# 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:** 6
**Author:** ![Evan\_Drake](https://avatars.discourse-cdn.com/v4/letter/e/b487fb/32.png) [@Evan\_Drake](https://boards.straightdope.com/u/Evan_Drake)\ **Post date:** [September 15, 2017, 1:25am UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/101 "2017-09-15T01:25:41Z")
> [@Ann\_Hedonia](#): > > 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. Why would druggies buy drugs from other druggies when they themselves can get all you can eat free ? ---
**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 15, 2017, 1:51am UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/102 "2017-09-15T01:51:23Z")
We can look to [Portugal](https://news.vice.com/article/ungass-portugal-what-happened-after-decriminalization-drugs-weed-to-heroin) to see what happened after they decriminalized opioids in 2000. > [@](#): > > When Portugal decided to decriminalize in 2000, many skeptics assumed that the number of users would skyrocket. That did not happen. With some exceptions, including a marginal increase among adolescents, drug use has fallen over the past 15 years and now ebbs and flows within overall trends in Europe. Portuguese officials estimate that by the late 1990s roughly one percent of Portugal’s population, around 100,000 people, were heroin users. > > Today, “we estimate that we have 50,000, most of them under substitution treatment,” said Goulão before adding that he’s recently seen a small uptick in use of the drug, predominantly among former addicts that got clean. This reflects Portugal’s tenuous economic condition, he contends. Here’s NPR’s take on [Portugal’s heroin decriminalization](http://www.npr.org/sections/parallels/2017/04/18/524380027/in-portugal-drug-use-is-treated-as-a-medical-issue-not-a-crime) > [@](#): > > Drug-related HIV infections in Portugal have dropped 95 percent. > > Drug workers hand out packets with clean needles and condoms and listen to another addict, Antonio, describe his anxiety. > > “If the drugs hurt too much my body, I escape a little, and then I come back again,” he says. “But it’s a world I cannot escape! If I turn there, it’s there — it’s everywhere. I cannot escape.” > > For every person in Portugal who cannot escape addiction, there’s daily methadone, counseling and free treatment. A generation ago, these addicts were put in jail. Now they’re on the street. > > But polls show the Portuguese — having lived through the ravages of a heroin epidemic — overwhelmingly support this policy. So there’s lots of evidence of harm reduction for those who continue using, and more people recovering and becoming clean, when users are given access to adequate treatment rather than being sent to prison. ---
**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 15, 2017, 2:02am UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/103 "2017-09-15T02:02:25Z")
Exactly. Which is why the whole “doctors should just prescribe opioids to opioid addicts” plan has some major flaws in it. ---
**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, 4:23am UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/104 "2017-09-15T04:23:52Z")
> [@Evan\_Drake](#): > > Why would druggies buy drugs from other druggies when they themselves can get all you can eat free ? Well,if the program is “free heroin for all”, where just anyone that walk into a pharmacy and get all the free heroin they want, no questions asked – then you are right. But if people have to go to a doctor and register as an addict and get a prescription, then a lot of addicts aren’t going to do it. Because they don’t want to lose their jobs or kids. And some addicts will want more heroin than they are prescribed. And some people that aren’t addicts ( yet ) may want to buy heroin. And how are you going to deal with the legal and moral ramifications of handing out free heroin to people who have children, operate motor vehicles and hold jobs that may involve things like public safety and heavy machinery? If you forbid them from doing these things you have a welfare problem and if you let them your free heroin program will get sued into oblivion. ---
**Author:** ![sweat209](https://avatars.discourse-cdn.com/v4/letter/s/9fc348/32.png) [@sweat209](https://boards.straightdope.com/u/sweat209)\ **Post date:** [September 15, 2017, 11:17pm UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/105 "2017-09-15T23:17:41Z")
> [@Richard\_Parker](#): > > If you have not yet been personally touched by the rapidly expanding human tragedy of opiate addiction, I suggest reading [this](http://www.cincinnati.com/pages/interactives/seven-days-of-heroin-epidemic-cincinnati/). > > It seems a moral and policy shame that the companies who helped create this crisis–marketing oxycontin and other pain killers as having no addiction risk–are not paying more to stop it. > > Should we tax them to pay for treatment? What else should we be doing? Read this thread… It was talked about and answered. [http://boards.straightdope.com/sdmb/showthread.php?t=832641](http://boards.straightdope.com/sdmb/showthread.php?t=832641) There no heroin epidemic, no pain killer epidemic, no drug epidemic but there is Fentanyl epidemic. All those people overdosing are overdosing on Fentanyl not the Fentanyl you get from the doctor but the Fentanyl you get from the street dealer. People overdosing on heroin are not overdosing on heroin they are overdosing where some of Fentanyl is cut in with heroin. It is Fentanyl epidemic. And Fentanyl is coming from China and there is nothing DEA or FDA can do but stop all trade with China and people coming and going from China. ---
**Author:** ![Evan\_Drake](https://avatars.discourse-cdn.com/v4/letter/e/b487fb/32.png) [@Evan\_Drake](https://boards.straightdope.com/u/Evan_Drake)\ **Post date:** [September 15, 2017, 11:56pm UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/106 "2017-09-15T23:56:07Z")
> [@Ann\_Hedonia](#): > > And how are you going to deal with the legal and moral ramifications of handing out free heroin to people who have children, operate motor vehicles and hold jobs that may involve things like public safety and heavy machinery? If you forbid them from doing these things you have a welfare problem and if you let them your free heroin program will get sued into oblivion. Perhaps, yet I always think the answer to what will happen if people do X legally is that they are _already_ doing X illegally, and nothing will stop that. If heroin users are a danger behind the wheel, then how come there aren’t thousands of heroin traffic accidents ? If cannabis users become unfit parents, presumably those who now take cannabis when it is illegal won’t become worse when it is legal. ---
**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 16, 2017, 12:49am UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/107 "2017-09-16T00:49:35Z")
Right now, how are things handled when someone who drives/operates heavy machinery/is involved in public safety is prescribed strongly psychologically active meds like benzos? ---
**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 16, 2017, 1:57am UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/108 "2017-09-16T01:57:25Z")
> [@Evan\_Drake](#): > > Perhaps, yet I always think the answer to what will happen if people do X legally is that they are _already_ doing X illegally, and nothing will stop that. If heroin users are a danger behind the wheel, then how come there aren’t thousands of heroin traffic accidents ? If cannabis users become unfit parents, presumably those who now take cannabis when it is illegal won’t become worse when it is legal. As always, the argument is that the illegality of \ prevents about 90% of the use of it. There’s always 10% who don’t give a crap about the law. But most people do either care about abiding by the law or care about the ancillary sanctions like employment policies. Or simply aren’t willing to do the risky stuff necessary to interact with black market suppliers. So however many users of \ we have today, we should expect that headcount to multiply by 10x when \ is legal, safe, easy to buy, and reasonably cheap. For something fairly benign that may be a tolerable trade off for increased personal freedom. For something like heroin with high addiction potential, that may be the change that, following your examples, turns US road danger & craziness into Russian levels of road danger and craziness. Which concern ought to give thoughtful people pause. ---
**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 16, 2017, 2:00am UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/109 "2017-09-16T02:00:43Z")
> [@MichaelEmouse](#): > > Right now, how are things handled when someone who drives/operates heavy machinery/is involved in public safety is prescribed strongly psychologically active meds like benzos? At least for FAA, they’re grounded until they’re off the drugs. I would not be surprised to find DOT has similar regs for truck drivers. The effect this has on treatment options for people in these industries is pretty obvious. ---
**Author:** ![nearwildheaven](https://avatars.discourse-cdn.com/v4/letter/n/90db22/32.png) [@nearwildheaven](https://boards.straightdope.com/u/nearwildheaven)\ **Post date:** [September 18, 2017, 2:27am UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/110 "2017-09-18T02:27:35Z")
We could use a few (insert your favorite multiple of 10) more interceptions like this one. > **[Black Tar heroin bust in Moline](https://www.kwqc.com/content/news/Black-Tar-heroin-bust-in-Moline-444683973.html)** > > A search of the vehicle found 2 kilograms of black tar heroin wrapped in bundles and concealed in the spare tire of the vehicle. :eek: ---
**Author:** ![PastTense](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/pasttense/32/14550_2.png) [@PastTense](https://boards.straightdope.com/u/PastTense)\ **Post date:** [January 24, 2018, 7:38am UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/111 "2018-01-24T07:38:40Z")
Philadelphia is planning an interesting idea: > [@](#): > > Philadelphia is looking to establish supervised drug injection sites as the opioid epidemic cements its place as the deadliest public health crisis in the city’s modern history. > > City officials announced Tuesday afternoon they would encourage the development of addiction engagement sites that, among providing other services, would oversee medically-supervised drug consumption. Often known as safe-injection sites, the centers are staffed with medical professionals who can immediately respond to an overdose. They also provide critical access to addiction rehabilitation services and clean medical supplies like needles. > > Dr. Thomas Farley, the city health commissioner, said the core purpose of the sites would be interfacing with drug users and offering addiction treatment services. “These sites serve as sites to bring people into drug treatment," he said. “We don’t see this as simply a site for supervised injection.” > **[Philadelphia Pushes Forward With Creating Drug Safe-Injection Sites as Part...](https://www.nbcphiladelphia.com/news/national-international/philadelphia-pushes-forward-with-drug-safe-injection-sites-2/219534/)** > > City officials announced Tuesday afternoon they would encourage the development of addiction engagement sites that, among providing other services, would oversee medically-supervised drug consumption. I would expect the Trump administration to prevent this plan from coming to fruition (by arresting people using drugs there…) ---
**Author:** ![UltraVires](https://avatars.discourse-cdn.com/v4/letter/u/ecccb3/32.png) [@UltraVires](https://boards.straightdope.com/u/UltraVires)\ **Post date:** [January 27, 2018, 4:21pm UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/112 "2018-01-27T16:21:44Z")
> [@Qadgop\_the\_Mercotan](#): > > 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. I know this post is several months old, but I believe that this hits the nail on the head in regards to the problem of long term recovery. I can get a client clean for a few weeks to satisfy the judge or the probation department. They sweat, cry and go through terrible withdrawals, but they are committed and have the drive and the adrenaline to see it through. However, nobody can fight something for 2 to 4 years. At some point in time, you simply get tired of being miserable and in one single moment of weakness you use again. People who are not addicts learn how to deal with stress, failure, loss, even deal with happiness or good things without heightening them with controlled substances or booze. Addicts have never been taught or have never learned how to do this. Even if we teach them how through rehab, their brains are still all out of whack and cannot adjust. I think any successful treatment in the future would have to deal with this chemical brain imbalance and introduce a gradual chemical treatment for it. I am not a doctor, but would a gradual coming off of the drug get a better success rate? IOW, say an addict uses 50 “units” of heroin per day. Would it, in your opinion, be more successful longer term for the addict to go to 40 units per day for 3 months, then 30 units for the next 3, etc? Does the brain begin to heal when exposed to less of a substance? ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [January 27, 2018, 4:25pm UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/113 "2018-01-27T16:25:28Z")
> [@UltraVires](#): > > I am not a doctor, but would a gradual coming off of the drug get a better success rate? IOW, say an addict uses 50 “units” of heroin per day. Would it, in your opinion, be more successful longer term for the addict to go to 40 units per day for 3 months, then 30 units for the next 3, etc? Does the brain begin to heal when exposed to less of a substance? That’s the whole idea behind methadone treatments. ---
**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:** [January 27, 2018, 6:03pm UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/114 "2018-01-27T18:03:50Z")
Disclaimer: I am not nor have ever been an addict, I am not a licensed drug and alcohol counselor, and I am not a doctor. But I did work for a methadone clinic for four years, saw a LOT of addicts, and of course my family (like all families) has been touched by drug addiction in one form or another. > [@Wesley\_Clark](#): > > The big issue seems to be synthetic opiates which are far cheaper and deadlier than heroin. So I don’t know how you can legislate your way out of this. Heroin is actually synthetic opiate, developed for the humanitarian goal of making a better pain killer. Pretty much the same reason all those other synthetic opiates have been created. They are tools. They are potentially very dangerous tools that must be used carefully and properly, but when used carefully and properly are very good things. > [@pool](#): > > He also went to a Methadone clinic but that seemed to be just trading out one addiction for another and he still did all of the other drugs too. There are good methadone treatment programs and shit methadone treatment programs. Good ones not only supply methadone, they also mandate regular and frequent counseling, try to get their clients care for medical problems, and look for ways to provide rehabilitation services as well as just handing out a drug. Shit ones just hand out a drug and are basically another form of pill mill. Methadone is also a hammer that, while good for dealing with nails, is all too often used for everyone other problem, even those that aren’t nails. > [@griffin1977](#): > > I’ve talked to doctors I know in the UK about this and they are completely amazed doctors were not prosecuted (or at the very least struck off wholesale) for this. Regardless of the what the drug reps say if you’ve been to medical school you absolutely expect that if you send someone home with a repeat prescription for a drug that connects to the opioid receptors in the brain they WILL get addicted. That is as basic a medical fact as if you send someone home with potassium prescription their blood pressure will go up. No, if you put someone on opiates for an extended period of time they will get a _physical dependence_, or as sometimes called a “physical addiction”. People with that problem do not seek a high, they seek relief from pain, and are not psychologically driven to keep using once pain is resolved. Those people can usually be tapered off their pain killers and then get on with their lives. It is not the same problem as psychological addiction. Yes, a certain number of people even on proper, carefully administered and monitored pain killers will develop a psychological addiction but it should be treated as a medical side effect (albeit a serious one) and not a moral or personal failing. > [@griffin1977](#): > > Treat it as a medical problem and allow doctors to prescribe heroin to heroin addicts. At a stroke it would solve the problem. Nope, it would not. Simply handing out drugs never solved anyone’s drug problem. > [@Arcite](#): > > “please, doc, you’ve got to help me, the pain is unbearable! I tried that, Tylenol and Motrin don’t touch it! I can’t go back to work like this! What am I supposed to do?! You can’t leave me like this! Please, I’m gonna get fried from my job! We’ll be homeless, my kids will starve!” And this is another societal problem - we don’t give people the _time_ they need to deal with either medical or psychological problems because society is so damned scared of malingerers they view EVERYONE as a malingerer. The social safety net is tattered. So if someone needs full time treatment for a problem they lose their job with no backstop to keep the family from starving or becoming homeless. This incentivizes maladaptive behaviors like going to work sick or injured, taking drugs to keep working while sick and injured, and trying to work while also trying to take care of serious medical and psychological issues. It often makes problems worse, not better. Keep in mind - many people DO start down the path towards addiction when they seek relief from very real pain. Blue collar workers are prone to this because blue collar work can be very hard on the body. > [@pkbites](#): > > I’m not saying lock addicts up just for being addicts. I’m saying if an addict commits a crime imprison him/her for the full amount. I have yet to meet a heroin user that got permanently clean from rehab. I have known quite a few that got clean long-term from rehab (you can’t say “permanently” until their lifespan is over and they’ve died of other causes). You don’t see them, though, because they move on with their lives and generally avoid revisiting the problem both due to social stigma and because they are on to other things. And let’s NOT imprison these people - let’s give them _treatment_, long term inpatient treatment if that’s what they need. Don’t know how things may have changed since I worked in the field (that’s now 25 years back) but back then it was a LOT easier to get thrown in jail than to get actual inpatient treatment through the medical system, and at least some jails had treatment programs in them. The waiting list for getting thrown in jail was a lot shorter than the waiting lists for methadone clinics. Yes, a lot of addicts don’t want treatment - a lot _do_, though, but had (and have) serious obstacles to getting it. Let’s knock down those obstacles so it’s easier to get treatment than jail time. > [@Qadgop\_the\_Mercotan](#): > > IAfter all my particular prison system had a guy that ATE quite a few people. And he didn’t use heroin either. C’mon, that guy was worse than the average cannibal - you left out the amateur home lobotomies and necrophilia. But yeah, there are some VERY bad people out there. But hey! He didn’t do drugs! Yay??? > [@MichaelEmouse](#): > > It seems that opioid and meth are the big scourges of lower-middle/working class whites in the US. Are there any links between those two drugs besides being illegal, stupidly dangerous and used by lots of down and out white people? Are they commonly combined in some kind of super speedball? The lower class/blue collar white folks are often locked into bad situations, have few to no job prospects, and may have long-standing injuries arising from manual labor. I’ve also got more than a few coworkers and neighbors using drugs due to long-running, untreated dental problems (this has started to abate a little bit since our poor peoples’ medical insurance started covering dentistry, but there’s a backlog of decades of problems to work on so it will take time). Opiates are cheap on the black market and meth is relatively easy to make at home. The poorest of the poor do shit like huff gasoline fumes. Some of the drugs of “choice” have to do with economics and availability. > [@griffin1977](#): > > Bear in mind I’ve heard the prospect withdrawing from opiates, once that physical addiction takes hold compared to going to without food for a week. Yes, you COULD do it and probably not die, but it’s a pretty horrible prospect. I’ve actually gone without food for a week. It wasn’t a happy week, but having seen addicts in withdrawal I’d say starving for a week is not as bad as full on opiate withdrawal. Opiate withdrawal is almost never fatal (the only instances I know of involved people with other, additional medical problems). Also - ALL “former” addicts have some struggle with it throughout the rest of their lives, just like other people with chronic conditions. You don’t really cure it, you manage it. Even if someone DOES relapse, if they can achieve long stretches of sober life - stay clean 5, 10, 15 years at a time - that is progress and a positive good. My understanding (based on observation and talking to medical personal specializing in the field) is that the first time through rehab is the most difficult, with coming back from subsequent relapses easier (which is not to say it’s “easy”, just less difficult. Usually.) > [@Oly](#): > > Nicotine is highly toxic drug, but nobody ever overdoses on it, because the amount you get from one cigarette, while sufficient to kill the craving, is tiny compared to the lethal dose. Yes, people can and have OD’d from nicotine. These days, it’s usually from overexposure to the liquids used in vaping equipment. You don’t OD from smoking or chewing tobacco. You CAN OD from the “improved” form utilizing highly concentrated chemicals for vaping. > [@Tee](#): > > A frequent problem is not being able to overcome structural deficits in health services. ^ This. > [@Tee](#): > > Why, because working with addicts really sucks, and you do it for as long as your emotional capacity holds out. Then you do something else. ^ This. I lasted four years before I burned out and had to leave, and I didn’t even have much direct daily contact with the bulk of our clientele. People doing the counseling lasted an average of _less than a year_ (a few, very few, lasted multiple years in the field but you can’t build an army of treatment professionals on the outliers). > [@Tee](#): > > Along with everything else, there’s a growing need to care for the people who care for others. ^ This. And for ALL chronic, long-term care givers whether in the treatment setting or in the home. > [@Qadgop\_the\_Mercotan](#): > > 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. ^ This. If someone breaks a leg we don’t just hand them crutches, we _treat the broken leg_. If someone needs knee surgery we don’t just hand them crutches, we give them rehab to get their knee working again. It’s not enough to just hand out methadone, it has to be WITH additional treatment. If you don’t, it really is just trading one addiction for another and gaining nothing. The clinic I worked had a handful of people on methadone for life. This treatment was arrived at empirically - when tapered off they relapsed. When maintained on it they were stable, held down jobs, did not do additional drugs, etc. All of them had gone through taper-off-crash-big-resume-treatment a half dozen or more times, with great disruption to them and their families each cycle. So eventually it was just better - less harmful - to maintain them on a low dose of methadone indefinitely. Consider them the equivalent of people who have lost a leg and really do need those crutches permanently because we haven’t developed a proper prosthesis yet for the missing body part. You can’t hop around on one leg forever, sooner or later you’re going to fall down. That doesn’t mean EVERYONE should be automatically shuffled into “drug X for life”. It’s _better_ if they can get off it entirely. It’s better to be on a lower dose than a higher one. > [@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? > [@Qadgop\_the\_Mercotan](#): > > 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. Back when I knew people like this it wasn’t always known whether it was one or the other or a combination of both. It’s just that after 20 or 30 years (or more! - we had one gentleman who had his first round of rehab in the last 1960’s) long term maintenance yielded the best results for those particular patients. > [@Qadgop\_the\_Mercotan](#): > > 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. ^ This gets lost a lot. I LAUGH when I hear some celebrity or other has “finished rehab” in 30 or 60 or even 90 days. That’s barely a start. The clinic I was at we anticipated _two years_ of treatment before we’d start tapering someone off methadone, and that could easily take another year or two right there. Some people took considerably longer. (A very few took less time, but like I said, you can’t build a program for this on the outliers. You still have to treat the outliers, of course, and do so appropriately, but you can’t base the program on them.) > [@MichaelEmouse](#): > > Right now, how are things handled when someone who drives/operates heavy machinery/is involved in public safety is prescribed strongly psychologically active meds like benzos? > [@LSLGuy](#): > > At least for FAA, they’re grounded until they’re off the drugs. I would not be surprised to find DOT has similar regs for truck drivers. Knowing some professional truckers (some pilots, some not) I can confirm that the DOT is just as harsh as the FAA about this. > [@LSLGuy](#): > > The effect this has on treatment options for people in these industries is pretty obvious. Yep. They lose their jobs. Frequently, they lose their entire careers. It would be nice if retraining were available for people no longer able to pursue their career due to this problem. > [@UltraVires](#): > > However, nobody can fight something for 2 to 4 years. At some point in time, you simply get tired of being miserable and in one single moment of weakness you use again. People who are not addicts learn how to deal with stress, failure, loss, even deal with happiness or good things without heightening them with controlled substances or booze. > > Addicts have never been taught or have never learned how to do this. Even if we teach them how through rehab, their brains are still all out of whack and cannot adjust. I think any successful treatment in the future would have to deal with this chemical brain imbalance and introduce a gradual chemical treatment for it. YES. That is why treatment HAS to include both extensive counseling AND rehabilitation. You don’t treat diabetes by simply shooting insulin into them. You have to teach them how to manage their illness. Ditto for most other chronic diseases _including drug addiction_. > [@UltraVires](#): > > I am not a doctor, but would a gradual coming off of the drug get a better success rate? IOW, say an addict uses 50 “units” of heroin per day. Would it, in your opinion, be more successful longer term for the addict to go to 40 units per day for 3 months, then 30 units for the next 3, etc? Does the brain begin to heal when exposed to less of a substance? > [@Nava](#): > > That’s the whole idea behind methadone treatments. Yep. That’s how it’s done, both for physical dependence and psychological addiction. It’s a gradual withdrawal. Back when I was at the clinic we had a very, very, very few people who wanted to go cold turkey. First thing was the clinic doctor tried to talk them out of it, not because of medical dangers but because it usually doesn’t work. If they passed that hurdle then they were screened for medical issues that could be a problem (almost never found, but it did turn up once or twice). I knew of two people who were cleared to do this, they were admitted to a hospital for monitoring, and went cold turkey. One of them relapse shortly and stopped coming to the clinic. The other did EXTREMELY well and, so far as random testing could determine, never relapse in the subsequent two years he was with us. _But he was an exception_ - and exceptional. That was out of THOUSANDS of patients I helped keep records on for four years. One out of nearly 5000 addicts. The vast majority of people who got off opiates for any significant length of time did it by tapering off gradually. Some of them subsequently required pharmaceutical treatment for things like depression and anxiety which means… then went from methadone to some other drug. Ideally, a drug better suited to their actual underlying problems, administered by a doctor in appropriate amounts with fewer side effects and more benefits. We did have some issue with the puritanical mindset that addicts had to get off ALL drugs forever and ever. Well… no, if they have a problem that is most appropriately treated with a medication they really should take that medication, don’t you think? It’s a complex problem with a lot of societal baggage attached. ---
**Author:** ![k9bfriender](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/k9bfriender/32/3283_2.png) [@k9bfriender](https://boards.straightdope.com/u/k9bfriender)\ **Post date:** [January 27, 2018, 6:40pm UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/115 "2018-01-27T18:40:58Z")
> [@UltraVires](#): > > I am not a doctor, but would a gradual coming off of the drug get a better success rate? IOW, say an addict uses 50 “units” of heroin per day. Would it, in your opinion, be more successful longer term for the addict to go to 40 units per day for 3 months, then 30 units for the next 3, etc? Does the brain begin to heal when exposed to less of a substance? What I don’t understand is how someone is expected to stay off a drug, when they are returned to the same environment that caused them to start doing the drug in the first place. You spend a bit of time in rehab, and that has its uses. you are physically separated from the drug, so you can’t get it. There are distractions for you so that you can stop thinking about your addiction. There are people there to help get you through it. So, yeah, while actually in rehab, getting off the drug, even if you go through painful withdrawal, is the easy part. What the hard part is is going back to your life, where you live 24/7. And every day, you think about the drug, and every night you think about the drug. And there are not activities and other distractions, there are not people there to go to for support. And the drug is available. If you could get it before, you can get it now. People need to be given the ability to rebuild their lives, and leave behind the life that led them down the path to addiction. ---
**Author:** ![kayaker](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kayaker/32/441_2.png) [@kayaker](https://boards.straightdope.com/u/kayaker)\ **Post date:** [January 27, 2018, 7:59pm UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/116 "2018-01-27T19:59:29Z")
> [@Broomstick](#): > > Nope, it would not. Simply handing out drugs never solved anyone’s drug problem. Well, it solves the immediate problem of procuring the drug, with the added benefit of knowing the purity and concentration. ---
**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:** [January 28, 2018, 4:53am UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/117 "2018-01-28T04:53:58Z")
Yes, that solves some of the secondary problem. It does not solve the problem of being addicted in the first place. ---
**Author:** ![Ruken](https://avatars.discourse-cdn.com/v4/letter/r/f475e1/32.png) [@Ruken](https://boards.straightdope.com/u/Ruken)\ **Post date:** [January 28, 2018, 1:34pm UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/118 "2018-01-28T13:34:54Z")
> [@Broomstick](#): > > Heroin is actually synthetic opiate. Semi-synthetic. It’s just acetylated morphine. As opposed to e.g. fentanyl. ---
**Author:** ![pkbites](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/pkbites/32/204_2.png) [@pkbites](https://boards.straightdope.com/u/pkbites)\ **Post date:** [January 28, 2018, 5:00pm UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/119 "2018-01-28T17:00:22Z")
> [@Broomstick](#): > > And let’s NOT imprison these people - let’s give them _treatment_, long term inpatient treatment if that’s what they need. Don’t know how things may have changed since I worked in the field (that’s now 25 years back) but back then it was a LOT easier to get thrown in jail than to get actual inpatient treatment through the medical system, and at least some jails had treatment programs in them. The waiting list for getting thrown in jail was a lot shorter than the waiting lists for methadone clinics. I specifically posted that I was not suggesting we imprison people just for being addicts. I suggested that if they commit a crime (such as burglary, robbery, theft, forgery, etc., crimes common among addicts) they serve hard time for that. Are you suggesting someone not serve any time for a serious felony simply because they are an addict? ---
**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:** [January 28, 2018, 5:23pm UTC](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079/120 "2018-01-28T17:23:00Z")
> [@pkbites](#): > > I specifically posted that I was not suggesting we imprison people just for being addicts. I suggested that if they commit a crime (such as burglary, robbery, theft, forgery, etc., crimes common among addicts) they serve hard time for that. > > Are you suggesting someone not serve any time for a serious felony simply because they are an addict? I’d suggest that charges for possessing the drug that one is addicted to be made less severe. Heroin addicts tend to possess heroin. IMHO it’s a pity to see someone come back into prison for 3-4 years for a relapse, because they had heroin in their possession. And at $35K/year to incarcerate them, it’s no bargain for the taxpayers either. I’ve known many opioid addicts who have found long-term abstinence after relapse; heck, I’m one of them, with over 27 years clean. But the chances for a good outcome are better if the consequences of their relapse are proportionate. Treatment is cheaper and more likely to result in better outcomes than incarceration. Theft, assault, battery, drug trafficking (as defined by actually dealing/distributing and not just accumulating a lot for the addict’s future use) and other such felonies merit treatment as felonies. Being an addict is not a permit to commit your typical crime. But we need to be cautious when deciding which addict behaviors to criminalize, and how severely to punish them when we do criminalize it. Just my two cents, from my perspective of 3+ decades of treating addicts, 3+ decades of being an addict, and 16 years treating convicted felons. [Previous page](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079.md?page=5) [Next page](https://boards.straightdope.com/t/what-should-we-be-doing-about-the-heroin-crisis/796079.md?page=7)