# What should we be doing about the heroin crisis? **URL:** \ **Category:** Great Debates\ **Created:** [September 11, 2017, 7:55pm UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079 "2017-09-11T19:55:18Z")\ **Posts on this page:** 20\ **Page:** 5
**Author:** ![MichaelEmouse](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/michaelemouse/32/101_2.png) [@MichaelEmouse](https://boards.straightdope.com/u/MichaelEmouse)\ **Post date:** [September 13, 2017, 4:55pm UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/81 "2017-09-13T16:55:56Z")
What makes the first six months dangerous? I can see why the first few times the releasee takes heroin would be particularly dangerous because their tolerance has (presumably) gone down in prison and the safety ratio for heroin is 6\*. But several months after release, hasn’t their tolerance gone back to their pre-prison levels? I realize that there can be significant variance in this but how many doses does it take before someone requires several times more heroin to get the same effect? Or does the increased OD risk come from something else than releasee taking the amount of heroin they’re used to even though their tolerance is lower? Qadgop must have seen plenty of people undergo withdrawal, some of whom must have stayed off heroin and others not. Any insights into what affects the success rate? For those who specifically seek out Fentanyl, can it be taken sublingually on tabs of a few hundred mcg? That would seem safer than injecting it because a small tab is unlikely to vary as much in its content as an injectable solution of tens of milliliters. \*[Safety Ratio and Dependence Potential of Psychoactive Drugs](http://politicsofsin.50megs.com/risk/Safety.Ratio-Dependence.Potential-Psychoactive.Drugs.html) ---
**Author:** ![griffin1977](https://avatars.discourse-cdn.com/v4/letter/g/977dab/32.png) [@griffin1977](https://boards.straightdope.com/u/griffin1977)\ **Post date:** [September 13, 2017, 5:13pm UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/82 "2017-09-13T17:13:11Z")
> [@Richard\_Parker](#): > > One theory I’ve seen floating around goes like this: > > There is no effective intervention for opiate addiction. Some people will recover. Some will not. We can throw a ton of money at the problem, but only move the–ahem-- needle a little. > > Moreover, the addiction crisis is largely a consequence of prescribing practices and pill mills that are already on the way out. So we can expect heroin use rates to return to their 1995 levels once the current generation of addicts dies or makes it out. > > What we can do is make sure fewer people OD or get Hep C. That means opening up safe injection sites that, among other things, will test for Fentanyl and the like (or at least tell you how powerful the dose is going to be, since Fentanyl is what some people are now looking for). It means equipping all of our first responders with narcan. It means making sure that when people are released from prison they have access to drugs and treatment through that very dangerous first six months when a ton of releasees OD. > > In this view, the proper response to the crisis is basically managing the death rather than the addiction and hoping to ride out the wave of addiction, assuming that we will eventually return to people who become addicted because they decide to try heroin recreationally which will be a much lower number than the people who move to heroin from pills. > > I don’t think I agree with that vision, but I see it becoming the conventional wisdom in some parts. I’m curious to hear what people who have thought about this more think. I agree with all of that except the best response to that conclusion. It is absolutely true that most heroin addicts will not respond to treatment, that is a simple fact. There are ways that we can improve the efficacy of treatment a little (offering better treatment as part of the criminal justice system, and encouraging treatment based on drugs that treat the physical effects addiction) but the fact is there is a huge number of addicts who are going get opiates. As a society we can choose to let an immense destructive criminal network profit from supplying those opiates (and require the addicts to commit crimes to fund it) or we can do away with all the appalling things that flow from that by letting doctors prescribe opiates to opiate addicts. To me it is a no brainer. Saying “oh we are going to have a lot of addicts there is nothing we can do” but still forcing those addicts to commit crime to fund their habit is nonsensical for everyone involved. ---
**Author:** ![LSLGuy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lslguy/32/5813_2.png) [@LSLGuy](https://boards.straightdope.com/u/LSLGuy)\ **Post date:** [September 13, 2017, 5:48pm UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/83 "2017-09-13T17:48:22Z")
> [@MichaelEmouse](#): > > What makes the first six months dangerous? … I \*think \* it’s not about the risk of OD directly. I \*think \* the point is that somebody getting out of prison will either successfully reintegrate into society or will turn back to crime and perhaps addiction within the first 6 months. So that’s the time to ensure we give maximum support towards going straight in all meanings of the term. IOW, after 6 months most ex-prisoners are settled on their chosen path, whichever it might be. Further intensive support after that time is mostly wasted (or at least unaffordable given current politics) effort. If somebody \*is \*diving right back into the heroin morass, 6 months is long enough to be pretty statistically sure they’ll have ODed at least once. Perhaps for their very last time. ---
**Author:** ![MichaelEmouse](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/michaelemouse/32/101_2.png) [@MichaelEmouse](https://boards.straightdope.com/u/MichaelEmouse)\ **Post date:** [September 13, 2017, 5:55pm UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/84 "2017-09-13T17:55:09Z")
Ah, ok. I thought about it in OD terms because Parker’s comment reminded me of a poster who used to come here; The poster’s sister was a heroin user who went to prison for a few months. About 3 months after her release, she had a fatal OD. ---
**Author:** ![Richard\_Parker](https://avatars.discourse-cdn.com/v4/letter/r/35a633/32.png) [@Richard\_Parker](https://boards.straightdope.com/u/Richard_Parker)\ **Post date:** [September 13, 2017, 6:37pm UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/85 "2017-09-13T18:37:18Z")
> [@MichaelEmouse](#): > > What makes the first six months dangerous? I meant to refer to the problem of people who had lost their tolerance taking a dose that is too high, a problem made more frequent by how hard it is to reintegrate and stabilize after prison. 6 months was just an arbitrary time period. The point is the danger zone upon release from a place where you probably detoxed and/or got treatment to some extent. > [@griffin1977](#): > > …or we can do away with all the appalling things that flow from that by letting doctors prescribe opiates to opiate addicts. I agree. Having doctors prescribe opiates to someone they have diagnosed with opiate addiction makes sense to me, and avoid some of the problems of decriminalization or legalization. But, I think you are still likely to encounter two big problems with that approach: (1) doctors unwillingness to prescribe because of the liability, regardless of what immunities are put into place for them; and (2) it is almost always going to be cheaper and easier to score heroin on the street. Not sure how you solve those. ---
**Author:** ![griffin1977](https://avatars.discourse-cdn.com/v4/letter/g/977dab/32.png) [@griffin1977](https://boards.straightdope.com/u/griffin1977)\ **Post date:** [September 13, 2017, 6:59pm UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/86 "2017-09-13T18:59:40Z")
> [@Richard\_Parker](#): > > But, I think you are still likely to encounter two big problems with that approach: (1) doctors unwillingness to prescribe because of the liability, regardless of what immunities are put into place for them; and (2) it is almost always going to be cheaper and easier to score heroin on the street. Not sure how you solve those. I don’t think (1) will be a problem. Given the lengths addicts go to find opiates, even if a lot of doctors refuse, finding the doctors that do won’t be a problem. (2) should really not be an issue either. According to all the laws of economics it should be far far cheaper to produce generic diamorphine by legal means than to illegally smuggle illicit opiates across the border and pay the enormous mark up the illegal drug trade imposes. The fact this is not the always case is symptom of how messed up the US healthcare system is, and I assume only a problem with brand name opiates that are still under patent (the current epidemic was caused by drug companies aggessively marketing new types of opiates, which they would only do if they had a patent). ---
**Author:** ![Richard\_Parker](https://avatars.discourse-cdn.com/v4/letter/r/35a633/32.png) [@Richard\_Parker](https://boards.straightdope.com/u/Richard_Parker)\ **Post date:** [September 13, 2017, 7:14pm UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/87 "2017-09-13T19:14:41Z")
> [@griffin1977](#): > > According to all the laws of economics it should be far far cheaper to produce generic diamorphine by legal means than to illegally smuggle illicit opiates across the border and pay the enormous mark up the illegal drug trade imposes. The fact this is not the always case is symptom of how messed up the US healthcare system is, and I assume only a problem with brand name opiates that are still under patent (the current epidemic was caused by drug companies aggessively marketing new types of opiates, which they would only do if they had a patent). I don’t think that’s quite right. The costs of legalized opiates include the doctor’s time, the overheard of the doctor’s practice, the cost and difficulty of getting oneself to the office, the cost of complying with FDA rules, the cost of paying people in the US to manufacture the medicine under US labor laws, etc. So while the black market imposes its own significant costs, it is not a given that those costs will be higher than the costs for even generic drugs. And, IME, for someone whose life is disordered like that of many addicts, making and keeping a doctor’s appointment is just as hard as coming up with the money. If it cost $5 to go to the Doctor and $10 to go to the corner, a lot of them are still going to go to the corner. On top of that, some percentage of drug trade involves goods and, uh, services, instead of cash. (I am assuming a scheme in which you have to go for appointments regularly. I guess you could have a long-term script, but I have not seen it described that way. That would seem to have a different set of issues) ---
**Author:** ![MichaelEmouse](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/michaelemouse/32/101_2.png) [@MichaelEmouse](https://boards.straightdope.com/u/MichaelEmouse)\ **Post date:** [September 13, 2017, 9:39pm UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/88 "2017-09-13T21:39:05Z")
> [@griffin1977](#): > > As a society we can choose to let an immense destructive criminal network profit from supplying those opiates (and require the addicts to commit crimes to fund it) or we can do away with all the appalling things that flow from that by letting doctors prescribe opiates to opiate addicts. How much leeway do physicians have when it comes to prescribing things off label? Because the effects of withdrawal and the risks of contaminants are arguably medical problems. So, how much can a physician say: “I prescribed opiates because I thought that was the best solution to this person’s problems even though it’s not a standard use of opiates”? Can they not already do that with methadone? What’s methadone like compared to heroin? Also, does Fentanyl feel different from other opiates or is potency the only reason some users seek it out? I suppose I could find out by trying heroin, methadone and Fentanyl and then comparing them but I’m not quite curious enough. ---
**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:** [September 13, 2017, 10:29pm UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/89 "2017-09-13T22:29:10Z")
> [@MichaelEmouse](#): > > How much leeway do physicians have when it comes to prescribing things off label? Because the effects of withdrawal and the risks of contaminants are arguably medical problems. So, how much can a physician say: “I prescribed opiates because I thought that was the best solution to this person’s problems even though it’s not a standard use of opiates”? We have plenty of leeway. Something like 60% of all prescriptions are for off-label use. It’s widely accepted that off label prescribing is beneficial, as a whole. > [@](#): > > Can they not already do that with methadone? What’s methadone like compared to heroin? > > Also, does Fentanyl feel different from other opiates or is potency the only reason some users seek it out? > > I suppose I could find out by trying heroin, methadone and Fentanyl and then comparing them but I’m not quite curious enough. Every user will have a different opinion as to how different opioids make them feel. But they all seek the euphoria delivered to them by the typical opioid. Opioids with a stronger affinity for the mu opioid receptor generally also give more euphoria than ones with less affinity for it. Short-acting opioids like oxycodone, dilaudid, heroin and fentanyl generally deliver more euphoria than longer-acting ones like methadone, even though they all bind tightly to the mu receptor. There are also kappa and delta opioid receptors; opioids which bind strongly to kappa receptors tend to cause dysphoria rather then euphoria. Heroin has less kappa receptor activation so less dysphoria than morphine. And then add the delta receptor, and well, it gets complicated. Really complicated. And each person’s response is different. ---
**Author:** ![griffin1977](https://avatars.discourse-cdn.com/v4/letter/g/977dab/32.png) [@griffin1977](https://boards.straightdope.com/u/griffin1977)\ **Post date:** [September 13, 2017, 10:38pm UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/90 "2017-09-13T22:38:03Z")
> [@MichaelEmouse](#): > > How much leeway do physicians have when it comes to prescribing things off label? Because the effects of withdrawal and the risks of contaminants are arguably medical problems. So, how much can a physician say: “I prescribed opiates because I thought that was the best solution to this person’s problems even though it’s not a standard use of opiates”? > > Can they not already do that with methadone? What’s methadone like compared to heroin? > > Also, does Fentanyl feel different from other opiates or is potency the only reason some users seek it out? > > I suppose I could find out by trying heroin, methadone and Fentanyl and then comparing them but I’m not quite curious enough. At the moment they cannot do that doctors face very strict restrictions, and criminal liability. This even applies to drugs that treat addiction. The restrictions are so onerous than it means buprenorphine a more effective treatment than methadone is actual very hard for addicts who want to recover to get hold of (in many cases it is easier for them get it on the black market!) ---
**Author:** ![septimus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/septimus/32/410_2.png) [@septimus](https://boards.straightdope.com/u/septimus)\ **Post date:** [September 13, 2017, 11:19pm UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/91 "2017-09-13T23:19:16Z")
Decades ago I thought of heroin as mostly an urban problem. Is that correct? Has there been a big shift due to legal painkillers? > [@asahi](#): > > A lot of addiction begins with underlying psychological causes, like depression or emotional distress. I think what’s at the heart of the opioid crisis is a psychosocial crisis. We as Americans like to pretend that we’re happy, but I think the reality is that a lot of people in this society are just mentally broke. The American ‘nuclear family’ model has been a complete and total failure. It was an ideal that was driven mostly by corporate and capitalist ideals – more smaller families means more households and household spending to prop up the big banks and corporate America, which keeps sucking the heart and soul out of this country. We as a society ought to just learn how to appreciate our interconnectedness with others, have more family living closer together, and just enjoy doing more with less. In other words, less capitalist and more socialist. Look at [the graphic half-way down this page](https://www.vox.com/science-and-health/2017/3/23/14987892/opioid-heroin-epidemic-charts) which assigns U.S. states to quartiles based on number of painkiller prescriptions. I was intrigued to notice that 13 out of 13 states in the top quartile voted (R) in the last Presidential election. States with the strongest (D) vote almost all rank low in prescription; this includes Vermont and Massachusetts (despite that “New England” is called a problem area). The only three (R) states in the bottom quartile are Wyoming, South Dakota, and Alaska. What’s the cause-effect relationship here? Is it just urban vs rural/suburb? ---
**Author:** ![griffin1977](https://avatars.discourse-cdn.com/v4/letter/g/977dab/32.png) [@griffin1977](https://boards.straightdope.com/u/griffin1977)\ **Post date:** [September 13, 2017, 11:51pm UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/92 "2017-09-13T23:51:12Z")
> [@septimus](#): > > Decades ago I thought of heroin as mostly an urban problem. Is that correct? Has there been a big shift due to legal painkillers? > Look at [the graphic half-way down this page](https://www.vox.com/science-and-health/2017/3/23/14987892/opioid-heroin-epidemic-charts) which assigns U.S. states to quartiles based on number of painkiller prescriptions. I was intrigued to notice that 13 out of 13 states in the top quartile voted (R) in the last Presidential election. States with the strongest (D) vote almost all rank low in prescription; this includes Vermont and Massachusetts (despite that “New England” is called a problem area). The only three (R) states in the bottom quartile are Wyoming, South Dakota, and Alaska. > > What’s the cause-effect relationship here? Is it just urban vs rural/suburb? The current epidemic was caused by long term prescriptions for chronic pain. Those areas have a large blue collar population, which means manual labor, which means lots of chronic pain (back, joint, etc.). ---
**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:** [September 13, 2017, 11:57pm UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/93 "2017-09-13T23:57:08Z")
> [@griffin1977](#): > > At the moment they cannot do that doctors face very strict restrictions, and criminal liability. This even applies to drugs that treat addiction. As I noted above, yes we can prescribe off-label. And despite all the statements made by many people, including doctors, about how the authorities won’t _let_ them prescribe opioids the way they used to, it’s really **not** the case. Guidelines have changed, recommendations have changed, and more physicians are finding themselves subject to review of their opioid prescribing habits, but us docs still can prescribe opioids, even in large amounts, if we think that’s best. Our documentation about the patient’s conditions and our findings and reasonings had best be damn complete. But if it is, we docs **can** prescribe opioids and not get into trouble with regulatory authorities. Some group practice have decided that they want to limit how the docs within the practice prescribe opioids, and not following those rules may jeopardize their jobs at that group. But their licenses and DEA numbers won’t be in jeoparty. > [@](#): > > The restrictions are so onerous than it means buprenorphine a more effective treatment than methadone is actual very hard for addicts who want to recover to get hold of (in many cases it is easier for them get it on the black market!) The restrictions HAVE NOT changed for the worse. Buprenorphine, if prescribed to maintain an opioid addiction, has _always_ required special training (a total of 8 hours in a classroom or studying online material on how to safely prescribe it). The only thing different about buprenorphine regulations is that they’ve been loosened to allow a licensed prescriber of it (I am one) to prescribe it for _more_ patients than were previously permitted. Buprenorphine certification is much easier to get and maintain than certification to prescribe methadone for opioid maintenance. That takes a ton of paperwork and review and oversight. But that is nothing new. And frankly, both buprenorphine and methadone maintenance treatment are analogous to crutches. Some people do legitimately need them, and benefit greatly from their use for a time. And most people should get off of then after the need for them has passed. At a recent medical conference on addictive disease I attended, a presenter discussed that it was only about 4-6% of opioid addicts that truly needed to stay on such drugs for life, to reduce risk of relapsing to heroin. The rest can eventually transition off. ---
**Author:** ![Tamerlane](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/tamerlane/32/7602_2.png) [@Tamerlane](https://boards.straightdope.com/u/Tamerlane)\ **Post date:** [September 14, 2017, 12:18am UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/94 "2017-09-14T00:18:37Z")
> [@Qadgop\_the\_Mercotan](#): > > At a recent medical conference on addictive disease I attended, a presenter discussed that it was only about 4-6% of opioid addicts that truly needed to stay on such drugs for life, to reduce risk of relapsing to heroin. Now that’s interesting. Was it explained whether the people in that position could not be safely transitioned for primarily psychological or physiological reasons? Or was it a combination? ---
**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:** [September 14, 2017, 12:39am UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/95 "2017-09-14T00:39:41Z")
> [@Tamerlane](#): > > Now that’s interesting. Was it explained whether the people in that position could not be safely transitioned for primarily psychological or physiological reasons? Or was it a combination? Their state was summed up basically as just having an extremely severe case of addictive disease, generally with other co-morbidities/dual diagnoses. Untangling psychological from physiological reasons with any real conclusiveness is beyond the state of the art at present, IMHO. However, as we get to understand dopamine surges and other neuropharmacology better, I expect we’ll eventually get a better handle on it. The key thing to remember in any addictive disease, but especially opioid addiction, is that it really can take 2 to 4 years for one’s brain chemistry to really stabilize and return to a more ‘natural’ state, once the chemicals are removed. ---
**Author:** ![Tee](https://avatars.discourse-cdn.com/v4/letter/t/73ab20/32.png) [@Tee](https://boards.straightdope.com/u/Tee)\ **Post date:** [September 14, 2017, 12:49am UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/96 "2017-09-14T00:49:19Z")
> [@LSLGuy](#): > > LADC? LDAC? Enquiring minds want to know. 🙂 Licensed Alcohol and Drug Counselor. I so hate when I do that. > [@Richard\_Parker](#): > > In this view, the proper response to the crisis is basically managing the death rather than the addiction and hoping to ride out the wave of addiction, assuming that we will eventually return to people who become addicted because they decide to try heroin recreationally which will be a much lower number than the people who move to heroin from pills. > > I don’t think I agree with that vision, but I see it becoming the conventional wisdom in some parts. I’m curious to hear what people who have thought about this more think. I’ve always thought that eventually we would be combating this drug problem with other drugs. Managing addiction, using and improved version of existing methadone clinics. People don’t like them but they serve a purpose. As to managing deaths though, we’re beyond the point of knowing heroin can cause instant overdose because it’s cut, and into knowing that some things can be fatal to the [first responders](http://nhpr.org/post/first-responders-prepare-possible-surge-deadly-carfentanil-use-nh#stream/0) who pick up the ODs. Which is insane. It does not matter what kind of history we’ve had with heroin in the past, no one is being standoffish now with that level of fuckery going on. ---
**Author:** ![Richard\_Parker](https://avatars.discourse-cdn.com/v4/letter/r/35a633/32.png) [@Richard\_Parker](https://boards.straightdope.com/u/Richard_Parker)\ **Post date:** [September 14, 2017, 2:10pm UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/97 "2017-09-14T14:10:58Z")
> [@Tee](#): > > …and into knowing that some things can be fatal to the [first responders](http://nhpr.org/post/first-responders-prepare-possible-surge-deadly-carfentanil-use-nh#stream/0) who pick up the ODs. I have heard this fear a lot among cops and EMS folks. Is it actually sound or is the risk from environmental exposure to carfentanil being overblown? I find myself a little skeptical. I get the theory. It’s strong stuff, and it’s possible the person will OD with enough on their clothes or body that the first responder has contact with it. But enough of it to kill the first responder, who is taking normal precautions like wearing clothes and gloves? ---
**Author:** ![LSLGuy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lslguy/32/5813_2.png) [@LSLGuy](https://boards.straightdope.com/u/LSLGuy)\ **Post date:** [September 14, 2017, 2:20pm UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/98 "2017-09-14T14:20:38Z")
> [@griffin1977](#): > > … > As a society we can choose to let an immense destructive criminal network profit from supplying those opiates (and require the addicts to commit crimes to fund it) or we can do away with all the appalling things that flow from that by letting doctors prescribe opiates to opiate addicts. > … Overall I agree with much of what you’ve said about the societal-level issues. Ref the snip above, you left out the last piece of the puzzle. Which is probably an innocent omission caused by you, like me, having decent medical insurance. Doctors prescribing can, as you say, reduce or eliminate the black market _supply_. But the only way to reduce the crime from addicts stealing to support the habit is for those prescriptions to then be filled for free = paid for by taxpayers. If addicts aren’t working and have no income then that shiny new scrip from the free clinic doc is just fancy paper. We have to complete the process by giving them the drugs too. I don’t doubt it’d be cheaper for the taxpayers to buy all the addicts unlimited drugs than it is for them to buy all the police, courts, and prisons they’re currently paying for. Plus all the private sector costs we all pay for security services and losses from theft & robbery. Not to mention the fire/EMS/medical industry burden from the concomitant violence. Getting many Americans behind the idea of funding free drugs for what they think of as “losers” is gonna be a very, very tough sell. No matter how much cheaper and more compassionate it might be. ---
**Author:** ![Tee](https://avatars.discourse-cdn.com/v4/letter/t/73ab20/32.png) [@Tee](https://boards.straightdope.com/u/Tee)\ **Post date:** [September 14, 2017, 3:15pm UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/99 "2017-09-14T15:15:46Z")
> [@Richard\_Parker](#): > > I have heard this fear a lot among cops and EMS folks. Is it actually sound or is the risk from environmental exposure to carfentanil being overblown? I find myself a little skeptical. I get the theory. It’s strong stuff, and it’s possible the person will OD with enough on their clothes or body that the first responder has contact with it. But enough of it to kill the first responder, who is taking normal precautions like wearing clothes and gloves? I can’t vouch for the potency of it. It would be good to get outside opinions of how dangerous it is upon contact. The attitude of the responders is heightened awareness and extra precautions and getting on with the job. I’m not one of them, still outraged on their behalf and that of anyone else on the scene, including people who maybe didn’t choose to shoot an elephant tranquilizer that day, but did. What\* is\* this about? My guess is it’s a statement from persons unknown that goes something like, Screw You and Your Narcan. ---
**Author:** ![Ann\_Hedonia](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ann_hedonia/32/319_2.png) [@Ann\_Hedonia](https://boards.straightdope.com/u/Ann_Hedonia)\ **Post date:** [September 15, 2017, 1:07am UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/100 "2017-09-15T01:07:16Z")
> [@LSLGuy](#): > > Overall I agree with much of what you’ve said about the societal-level issues. > > Ref the snip above, you left out the last piece of the puzzle. Which is probably an innocent omission caused by you, like me, having decent medical insurance. > > Doctors prescribing can, as you say, reduce or eliminate the black market _supply_. > > But the only way to reduce the crime from addicts stealing to support the habit is for those prescriptions to then be filled for free = paid for by taxpayers. If addicts aren’t working and have no income then that shiny new scrip from the free clinic doc is just fancy paper. We have to complete the process by giving them the drugs too. > I don’t doubt it’d be cheaper for the taxpayers to buy all the addicts unlimited drugs than it is for them to buy all the police, courts, and prisons they’re currently paying for. Plus all the private sector costs we all pay for security services and losses from theft & robbery. Not to mention the fire/EMS/medical industry burden from the concomitant violence. > > Getting many Americans behind the idea of funding free drugs for what they think of as “losers” is gonna be a very, very tough sell. No matter how much cheaper and more compassionate it might be. If you give addicts unlimited drugs you’re going to have a huge problem with diversion, because they’ll take more drugs than they need so they can sell the rest. And I don’t think unlimited free drugs would solve the problems because active addicts aren’t going to be able to hold down a job or care adequately for their children and it will fall to society to pick up the tab. If drugs are expensive addicts will hoard their supply. If they are free and easy to come by they will be handed out like candy to anyone that wants to try them including non-addicts. [Previous page](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079.md?page=4) [Next page](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079.md?page=6)