are lots of liquor stores and relatively few heroin dealers. Obviously there are many other factors involved. Regards, Shodan ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [December 5, 2012, 4:43pm UTC](https://boards.straightdope.com/t/should-heroin-addicts-be-given-heroin/642359/56 "2012-12-05T16:43:29Z")
Making heroin available to opioid addicts doesn’t mean making it available in general. Instead, a medical history and exam to determine if the patient qualifies, along with the need to register as an opioid addict who is to be maintained on heroin can be requirements to get the drug. Granted, this would provide another route for diversion of heroin to the general population, but it’s not the same as selling it alongside the cigarettes and booze at the local convenience store. ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [December 5, 2012, 5:25pm UTC](https://boards.straightdope.com/t/should-heroin-addicts-be-given-heroin/642359/57 "2012-12-05T17:25:14Z")
True, but I was responding to this - > [@](#): > > if it was possible to procure heroin without risking legal penalties, most or a lot of people would actually jump at the chance to try a drug that is well known to be incredibly addictive with no other incentive than it being possible to do so? I assume from the reference to “trying” the drug rather than already being addicted to it, meant that the suggestion was to remove the “prohibition on recreational drugs”. Regards, Shodan ---
**Author:** ![Stoneburg](https://avatars.discourse-cdn.com/v4/letter/s/df705f/32.png) [@Stoneburg](https://boards.straightdope.com/u/Stoneburg)\ **Post date:** [December 6, 2012, 1:53am UTC](https://boards.straightdope.com/t/should-heroin-addicts-be-given-heroin/642359/58 "2012-12-06T01:53:16Z")
What does Portugals or any other nations SIZE has to do with anything. Really, I do not understand it. If the administrative area of Portugal incorporated more cities, say a few spanish ones, would the basic biological functions or economical incentives suddenly change? I have to say that bringing up the size of the nation is just incredibly weird. Portugal had massive drug problems and decided to enact a radical reform to counter it. The result was exactly what they had hoped for. And the argument against that is now that “Well hey, it could have happened anyway”. After criminalisation the amount of heroin addicts in England went from hundreds to hundreds of thousand, but I guess “Hey, it could have happened anyway”. It is true that marijuana consumption has gone up (slightly) when it’s been decriminalised, which could be viewed as a success since it means that people switch from more dangerous drugs to one that has pretty much zero negative health effects. Basically people are making rational decisions when given the opportunity. I don’t understand why this is so hard to grasp. Prohibition is a massive and dangerous failure. It creates a huge financial incentive to recruit and supply customers. Enforcing it uses up resources that could be spent on treatment and information. OF COURSE more people will end up using drugs if every addict has an incentive to recruit more users. And OF COURSE the usage will be more dangerous if people are ostracised and treated as criminals instead of getting care. Not to mention that the drugs themself will be more dangerous when the production and supply is devoid of any regulation. > [@Shodan](#): > > True, but I was responding to this - I assume from the reference to “trying” the drug rather than already being addicted to it, meant that the suggestion was to remove the “prohibition on recreational drugs”. > > Regards, > Shodan It’s rather silly to assume that I would propose making them easily available, since that would make no sense AND I have already stated the opposite in this thread: > [@Stoneburg](#): > > I’m not sure why people imagine that the regulation of supply would be so troublesome. There are both medical and recreational drugs that are regulated today in different ways, so why assume that you have to invent a completely new system? > > I guess you could divide drugs into five categories: > > -Legal recreational drugs with no restrictions (like caffeine, or khat in some places) > -Legal recreational drugs with restrictions (alcohol and tobacco, cannabis in some places) > -Medical non-prescription drugs (like asprin) > -Medical prescription drugs (like morfine) > -Illegal drugs (like heroin) > > Now if you want to legalise a drug that is currently illegal, you ust move it from that category to another. In the case of heroin I suppose either “medical prescription drug” or "recreational drug with restrictions"are the valid options, and I’d say the latter is the obvious choice for heroin. I’d really suggest taking 5 minutes to read this link: [What's wrong with the war against drugs | Flat Earth News](http://www.flatearthnews.net/footnotes-book/page-28-heroin/whats-wrong-war-against-drugs) ---
**Author:** ![Typo\_Negative](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/typo_negative/32/484_2.png) [@Typo\_Negative](https://boards.straightdope.com/u/Typo_Negative)\ **Post date:** [December 6, 2012, 2:50am UTC](https://boards.straightdope.com/t/should-heroin-addicts-be-given-heroin/642359/59 "2012-12-06T02:50:19Z")
> [@Shodan](#): > > People will tend to use (and abuse) drugs more if those drugs are available easily. Therefore more people use alcohol than heroin, because there are lots of liquor stores and relatively few heroin dealers. > > Obviously there are many other factors involved. > > Regards, > Shodan I disagree with the first point. I agree that other factors play into it. the fact is that almost all drugs are readily available, just not that convenient. _Some_ people may be dissuaded from trying it because they fear legal consequences. I just don’t think that (legality) is a factor when a person decides to take a drug. Some people who only drink also end up committing acts that are illegal, dangerous and often deadly. They choose to obey one law and ignore others. So is it the _legality_ that restricts them to only booze, or just _personal preference_? Also remember that are still counties in the USofA where booze is still illegal, and they have a bootlegging problem in pretty much all of them. The fact that it is illegal there doesn’t seem to stop them from using any more than it did during prohibition. (Dry Counties. Good Lord, WHY??) ---
**Author:** ![user\_hostile](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/user_hostile/32/474_2.png) [@user\_hostile](https://boards.straightdope.com/u/user_hostile)\ **Post date:** [December 6, 2012, 7:56am UTC](https://boards.straightdope.com/t/should-heroin-addicts-be-given-heroin/642359/60 "2012-12-06T07:56:50Z")
> [@Typo\_Negative](#): > > I disagree with the first point. I agree that other factors play into it. the fact is that almost all drugs are readily available, just not that convenient. _Some_ people may be dissuaded from trying it because they fear legal consequences. I just don’t think that (legality) is a factor when a person decides to take a drug. Some people who only drink also end up committing acts that are illegal, dangerous and often deadly. They choose to obey one law and ignore others. So is it the _legality_ that restricts them to only booze, or just _personal preference_? > > Also remember that are still counties in the USofA where booze is still illegal, and they have a bootlegging problem in pretty much all of them. The fact that it is illegal there doesn’t seem to stop them from using any more than it did during prohibition. (Dry Counties. Good Lord, WHY??) What counties? When a county goes dry, it means you can’t sell alcohol at the retail level. Which means your outta luck if you want to open a bar or run down to the Quik-E Mart. But you can certainly buy booze in wetter areas, bring it home, and imbibe to your liver’s contempt. ETA – Moonshine is about making money, and skipping out on paying taxes; it’s been around longer than the Republic has been around. [Previous page](https://boards.straightdope.com/t/should-heroin-addicts-be-given-heroin/642359.md?page=2) [Next page](https://boards.straightdope.com/t/should-heroin-addicts-be-given-heroin/642359.md?page=4)