Why would druggies buy drugs from other druggies when they themselves can get all you can eat free ?
We can look to Portugal to see what happened after they decriminalized opioids in 2000.
Here’s NPR’s take on Portugal’s heroin decriminalization
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.
Exactly. Which is why the whole “doctors should just prescribe opioids to opioid addicts” plan has some major flaws in it.
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.
Read this thread… It was talked about and answered.
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.
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.
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?
As always, the argument is that the illegality of <whatever> 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 <whatever> we have today, we should expect that headcount to multiply by 10x when <whatever> 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.
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.
We could use a few (insert your favorite multiple of 10) more interceptions like this one.
:eek:
Philadelphia is planning an interesting idea:
I would expect the Trump administration to prevent this plan from coming to fruition (by arresting people using drugs there…)
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?
That’s the whole idea behind methadone treatments.
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.
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.
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.
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.
Nope, it would not. Simply handing out drugs never solved anyone’s drug problem.
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.
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.
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???
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.
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.)
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.
^ This.
^ 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).
^ This. And for ALL chronic, long-term care givers whether in the treatment setting or in the home.
^ 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.
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.
^ 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.)
Knowing some professional truckers (some pilots, some not) I can confirm that the DOT is just as harsh as the FAA about this.
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.
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.
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.
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.
Well, it solves the immediate problem of procuring the drug, with the added benefit of knowing the purity and concentration.
Yes, that solves some of the secondary problem. It does not solve the problem of being addicted in the first place.
Semi-synthetic. It’s just acetylated morphine. As opposed to e.g. fentanyl.
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.