Ah, if the trend toward nastier and more potent fentanyl analogues was an expected and predicted consequence of opioid prohibition. That would have been nice to know!
Before opioid prohibition deaths from opioid use were quite rare. You ever heard a pothead drone on about "it's nearly impossible to overdose from smoking marijuana"? The same thing applies to smoking opium. It's nearly impossible to overdose on that. But prohibition has pushed us from opium smoking and oral laudanum to injectable heroin to fentanyl and now we're at carfentanil.
The current USian "opioid crisis" is another manifestation of opioid prohibition pushing people from safer, cheaper, less disruptive and deadly drugs to more deadlier ones. Two decades ago some USian opioid users could go to pill mills and get prescriptions for pharmaceutical grade opioids but the DEA kicked down doctor's doors a bunch and that ended up pushing people to the illicit market. Maybe next time you see those scary increasing graphs of opioid deaths vs time, give that a thought? Sum up all those deaths (compared to the baseline, prior to the increased LEA focus on "pill mills) and ask yourself: are all those needless deaths worth it?
For a unit volume (so, for a unit risk of ending up in a concrete box as a consequence of shipping/making raw product) of uncut/active material, you want to be able to sell the most diluted/cut doses to end-users. Of course people will want their chemist to synthesise carfentanil (over regular fentanyl), because you can supply the the same number of end-user doses with 10,000 times less active material. The harder the enforcement, the more potent this selection pressure gets: https://en.wikipedia.org/wiki/Iron_law_of_prohibition
I agree with your dim view of prohibition. It clearly makes things much worse. In fact, I lean toward the extreme opinion that prohibition isn't merely counterproductive, prohibition is the entire problem. Furthermore, the notion of "drugs" and all that they represent is socially constructed; only a sliver of what is believed about drugs comes from the chemicals themselves; most of it is a tradition of myths that form a sort of secular religion, along parallel lines to belief in things like black magic and curses. Drugs are thought of as possessing evil and demonic properties; they are tainted with black magic, and consuming them brings the black magic into a person's body and causes them to commit evil acts, infects their minds and causes madness and irrationality, causes everything the person is connected to to self-destruct, and ultimately kills them. Unless, that is, they are able to break the hold of the magic, renounce drugs, and perform rituals of cleansing (getting "clean"), etc., to symbolically remove the magic and show that you have been reborn as a person who recognizes the terrible power of the black magic and now wants nothing to do with it. Except that the magic can never be completely washed off; you are now an "addict".
One more thing. I think rehab causes people to die, because a heroin user is made to stop, then they are in rehab for a while, and then they get out and accidentally inject too much and overdose. When you are denied something you want for a period of time, the tendency is to make you want it more. It makes the drug into an obsession and the whole thing just reinforces the importance and perceived desirability of the drug.
I think that even users of a drug have beliefs about the drug and its effects that are myths promoted by the anti-drug side. Drugs are supposed to feel like more pleasure than 100 orgasms, right? I actually think that no drug directly causes pleasure. It's like alcohol. Alcohol by itself does not plaster a smile on your face. The enjoyment of drinking comes from combining it with an enjoyable activity. Likewise for drugs. Their effect on mood is neutral and the enjoyment comes from combining it with an enjoyable activity.
I see the rehab industry as selling snake oil. I'm sure that it has been a good business to be in with the trend to send fewer addicts to jail and redirect them to rehab instead. Going to rehab is a good idea if you need to rehabilitate your image, e.g. to get a job. I have no experience of American rehab. The whole idea seems weird to me.
I think one of the practical effects of it is that serves to teach drug users about the "addiction disease" and how to act their part in the drama. I suspect that it helps bring about the symptoms of the "disease", because without being educated about the symptoms, how would you know what you're supposed to do?
It almost seems like the message of NA was maliciously designed to induce hopelessness and defeatism, the exact opposite of what would help a person who needs optimism and confidence to make a change that might seem scary.
> Before opioid prohibition deaths from opioid use were quite rare.
Maybe in the U.S., less so in China where ~25% of adult males were opium addicts in the early 1900s. The war on drugs isn't a success by any means, but at least the problems that exist aren't on that scale.
A better example of prohibition backfiring is with marijuana, where before prohibition ~0% of Americans were marijuana users, whereas today ~85% of American adults have used marijuana.
My argument isn't that opioid use in the time of opium dens was harmless, nor that opioids can be used willy-nilly without any harms. I am well familiar with some of the dangers of opioid use and do not wish to discount them at all. My argument is that opioid prohibition in the 21st century in the US is a legal regime that amplifies those dangers -- it kills lots of people quite effectively (and keeps killing more every year).
The number of people who use opioids regularly is a second-order concern (if only because fent-laced heroin certainly gets that number down) to me, frankly -- reducing morbidity and mortality due to drug use is a lot more important. With a decent medical infrastructure, addicts should be able to get opioid maintenance therapy with the right drugs and dosage and be able to lead actual interesting lives beyond trying to score the next hit.
I'd so much rather live in a country where people who want to get high on opioids can buy cheap, pure, precisely metered opioids that won't kill them rather than smashing car windows to be able to pay for overpriced fentanyl-laced drugs sold by criminals that might overdose them in the street (which will cause even more expense and load on the already-awful USian medical system).
"There are 100,000 total marijuana smokers in the US, and most are Negroes, Hispanics, Filipinos and entertainers. Their Satanic music, jazz and swing, result from marijuana usage. This marijuana causes white women to seek sexual relations with Negroes, entertainers and any others." ~ Harry J. Anslinger
By comparing the anecdotal regular users in the 1930s to the current population that has had at least one use you are purposefully making a faulty comparison. Why did you not compare past and current users?
> The harder the enforcement, the more potent this selection pressure gets:
And the higher the potency, the easier it becomes to smuggle. Contrast marijuana, where they have to haul the stuff over by the bale, vs even one brick of super potent opioid which could supply half the country for a couple days.
Some of these synthetic opiates are a bit terrifying. There are some research chemicals available that are hundreds or thousands of times more potent than fentanyl and they're still technically legal.
It's so hard to work with these that even the drug boards say it's suicide to try to work with them without a clean room and a hazmat suit. If you inhale just a little bit of the drug dust in the air it will kill you.
It's gotten to the point where some of these respiratory depressant drugs can be used as a chemical weapon if inhaled.
For instance:
Heroin = 2.5x potency of morphine
Hydromorphone = 7.5x potency of morphine
Fentanyl = 120x potency of morphine
Carfentanyl = 5000x to 7500x the potency of morphine
Methoxyacetylfentanyl = 30,000x the potency of morphine
A lethal dose of Methoxyacetylfentanyl is so small it's not even visible to the naked eye. Some powdered methoxyacetylfentanyl released from a drone over a crowd would be disastrous.
> Is there any reason to treat these as drugs instead of just poisons?
because they have useful medical effects, a safe dose, and a decent therapeutic index. They have accepted uses in human and animal medicine.
That the effective (and lethal) doses are both very small (and thus hard to precisely meter and dispense) only becomes a problem for people who can't access pharmaceutical-grade opioids.
In Canada they have identified that Carfentanyl was found in current drugs on the street and after further evaluation was trigger for a strings of od deaths from last year to present that they had attributed to fentanyl.
There is of course still fentanyl related occurences aswell still, but scary Carfentanyl was in the wild already for some tims
So why not outlaw "any substance which is not already regulated which has _this_ effect on _that_ part of the human brain".
Then no matter how anyone tweaks the formula if it has analogous effect it's already illegal. Or switch from default allow mode to default prohibit mode.
This is a yellow journalism headline. Hearst would be proud.
As I've remarked before, the war on drugs and getting tough on crime is not working out too well for us, so it's time to change our plan.
I don't advocate off the shelf heroin or any of the cluster of ideas that suggest that. I do advocate focusing on the funnel that leads to addiction, homelessness, and death. Part of that is significantly amping up mental healthcare spending; part of that is having legally controlled drugs available in pharmacies for reasonable prices; part of that is supporting better schools (giving a window into a better world, and a way to climb through); part of that is supporting jobs programs. All of those relate in one way or another to the problem, some years and years earlier in the funnel.
No one is born choosing to be an addict in their later life; a series of choices and pressures put them there. The pressures from society can be changed, which shapes the set of choices visible.
I live next door to a rich heroin junkie. She has no job. What's left of her family has basically cut her off. She can afford all of the care in the world, but chooses heroin over treatment instead. Why? Heroin don't care.
The city of San Francisco took her dog away (twice) and declared her place a health hazard for a while, but ultimately it never forced her to get treatment and is tacitly approving of her heroin use. She hasn't paid her property taxes in years and the police come out about once a month, but the US has no ASBO laws so it's catch and release in hippie dippie SF.
She's got the money for the dope, and heroin don't care.
Part of me wonders what the problem is exactly? It doesn't sound like she's hurting anybody, just wasting her life away. But really, that's just my opinion. I think people who watch TV are wasting their life away, too, but it's really not my problem.
But to the OP's point, if heroin was sold at clinics or pharmacies there'd be an opportunity for nurses and pharmacists to intervene and offer alternatives before a person's a full blown addict. Even if it's just, "Hey, you're hitting it a bit hard lately, maybe try this meetup group instead."
Heroin dealers are pretty smart. Even if you have a ton of money, they'll only sell you a bit at a time. They don't want you doing something stupid and messing up their gravy train. At least, that's what I was told by someone who was a former heroin user (I asked him for advice and guidance in this situation).
She's wasting her life away, but also endangering others' (as well as her dog's). Her dog was taken away most recently because she was out on a weeklong bender and left the dog locked inside the house. After a few days of wailing and notices, animal control finally went in and rescued the dog. This being San Francisco, of course she got the dog back after claiming she went on vacation and just forgot about the dog.
That said, there was feces and urine piled up in the apartment for that week, and a few weeks after. She also had a stopped up toilet that backed up raw sewage into her apartment for "several weeks" according to the health dept. She was literally walking around on waste soaked carpets for weeks...and didn't care. Because heroin don't care.
She would also freak out and randomly dial 911 while high and insist that there were people in her apartment that were trying to kill her.
I, mean, I could go on for days writing up the crazy stuff she does while high. Her family wants nothing to do with her. She owns her place, has a pile of money, doesn't pay any real estate taxes, is a "frequent flier" for the police and fire department, but all of this is just A-OK, right San Francisco?
Honestly, I could care less about her life at this point. I'm just worried about the dog. It never gets walked and lives in literal squalor.
So your problem is with the animal abuse and not the heroin addiction? Heroin isn't helping, but for all you know she treats the dog that way when she's sober.
Definitely keep complaining to animal control about the dog, and report illegal activity, but other than that it sounds like you should mind your own business.
She creates a wake of police calls, fire department dispatches, defenestration on a regular basis, getting her lock drilled out at 3AM because she lost her keys on a bender, etc. Her behavior makes it my business (and everyone else around her).
Yeah, that's not surprising, both on the part of the City and the part of the addict. West Coast cities tend to be pretty schlubby about dealing with those sorts of issues, afaict. Unsure about other parts of the country.
That's part of why I think the funnel approach is going to yield better results: when someone's hooked, they are in deep trouble, and with far-reaching impacts.
My musing is that federal agencies are the right choice for this: they can ignore local pressure groups and focus on the global optimum.
Until people realise that this is a rational and sensical decision there won't be any solutions for these problems and these cases.
The US drug "treatment" / "rehab" industry is notoriously awful and is dominated by pseudo-religious ideologues obsessed with abstinence (to the point that "cult" is often an accurate, non-hyperbolic term) and whose practices are not based on any medical evidence of what reduces deaths. It's a fucked up industry that loves to use degradation, isolation, and humiliation on its "patients", loves to make people withdraw suddenly from their drug use and force them to endure the withdrawal symptoms, and isn't even particularly good at helping people not die from heroin/opioid use.
Given the current state of the rehab industry, and given how ineffective the "treatments" it offers are, it can alas be a rational decision to avoid it.
I don't have a solution, but my point was that not all addicts are victims. For some, it's a conscious decision about choosing heroin over life (insert Trainspotting ending here).
Unless the US adopts some sort of ASBO laws, there's not much you can do about forced treatment for someone who doesn't choose treatment.
Also, you could substitute heroin here with any other equally damaging substance like alcohol and the situation wouldn't change.
Even if ASBO laws were effective, I'd rather have a few drug abusers than ASBO laws. I don't want the government to be able to use force against people for being "anti-social", however that happens to be defined or interpreted. I've seen some ridiculous cases of punishment for "anti-social behavior" out of the UK, including what essentially amounts to outlawing particular unsavory political beliefs.
This is the problem with the HackerNews libertarian streak. You're in favor of legalized drugs, prostitution, etc. But no one wants their daughter to grow up and be a crackwhore.
I'd rather take the risk that my daughter would grow up to be a crack whore than leave anti-drug busybodies the kind of power they've managed to accrue.
How about we just let addicts be addicts while we figure the rest out. That's certainly better than today's situation where we make extra sure we ruin their lives to, ya know, protect them from themselves.
How about charging them for their public costs? If you get rescued by helicopter because you went skiing out of bounds at a resort and got lost, don't they send you a bill? How about that for people with money who abuse the system while abusing other things?
All economics are redistribution, it's simply the details that change with the methods. It is unrealistic to want a world where each person pays exactly for what they consume or are liable for.
Maybe you are right but I cannot understand or agree with this idea that has taken hold among some on the internet that we should be happy to pay taxes because the government will go and solve problems with that money. Beyond the fact that the government is horrible at allocating resources and using them efficiently, every tax is a dollar being taken from the economy that could have gone to people that produce things of value not what some bureaucrat decided was of value.
Three arguments in favor of governments and taxes:
1) Taxes are what makes a currency valuable (if you don't believe me, try printing your own money, or using Monopoly money, to pay for something)
2) Governments provide currency (also, see above). Look for the lowest interest rates on financial instruments, and you'll find governments.
3) Governments enforce property rights.
No taxes, no currency, no economy to speak of (see: anywhere without a functioning government).
I don't get how some on the internet live and breathe in a government-sponsored property and currency regime and rail against the government part of it, but want to keep the property and currency.
Sending the bill to the family is dumb but there's sense in sending the person responsible for damages bills. I think we already mostly do that though, they just don't always pay the bill.
From anecdotes of living beside the biggest open air drug market in Canada for a decade, and from watching my own friend's behavior growing up it seems to me the biggest problem is being unable to do anything when somebody you know or a family member becomes an addict. You can't force them into treatment, you can't even get the police to find them if they disappear into the streets, and the cycle in and out of jail just makes them career addicts as any chance of normal life seems over to them at that point.
Here if they check into detox, even if you are direct family you can't visit them or bring them anything because detox will deny they are there. You can't ask detox to call when they are released so you can pick them up and they don't end up released back on the streets.
Another problem is the waiting times for treatment. Real treatment is a long commitment sometimes living for years in a halfway house being supported by other peers to remain sober. An addict should be able to check into treatment and immediately commit themselves instead of waiting for months for a spot to open.
Lack of any facility for police to just dump out of control users and have them treated by doctors and addiction specialists is another issue. Often there are mentally ill with secondary addictions or other problems, and the police don't know what to do with them and money is wasted having them ferry around doctors to look at these addicts in jails or playing catch and release after a weekend in jail. A one stop sober shop and treatment option is always requested by police here but it never materializes.
Of course all of this costs money nobody will get elected with this spending platform on junkies until the synthetic opiates problem is so large the political will exists to do this.
All the addicts I've talked to including 2 of my friends who had a bad addiction for a few years, they all ended up addicts by becoming successful and partying to celebrate it. Anybody who lives in Vancouver if you go to VANDU and listen to one of their meetings sometime this is the same story you will hear: I was successful, I started drinking and partying, I used drugs to help regulate my sleep, or to get sober (cocaine sobers you up) or stay awake to function, I ended up an addict and lost everything here I am living in the dumpster or flop hotel being enabled by other addicts because I stole from every family member/friend and burned all those bridges.
Started an addiction clinic (outpatient) and I'm pretty convinced it's a great model for large populations. It's not for everyone initially - you may need more attention than weekly/bi-weekly visits to a treatment center, but we've seen more than half remain in treatment.
Of that group that stays in treatment, more than half got jobs (almost all without our help, although we're starting to help now). Focusing on rebuilding your life while on Suboxone, while having access to mental health professionals (doctors, counselors, therapists) is working.
Open 6 months, we're growing fast and hope to help everyone we can. Only one in our city who accepts insurance without a waiting list, and we do that exclusively (no self pay).
It's good you have immediate treatment they still can't figure that out here, the "Rapid Access Addiction Clinic" in that story is unfortunately not accessible to all addicts and has temporary funding.
Methadone is a full opioid agonist, similar to traditional opioids like painkillers and heroin. So the abuse potential is there. And nearly all methadone clinics don't provide additional supports (behavioral health or otherwise). They more or less function as pill mills.
I don't need to own the entire system with this stuff, but it's very hard to set up (unfortunately). Hoping more people wake up and are able to do similar things. And we're going to keep expanding access to treatment.
We only accept medicaid (for the poor in the US), who otherwise wouldn't have access to free treatment. They pay $300-500 per month for Suboxone at cash clinics, but typically don't get as much behavioral health treatment.
This reads like a thousand other articles over decades, like moral panic. There's always some new drug that's coming along, whether meth, this, bath salts, whatever.
When will culture come to its senses and realize that humans like to get high and that this will never stop?
Let's just focus on giving users accurate information and pathways out of usage, and skip the moral panics and claims that X is "sweeping the nation".
You do a great disservice to the people overdosing with such a middling dismissal. This is not a 'moral panic' this is a medical disaster unfolding in slow motion.
The combination of the technology to synthesize these drugs from unconstrained pre-cursors, the intensity of their effect, the lack of education on the part of consumers, and a tracking/enforcement system which responds more slowly than conditions change is leading to a situation where tens of thousands of people are going to die essentially at their own hand.
It is not a question of 'people like to get high' it is that 'people getting high on arbitrary things will kill themselves'.
I understand that you're approaching this from a legalization standpoint, and on that we agree. But the overdose rate is "actually" sweeping the country now and that is born out by the available reports of emergency rooms around the country. And between your "regulated and safe" future and now, there is a large pile of unnecessarily dead people.
I do realize this, and agree that a saner drug policy is to legalize them and regulate them rather than the prohibition we have today. My point is that between the time we can get to that point, and now, a lot of people are going to end up dead unnecessarily and that they are worth trying to save. Sometimes this sort of 'look how horrible it is' type of article can help with that.
If we had similar labelling for opiates, and distributed them in the same way we distribute booze or marijuana, surely they could be consumed more safely / appropriately. It seems the overdoses are not necessarily thrill seekers, but where the consumer doesn't know that they're taking a 5000x dose of morphine vs a 2.5x dose.
IMHO Marijuana isn't a relevant example for the parent's argument because it's not that dangerous; it still is distributed illegally except for a few states in the U.S. and parts of Europe, and (almost) nobody dies from marijuana overdoses.
> Some things are too dangerous to distribute to consumers, no matter how they are labeled.
opioids, especially the lower potency ones, do not meet this criteria at all. With tolerance, minimum effective dose increases, but so does the lethal dose. With pharmaceutical-grade opioids whose amounts are precisely metered, it's possible to live in that window.
It's only opioids under prohibition (aka, uncertain/varying doses and ingredients) that are inherently dangerous.
Labeling for opiates does not matter as opiates in and of themselves are highly unpredictable. Example: The same batch of heroin - first dose could be fine. You come back several hours later, take 1/3 the dose you did before and you're dead from an OD.
That's how a couple of people in my rehab ministry died. Meth is more reliably predictable in comparison.
This is an unintended side effect of the drugs being illegal. Make them legal, and addicts will have a safe, predictable and inexpensive access to the drugs.
Addicts are already punished enough just by being addicts. I doubt any of them want to be addicts. Making it illegal, heaping on more punishment, does not help and just makes it worse.
Government policy on addictive drugs should be focused on treatment, not punishment.
Interesting predictions, but I'd like to see research providing a basis for them before I take risks with people's health and lives.
I agree that the current approach works very poorly; that doesn't mean any other approach is better. Sometimes what works poorly is still the best we can do, such as our approach to pancreatic cancer (though I don't think that's the case here).
Government restricts access to many things for safety reasons, from unsafe cars to prescription drugs to dodgy financial deals to highly enriched uranium. It's a simple formula, almost a slogan, to say 'legalize it and consumers will decide for themselves' (and in fairness maybe the parent isn't being formulaic in this case). In some cases that's true; in some cases consumers simply don't have that capability. In our business, IT security is a good example; consumers have no way to make a judgment or even know that it's working. It's the same for prescription drugs: Am I better? Is that due to the drug? The placebo effect? Natural progress? Maybe I'd be even better without the drug.
But that's all theory; before we mess with people's lives, we need evidence.
> Government restricts access to many things for safety reasons
By making drugs illegal you cut off reliable, safe, and inexpensive access.
I personally know two addicts who OD'd because they acquired a batch of heroin that was more potent than they realized. One had been in and out of jail due to drugs.
They'd likely be alive today if addiction was treated as a disease rather than a crime.
If you make drugs legal, allowing for reliable, safe, and inexpensive access many more people will become addicts. What's the right trade-off between making the burden from addiction lighter for current addicts and protecting current non-addicts from addiction?
You said the fact that it is illegal makes access unreliable, unsafe and expensive. If find it hard to believe that reversing that situation would not increase usage at all!
For example, I voted in favor of marijuana legalization in Washington State. It's now legal. I didn't smoke weed before legalization, nor after. I simply have no desire for it. I don't know anyone who took up weed because it is now legal.
I'm sorry to hear about the people in your life that passed away.
I understand the claims, but without evidence they are only a couple claims among very many. Evidence is what separates science from all the other theories of the world.
What is the proportion between opiate consumption derived from Chinese mailorder sources and those from domestic US ones, prescriptions, and whatnot? NPR doesn't deign to explore this angle, which aids the "moral panic" critique.
You're talking about (legally prescribed) opiates, though, right? I'm not really sure what substances you're referencing from ER reports. Could you clarify?
Fentanyl is commonly sold in place of heroin with 'spacers' that are (hopefully) non-active compounds like talc or something else to mimic the difference in mass between fentanyl and heroin. Or heroin is 'boosted' by adding fentanyl to make it seem more potent/pure.
The problem with fentanyl is the dosage is in the micro-gram range which is why so many opiate addicts die from it. You simply can't gauge the dosage with such a powerful compound with any sort of accuracy.
This is patently false. Volumetric dosing is easy for even the most brain dead drug dealer to figure out. 1g furanylfentanyl in 1000ml of liquid, you can easily dose out 1ml=1mg
The problem is again with education. When heroin addicts are getting stuff cut with fentanyl, they fall out because they do not know what dose they are taking.
If you know how much you are taking, these fent analogs can (and have been for years) be used quite safely)
> When will culture come to its senses and realize that humans like to get high and that this will never stop?
People who become addicts don't like the highs and lows of the emotional roller coaster they're on, but it's the only way they know to cope with their emotional/physiological angst.
I've met someone who'd used cocaine 'recreationally'. His attitude was "been there, done that, don't need to use again."
Most of the street pharmacy's customers are self-medicating emotional pain. My mom didn't get hooked on the opiates her doctor recently gave her for her broken arm because she has a supportive environment.
The friend (who I've written about here before) relapsed on cocaine because she was depressed. Then she relapsed on heroin, supposedly to treat the high blood pressure cocaine gave her (but probably more because she needed something to 'numb' emotional pain). This was the summer before she met me.
Really I think she just must've been lonely. This week I found a copy of a book she gave me for my birthday after we met. She inscribed it, in part, "my heart melted the moment I first heard you speak."
I think I've successfully bullied her current court-ordered mental health providers into recognizing the mistaken diagnosis made by their colleagues in the other county. The earlier psychiatrists just thought she was "persistently disabled" because they didn't try to figure out why she'd become psychotic in the first place (doctor-administered depo provera birth control injections made her suicidal -> street pharmacy -> psychosis).
To add to what you're saying, many users aren't just self-medicating emotional pain, but serious psychiatric illnesses. This can be for a number of reasons: lack of insurance coverage, difficulty navigating the medical system (which can be very challenging for someone with mental illness), and unfortunately, the fact that modern medical science just does not have effective treatments available for some of these conditions.
Branding these people as criminals and throwing them in prison is outright cruel.
> and unfortunately, the fact that modern medical science just does not have effective treatments available for some of these conditions.
I suspect that many psychiatric illnesses are indicative of metabolic disorders, and/or malnourishment. An effort to apply the findings of physiology to psychiatric practice would certainly lead to an Understanding that would allow effective treatments to become mainstream.
> Branding these people as criminals and throwing them in prison is outright cruel.
In the future the 'war on plants' will certainly be recognized as a crime against humanity, or at least as society's autoimmune disease.
> Really I think she just must've been lonely. This week I found a copy of a book she gave me for my birthday after we met. She inscribed it, in part, "my heart melted the moment I first heard you speak."
> I think I've successfully bullied her current court-ordered mental health providers into recognizing the mistaken diagnosis made by their colleagues in the other county.
I don't know who you or her are but the situation you describe is rather familiar to me. Thank you for being around for someone else and doing these sorts of things to help them.
You've undoubtedly met lots of people who have used cocaine recreationally. I think it's a lot easier to do than using opiates recreationally.
Cocaine gets a bad rap and probably justifiably so (as it has ruined or taken more than few lives) but it's not the same type of addiction as opiates. If people were able to use cocaine responsibly in small amounts I really think it wouldn't be much of an issue. The trouble is that people have trouble gauging where they and tend to go overboard, particularly during a session. But it doesn't have to be used like this. A good analogy might be turning up a bottle of liquor vs slowly enjoying a few beers. With cocaine many people are simply unable to resist the temptation of overdoing and it causes problems. But in my mind it's not the same level of harmful as something like opiates or methamphetamine.
I don't recommend running out and looking for cocaine because "hey it's not really that bad" though. Chances are good you'll get carried away. As for smoking or injecting cocaine, that's a whole different topic.
A lot of people use cocaine recreationally but you don't see what happens to them after you stop going to the parties. Therefore you can go through decades of seeing the stuff around and having friends that will take the stuff if it is going, but not see what happens to people who get a proper taste for the stuff.
A girl I work with moved house a couple of years ago, to move in with some cool people who invited her out to cool parties. To fit in she tried the cocaine, then moved on to buying her own to share with her best friend. Roll on two years and her life is as good as over. Bearing in mind that she is just a workmate, not the love of my life or a relation, however, finding out that she has moved on from cocaine to crack has been the most shocking thing that has happened to my life. Today she has conjunctivitis which is a progression of what kept her off work last week - some grizzly puss filled sores in her throat and ears. Obviously it is just a flu and not because she has wiped out her sinuses by smoking/snorting cocaine.
As mentioned I have seen these white powders around all my life, if I think now how lucky I was to be naive enough to not take the path of my workmate, otherwise I would be done over a dozen times by now!!! Only now in seeing the descent of my workmate have I learned what these things do. I am now wondering how the marriages and jobs worked out with those people I saw along the way with the white powders at parties, maybe I saw them at the stage my workmate was at a couple of years ago, seemingly in control.
I have had to read 'Beyond Addiction' to personally cope with the one-person humanitarian crisis that I only learned of three months ago. I can already see how the next stage gets progressed to, my workmate has nightmares and awful sleep, I believe that 'benzos' help with that or there is also the heroin mix. So then there is the descent into homelessness and prostitution, then the legendary rock bottom where a methodone script can be my workmate's existence for the rest of her days.
I would do anything to save my workmate but it is already too late. If she lasts three months in work then that will be a miracle. With a 'payday loans' existence as it is the fall is going to be out of control crazy stuff.
Essentially her problem is a triple onion of the childhood hurt, the drug itself and the scene of 'happy party people' that she 'has a good time with'. She thinks that if she can solve the childhood hurt then everything will be great but she ignores the elephant in the room.
The disease she has is 'addiction' and there is no cure. It makes no difference whether she is on cocaine or opiates because the journey is the same. It is a horror movie and it really does affect more than just the addict.
I've witnessed crack cocaine induced psychosis, before I knew anything about psychosis. People can recover from a lot of damage with the right interventions.
I understand that Cocaine's effect on brain chemistry is sort-of like the Mono Amine Oxidase Inhibitors (MAOIs, 1st-generation anti-depressants). The reversible MAOIs are safer than the non-reversible ones.
Methylene Blue is a research chemical that has MAOI properties, and is reversible.
If you're interested in emailing let me know where to contact you.
> Not sure about the US, but there has been significant overdoses and fatalities relating to fentanyl and other related.
Same here in the US. I live in a heavily effected area and its always the same thing fentanyl. People are used to taking a certain dose so that's what they do not knowing fentanyl is in there and it usually results in a death unless someone has or can get narcan there quickly.
Part of me wonders why they don't just do a little first and then do more, but I guess I get it- they are addicted and they just want their fix ASAP.
It would seem logical to use a little to test the potency of a new batch especially. Unfortunately, as an ex user, when you're sick, you're going to do your usual shot or more. I've lost a few friends that were coming down to hard to care about a little to get well first. Big shot, dead.
That's the thing though, a difference of smaller than a grain of salt would be a death sentence.
So if you try a small sample, or a large one, it doesn't matter.. it could be the next hit you try has that extra microgram of fentanyl.
I have had friends with brothers who died from taking a all night study aid in university, that happened to have Carfentanyl in it.
Always caution on the side of safe regardless of what type of illicit drug is, or if it's your first time, once in a lifetime.
They just don't make illicit drugs like they use to...
They could definately kill u always, but now the potency of a microgram difference can and that's pretty scary.
> They just don't make illicit drugs like they use to... They could definately kill u always, but now the potency of a microgram difference can and that's pretty scary.
The problem is that an illegal drug has no quality control. If you want to stop this kind of stuff, legalizing it is one of the few (possibly only) useful solutions.
>> It's a word of caution, you don't know what's in your drugs, it can kill you more than ever.
People aren't very selective at what they stick up their nose or in their veins. Your average cocaine end-user is the 14th person who's had their hands on that particular drug. Chances are it's been cut with who the heck knows what at every step along the way, since everyone wants to maximize their profits.
When you get a package of what-should-be drugs from China or Colombia or anywhere, who's to say what's actually in it? The FDA isn't testing that stuff. If you think it's heroin and there's even a little fentanyl mixed in it, your last use could be fatal.
I never finished watching Breaking Bad, but the season or two that I did watch did make me think:
How much safer would 'recreational users' be if they had a legal, clean (pure), supply and a place to use it where they are monitored?
As the parent posts have said, the above combined with help for getting out of the hole in the same place would probably be more effective. It would /ALSO/ be the most effective way of defeating the criminals that make money off of the drugs; by depriving them of sales.
Much safer. This Swiss have implemented this and have published the results. There were large improvements in almost every public health/safety issue caused by heroin use [0].
>Crime Issues: 60% drop in felony crimes by patients (80% drop after one year in the program). 82% drop in patients selling heroin.
>Death Rates: No one has died from a heroin overdose since the inception of the program. The heroin used is inspected for purity and strength by technicians.
>Disease Rates: New infections of Hepatitis and HIV have been reduced for patients in the program.
>New Use Rates: Slightly lower than expected. 1) As reported in the Lancet June 3, 2006, the medicalisation of using heroin has tarnished the image of heroin and made it unattractive to young people. 2) Most new users are introduced to heroin by members of their social group and 50% of users also deal to support their habit. Therefore, with so many users/sellers in treatment, non-users have fewer opportunities to be exposed to heroin, especially in the rural areas.
>*Cost Issues: 48 dollars/day: Patient costs are covered by national health insurance agency. Patients pay 700 dollars/year for the compulsory insurance. Note: The Swiss save about 38 dollars per day per patient mostly in lowered costs for court and police time, due to less crime committed by the patients.
They removed any kind of help getting out of the hole here from supervised injection sites because the addicts here have a drug taking union and claimed it shamed drug users implying they had a problem. They claim the problem is prohibition, and that's why they need a safe injection site in the first place because quality of drugs cannot be determined so they're forced to shoot up there to not die from synthetic adulterated heroin.
Legalized drugs would absolutely deprive criminals of domestic profits but there would still be gangs that export and fight over that black market. For example large amounts of marijuana in Canada ends up exported to Vietnam and sold at every newspaper stand in Hanoi for premium prices to the new middle class users there. The various gangs shoot each other here on a regular basis for control of that export operation or rob legal grows to get free product. In other words large amounts of money will have to go to export prevention enforcement.
The best argument for legalized/regulated narcotics is it prevents this kind of synthetic opioid medical disaster by either prescribing heroin to addicts or selling it without prohibition price spikes due to busts, so the incentive to import cheaper synthetics is gone and drug quality could be more easily identified by the end user. The income from any sales can go to treatment to prevent new addicts but many of us remember having been promised by governments who run gambling/lotteries how that money would go towards gambling addiction treatment and instead it just disappeared into general revenue.
This has already been implemented in some European countries, I know they opened what's called a "salle de shoot" ("supervised injection site" in English) last year in Paris.
I don't think there's any data out yet, but the idea was to prevent overdoses, but also provide clean syringes to avoid HIV transmission.
When you get a package of what-should-be drugs from China or Colombia or anywhere, who's to say what's actually in it?
It depends. Someone looked at PDE5 inhibitors (i.e. Viagra) purchased from online pharmacies and found that their products were accurately labeled. They were "own-brand" and from a clandestine lab, however the product was what is claimed to be. But these pharmacies rely on repeat customers and word-of-mouth, that encourages them to be responsible.
Dunno about opiates. If the customers seek consistent quality and use a "research chemical" website instead of a guy on a street corner this may actually be a step in the right direction, you get consistent quality, and opiate addicts with a regular supply of drug are surprisingly functional.
The patent literature is vast and the pharmacology established. You don't have to resort to the kind of experimentation that Shulgin did when he worked on phenethylamines (i.e. amphetamines).
Hadley Wickham of R-Studio and ggplot fame did a great talk on data plotting using his tinyverse tools. The dataset was from the DEA and one of the interesting things is almost every seized shipment of drugs was cut. Purity is rare. I know addicts by definition have little or no control but this sounds like a fool's game to me. One with potentially deadly consequences.
Anecdotally the issue of potentially fatal heroin doses from fentanyl adulteration came up in a citizen's police class I took in Houston. One of the officers there claimed drug dealers don't mind accidentally killing the occasional customer because it puts word on the street that the dealer has really potent product. Who knows if that's really true but it's an interesting theory, anyway.
> When you get a package of what-should-be drugs from China or Colombia or anywhere, who's to say what's actually in it?
I can almost guarantee, if you get a drug in the mail chances are its a research chemical that will probably get you high, but NOBODY knows what the long term effects are.
Some would say it is just karma or blow back for all the unjust wars the US of America keep on waging to keep its monopoly on resources, be it oil, drugs or human resources...
It seems like an ironic reversal of sorts in Sino-western opium relations, given the Opium Wars[0], which if I understood correctly, forced China to accept opium trade from the British.
Note that it was primarily the UK, not the USA, who were the ones started pushing opium on Qing China (and were the most successful, it would be more ironic if they were sending opium to the UK). Also, the boxer rebellion comes long after the opium wars.
Anyways, if that many opiates are being exported to to the US, one has to wonder how many are sloshing around inside China itself.
It's amazing what isn't legal to buy or sell in the USA, but you can easily buy from China and have delivered in the mail. $100 of testosterone powder which you can re-constitute and sell for $20,000 on the street here. Some of the more sophisticated resellers will even pack your order inside of a less conspicuous object.
If you order anything at all for consumption from China be aware that you may get anything and everything besides the product that you ordered. White powder of any kind is an easy substitute for white powder of any other kind.
I don't know how much is psychology/paranoia, but every package I get from there smells chemically bad. One stupid plastic case for a laptop dvd drive gave me headache I had to throw the thing out.
That said, I also bought an old FP book from the US and got a similar smell.
Yellow journalism just attacked your postal secret, your democracy ; this by means of using your disdain for junkies and drugs.
Who else besides the mentioned politician and a large chunk of the logistics sector profits ? Put their heads on a pike, show the world how utilitarian their true face is.
IANAL but would be interested to hear from one about the privacy and financial implications of this bill. For example, (d)(1) seems to suggest a $1 processing fee for non-letter class mail originating outside the US.
I wonder as an analogy what markets would develop if caffeine sources were illegal. Caffeine isn't as harmful as other drugs but it is very addictive. By the same extension, this is why I think getting any drug should be eaiser. It's safer
>A better example of prohibition backfiring is with marijuana, where before prohibition ~0% of Americans were marijuana users, whereas today ~85% of American adults have used marijuana.
No a better example was when Alex3917 made up shit, and then tried to legitimize his shit by comparing regular "users" to the population that has had at least one use. Wait that's not a better example, I'm just calling you out.
Cannabis use was alive and well before Federal Prohibition, Alcohol and Marijuana. ~0% of Americans were users? Maybe in the early 1400s.
Harry Anslinger estimated that there were 100,000 marijuana users when marijuana was banned 1937, when the U.S. population was ~129 million. In other words, a little less than 0.08%, or ~0%. Fail.
Sure, but he wasn't exactly known for underestimating the scope of any drug-related problems. A better analogy would be that if Falwell says that gay marriage isn't responsible for causing hurricanes, you can probably take his word for it.
Before opioid prohibition deaths from opioid use were quite rare. You ever heard a pothead drone on about "it's nearly impossible to overdose from smoking marijuana"? The same thing applies to smoking opium. It's nearly impossible to overdose on that. But prohibition has pushed us from opium smoking and oral laudanum to injectable heroin to fentanyl and now we're at carfentanil.
The current USian "opioid crisis" is another manifestation of opioid prohibition pushing people from safer, cheaper, less disruptive and deadly drugs to more deadlier ones. Two decades ago some USian opioid users could go to pill mills and get prescriptions for pharmaceutical grade opioids but the DEA kicked down doctor's doors a bunch and that ended up pushing people to the illicit market. Maybe next time you see those scary increasing graphs of opioid deaths vs time, give that a thought? Sum up all those deaths (compared to the baseline, prior to the increased LEA focus on "pill mills) and ask yourself: are all those needless deaths worth it?
For a unit volume (so, for a unit risk of ending up in a concrete box as a consequence of shipping/making raw product) of uncut/active material, you want to be able to sell the most diluted/cut doses to end-users. Of course people will want their chemist to synthesise carfentanil (over regular fentanyl), because you can supply the the same number of end-user doses with 10,000 times less active material. The harder the enforcement, the more potent this selection pressure gets: https://en.wikipedia.org/wiki/Iron_law_of_prohibition