I live in SF and work in Civic Center. Not long ago I attended to a guy who was OD'ing on the sidewalk, and a number of things about the experience surprised me. I called 911 when the guy started seizing. He stopped breathing but still had a decent radial pulse, and I was surprised that the 911 operator wanted me to start chest compressions nonetheless. I was doubly surprised that the operator wanted me to stay on the phone while I did it, which is basically impossible. I just said "I know how to do it I'm putting the phone down." As I was doing it I yelled for Narcan and the junkies on the block immediately leapt into action trying to find some. Eventually somebody came by with some and set about giving him an IM injection. I thought, "I don't know if that needle is clean but I also don't know when the EMT's will get here so I guess it's better for him to get hep or HIV than for him to die." When the EMT's finally showed (probably quicker than it seemed) the first thing they did was start yelling at everyone, especially the woman with the Narcan. I found it very unprofessional.
I'm very glad you and the nearby opioid addicts were able to help that person.
Regarding the EMTs yelling, could they have been trying to clear people away, to be confident the scene safe for themselves (one of the first steps I've heard some first responders have), or to get access to the patient? Or maybe the opioid epidemic is wearing heavily on them, though they keep doing their job?
(I looked into EMT-B training a while ago, and it's a really difficult, scary, and severely underpaid job. I probably couldn't do that job for very long, emotionally, even if I could afford it financially. Ironically, the compensation for being an EMT, helping people, seems unfortunately backwards, by societal value, with a lot of software jobs I'm considering right now.)
I agree with you re: the bottom point about EMT's salaries. It's the same with teachers; they're one of the most essential parts of society, and they're paid so little.
An example: in Georgia, just picking a random county, teachers make around 20,000~60,000$ a year, leaning more toward the lower end. It seems that importance to society and salary are negatively correlated...
> they're one of the most essential parts of society, and they're paid so little.
They can somehow hire enough even at this salaries, and appear to think that's enough. Quality of education is hard to measure, and it takes very long to measure, much longer than a typical election term.
Agreed, however the turnover is terrible. With the low wages and tough working conditions, the department I worked had 15 EMT-firefighters when fully staffed, which was pretty much never. We averaged a little over two and a half new hires a year the time I worked there, nearl 17 percent turnover, every year. Ran into a former coworker a the grocery store a few months ago, he told me an entire shift just quit, a third of the department. That is no way to run a business.
>> I agree with you re: the bottom point about EMT's salaries. It's the same with teachers; they're one of the most essential parts of society, and they're paid so little.
See also:
- Truckers
- Farmers (though some do pretty well) and farmhands
Recently retired EMT here. Kudos for saving a life. I very seldom saw a person OD more than once, but it happens some times. I once ran on the same guy ODing three times in 24 hours. He died of an OD a few weeks later, though not on my shift. He was only 18. Folks, if you are going to use opiates, keep a friend that knows CPR with you. Simple chest compressions can keep adequate air exchange until somebody arrives with Narcan.
There are two drugs I carried that had an instand life saving effect: Narcan and D50 (50% dextrose solution). Somebody with low blood sugar will often present with a radically altered level of response, if they are even conscious. Start an IV, push D50 and within seconds, they sit up and talk to you as if nothing is out of the ordinary. Be advised, it is relatively short lived and the patient needs to consume some complex carbohydrates or protien to sustain their blood sugar levels.
Yes, it is terribly under paid, but there is great job security. I worked tech/research most of my adult life, but market and government priority changes made it really tough to work toward a retirement. It seems every few years, either the project was cancelled, or the line was shut down.
As an EMT/firefighter, my minimum week was 56 hours (by federal law due to the standard 33% duty cycle of a 24 hour, 7 day week) and sometimes nearly double that. Unfortunately, only the firstw 40 hours, (at just above minimuim wage) applied toward retirement benefits where I worked.
I got a lot of satisfaction from being an EMT-B. But no pay; I was a volunteer. If you're at all interested and you already have a day job I recommend you seek out a volunteer fire department near where you live, or move to an area that has one. Often they will pay for your training if you agree to be on call.
The reason why they tell you to start chest compressions when the breathing stops even if you think you feel a pulse is that it is really easy to feel your own pulse, especially in such a high pressure situation. If the electric circuitry of the heart is still intact you wont damage it, but if you skipped compression because you felt your pulse that person is very dead.
On what is so hard with putting the cell phone on speaker and setting it down next to the downed person? Your are still on the line but have your hands free?
Aside from that: thanks for helping a fellow human and congratulations on keeping it together under high pressure.
Well yeah. Chest compressions produce enough air exchange even without rescue breath to keep the person alive for 5-10 minutes. If you have to do CPR longer than that outcomes are better with rescue breath. I hope you do have a mask or at least a face shield when you have to do that for a stranger...
A policeman I know was telling me how a few times he had to get Narcan from the nearby junkies to save the person who was OD-ing.
I had forgotten to ask if there is any legality or cover-your-ass issues there, say if they infect the person or the Narcan ends up being something else that kills the person. I imagine they probably thought this person is going to die and decided to do it anyway.
It's sad that such altruistic behavior can lead to massive litigation, but that's probably what the EMTs were thinking. You did the right thing for sure, but I'm willing to bet junkies are statistically more likely to attempt litigation in order to feed their addiction.
I strongly believe that calling medications by their brand name is a bad idea. It's marketing departments' work to put into peoples' heads their stupid and annoying brand names. They want people to seek %brand_name% rather than %chemical_name%. They want people not even to know actual names of the chemicals. It's so widespread that people start thinking that medications called by their brand names are more effective than their generics. Companies that produce and sell generics have to write on the packages "compares to the active ingredient of %brand_name%™" otherwise people will not buy it. People don't know what diphenhydramine is, they only know B......l, and it's the only antihistamine they know. For that reason, when two exactly same medications are located at the counter right next to each other, one plain small adequately-looking box with a generic, and another one is a colorful oversized stupidly-named box with words "ultra", "fast", "extra", that easily costs 3 times more, people go for the later. Don't propagate this practice.
This seems to be a uniquely American problem. I’m a Brit who now lives in the USA, but back in the UK, calling things by their generic drug name was the default, and while brand names were also still common, there was usually more than one to choose from.
Aside: It took me far too long to figure out that “paracetamol” is called “acetaminophen” in the USA. You would think that at least the generic names would be universal.
Technically, the true generic name is para-acetylaminophenol, from which both paracetamol and acetaminophen are derived (and Tylenol, for that matter). That nobody ever calls it para-acetylaminophenol (and that I needed to copy/paste that because I can neither spell nor pronounce it) is a good indication why brand names are preferred over chemical names.
I know that in the UK painkillers that contain codeine as an additive are common, which makes them stronger. I don’t believe it’s possible to get it in the USA.
To make up for it, it’s very difficult to buy painkillers in the UK in quantities of more than about 8, while Costco sells jars of literally hundreds of tablets.
In the UK you can buy 16 tablets of paracetamol off the shelf. You can buy 32 tablets over the counter. You can have a discussion with a pharmacist if you want to buy more - up to about 100.
This is a useful suicide prevention measure and we've seen deaths by suicide from paracetamol reducing a bit as a result.
I was 35 before I understood, truly, deeply understood why people become addicted to opiods. Prior to 35 never had pain medication of any kind. Got a kidney stone, writhing in pain, vomiting, couldn't quit crying. The pain is the worst you can experience.
IV Morphine wasn't touching it. Then she came in. An older lady and told me it was going to be alright. She pulled a syringe up and I was blubbering in pain, crying and explaining to her I would do anything to make the pain stop and how I
I quit talking. I quit crying. I was comfortable. Happy. Content. The world was fine.
It was Dilaudid.
When I was released it occurred to me that this is how people feel when using the drugs.
The best explanation I've ever heard is from a reddit comment:
It blows my mind people still link to that YouTube video. I wrote that comment nearly 10 years ago, not that I have any proof. It's cool to see something I wrote have staying power.
I'm glad that it spoke to you! Yeah I wrote it when I was 21 and wayward. Thankfully shortly thereafter I found that a strict regimen of programming, lifting weights, exercise, math, statistics etc gave me more than enough meaning to occupy my time and interest, at which point drugs got boring. Hence why I'm on hacker news :)
All you needed was stimulation and a plan. Without a plan you don't have motivation and without motivation you develop anxiety and begin seeking an escape. With a solid plan, you find that an addiction just gets in the way of what you want to do. Glad you're doing better! Good luck!
Yeah, stimulation was the big one. I eventually realized that it's sort of impossible for me to 'relax' (more than 5 hours a week). I just can't do it, and when I try I get frustrated. So I've developed a lot of self-development hobbies instead, which works out well.
I had the exact same experience. I had the kidney stone and dilaudid about 10 years ago, but deep down still hope to get a kidney stone again so I can have that feeling again. It’s terrifying. (And I don’t think they’ll even administer it anymore for kidney stones.)
I have had them 3 times since. The last time was after the opioid crisis hit and I was petrified I wouldn't be able to find relief. The local hospital no longer provides anything more than morphine in the ER; you have to be admitted. I was admitted and no issues getting the shot.
Somewhat tangential here: I once fell off a high wall and broke my leg in two places. A couple months prior to that, I’d had a kidney stone. As I lay there in the mud clutching my leg, one of my first thoughts was, “hey, this isn’t nearly as bad as a kidney stone.”
I once had a motorcycle kickstart lever shove my thumb backwards through the middle of my wrist. An odd feeling, looking at hand-bits poking out of one's skin. And my first thought was exactly the same as yours!
tl;dr: kidney stones suck. When we say that they hurt more than $terribad_injury, that is not hyperbole.
Contextualization and personality wrt addiction are major factors though.
I had morphine for for extreme pains as I had my appendix blow out and my whole abdomen was a cesspool for a few weeks in hospital. I never had withdrawal nor addiction symptoms as the experience was confined to hospital.
I am lucky to have a personality type that can easily externalize addiction. Basically for me it is like flipping a switch, or confining the feelings to certain contexts.
Even so, I can easily see how people do get addicted beyond their control, so I would never say it is 'easy' to 'just stop'.
Reading everyone's experiences with Dilaudid is really interesting to me. I had appendicitis a year-and-a-half ago. It was the most incredible pain I'd ever experienced in my life. They gave me Dilaudid in the ER - a pretty good dose apparently - and it barely touched the pain.. maybe took it down a notch or two. Even after a second dose, the pain was still incredible. Looking back, it did dull it and just put me in a daze. So, yes a large dose helped, but I didn't get the experience others are talking about.
Edit: a nurse friend came to visit after surgery and said: "oh, they gave you the good stuff." I still wasn't impressed.
Interesting to bump into this article as a young friend recently quit his just-obtained ambulance EMT job for, in essence, the exact issues described.
His take was less sympathetic (paraphrasing): "i thought i would be helping society, not endlessly cleaning up after its recurring mess-making."
I know a few people in first response fields (eg, fire, emergency med, police) and this is a common view, albeit not often leading them to quit their jobs.
Since there is seemingly no political will to prevent and mitigate drug epidemics, the issue rolls downhill to emergency workers.
I worked for a year as an EMT, and saw a lot of folks who were extremely jaded and unsympathetic after years of dealing with this. There were a few angels who did really feel that they were doing the good work, but it is really hard to keep that attitude up for long in the face of this.
Recently retired EMT here. You hit the nail on the head. For me, dealing with the patients was the easy part. I had one simple rule: just be nice and show that you care. Sometimes, that was the most important thing, especially with the chronic "frequent fliers" we were picking up nearly every day.
Coworkers were the hardest part, not just that they were jaded, but they actively viewed coworkers that did not ascribe to their jaded worldview as the enemy.
Similar experience w.r.t. patients (my coworkers were great though). It's really not about saving lives. It's about confidently telling somebody it's going to be okay when they are having the worst day of their life. That means the world to people.
Narcan can also be delivered via nasal spray. I’ve heard of patients waking up and immediately taking a swing at the medic who administered the narcan.
It’s fast and potent, but only lasts a few minutes. For a really bad OD, you might go through several doses.
Where I am Narcan is $50+ per dose, a small price to save a life but kinda crazy when you meet the same patients again and again.
Recently retired EMT here. I never found the nasal spray to be very effective for a number of reasons. The patient has to be breathing, absorption rate is highly variable and it is difficult to adjust the dose. In fact, our protocols did not allow the dose to be adjusted with the intranasal route.
IV push is the best, though SQ and IM are pretty good. IM and SQ are slow acting. You have to slowly bring the patient up. The important thing is to titrate dosage to rate and depth of breathing and slowly bring the patient up. If you push a large dose and suddenly rip the patient out of their warm, fuzzy cloud, into a world of hurt, they will often come up swinging.
You can breathe for a patient with artificial respiration for as long as needed, there is no rush to slam the Narcan in quickly. In fact, the protocols I ran under said nothing about bringing an OD patient back to consciousness, only to ensure adequate air exchange.
Also, talk to the patient with soothing, caring tones. Even though they are not responding, they can still hear you, increasingly so as the Narcan takes effect.
I never had a patient swing at me after administering Narcan once learning technique from a master that had administered literally gallons of the stuff over his career.
Some of the more jaded EMTs will purposely slam an OD patient with Narcan to punish them for using. This is just wrong.
Former UK EMT and I agree with this. Treat everyone, even the frequent flyers, professionally. Same protocol as well; keep me safe from angry addicts by not fully rousing ODs!
The problem with nasal spray is that the patient still has to breathe. That's a tall order for someone who's OD'd. And it is why injectors are used instead.
Not sure why you think this will be a problem. The naloxone won't block the nose and will be absorbed through the nasal membranes. If the patient needs extra oxygen or artifical ventilation that's still feasible.
Everybody needs regular food to avoid dying. Many need insulin or heart medication. Many need regular pills to keep their brains from going off the rails. Is this so different?
Most people don’t have their groceries delivered via ambulance, and risk dying if their food doesn’t arrive soon enough. If you did that, then yeah I’d say that’s kinda crazy too.
Some would see narcan as more like deploying car airbags - good that it's kept you alive, but if you need them routinely you should probably think twice before getting behind the wheel.
Overdosing isnt an unfortunate sideffect, its people making an error while dosing. An error that is easily preventable with a bit of care. The airback equivalent is very much fitting, its an emergency aid for once you made a mistake. If you are overdosing regularly, you are majorly screwing up making unnecessary mistakes.
I doubt it's easily preventable, or there wouldn't be so much of it. My understanding is that drugs are cut to varying strengths, and sometimes are laced with stuff like fentanyl or other compounds that you weren't expecting and that are highly active at lower doses.
Preventing ODs is easy if you have a pure product of an exact known strength and an accurate scale, but these conditions aren't often true in the real world.
Its largely preventable if you act with a reasonable level of care. Test the water with a new batch before you use it, even if its just administering a fraction of what you cooked up first. You are unlikely to have such potent stuff that a hundredth of an active dose is giving you an OD. That is unless someone is actively trying to kill you. The equivalent of an allergy test is nothing specific to injecting hard drugs.
Addicts often dont do it since the test dosage is wasted and its extra injection. It becomes especially problematic when money is tight and you buy individual bubbles. But that is the inherent risk you take with street drugs and the care and effort you have to invest to not OD. Its like never sharing anything that goes into your veins. Neither an OD nor catching HIV or Hep-C are cases of just bad luck, they are the result of being reckless and skipping an important and necessary step.
Given the psychology of addiction, is it reasonable to expect an addict who's seriously jonesing for a hit to be this cautious and delay the satisfaction of getting high?
I dont see how there is a difference to not sharing needles. The addiction argument is the same there and even people at the end of their line managed to follow that rule during the periods in history where the war on drugs included syringes as drug paraphernalia. Its simply not an option to break that rule. No ifs or buts.
Overdosing pretty clearly is an unfortunate side effect of addiction to a substance that can be overdosed with, especially one that has to be obtained on the black market.
The equivalent of an allergy test is not optional if you consume street drugs of an unknown composition. Its like never sharing anything that goes into your veins. Getting HIV or Hep-C isnt an unfortunate side effect either, its people making a stupid mistake despite knowing better. You dont have to get HIV or even HEP-C as an addict just as you dont have to OD. Make the effort and follow the appropriate precautions or you are playing Russian roulette.
As unfortunate as it is, but normally people who OD are those that no longer care if they do. There are freak exceptions of course, like tainted or mixed up batches where even a allergy test can kill you, but those arent happening regularly to individual users.
People are just risking it, and its a very human thing to do. You can see the same behavior with the failure to use protection during sex. People should know better, but some people still risk it and are then faced with the unfortunate consequences.
edit: Dont get me wrong this isnt about victim blaming, but not promoting the myth that these things are just out of peoples control like the weather. You can be a heroin addict without catching HIV or Hep-C and with a reasonable level of care you are not going to end up needing Narcan regularly. You already fucked up by becoming an addict, there is no reason to also OD or catch something. Telling people that these are just inherent side effects to being an addict just makes it easier on people to excuse themselves for forgoing basic safety precautions. ODing regularly is not something normal, even for an addict. Its the result of being reckless.
Eating healthy food and exercising regularly isn’t optional in this sense either, and yet people avoid it. Sunscreen isn’t optional if you’re light skinned and go out in the sun, but people often skip it. More examples abound.
You can talk about what people should do all you want, it doesn’t change anything.
My main point is that, as a health problem, drug addiction doesn’t look that much different from a lot of other health problems. Personal choices greatly influence your chances of acquiring it, your ability to beat it, and your odds of dying from it. This applies to many other medical conditions as well, but attitudes toward addicts are vastly different.
>Eating healthy food and exercising regularly isn’t optional in this sense either, and yet people avoid it. Sunscreen isn’t optional if you’re light skinned and go out in the sun, but people often skip it. More examples abound.
And if you are an adult chances are you know better and those arent unfortunate sideffects either. Its precautions you have to take or risk the consequences. If you get a sunburn you are not a poor victim of the sun but an idiot who skipped the necessary step of using sunscreen. As a result you are risking skin cancer. If you dont brush your teeth you get caries. It is similarly absurd to say that caries are the unfortunate sideeffects of eating. They are the reaction to your behavior of not brushing your teeth as you should. Wearing your belt in a car isnt optional either just because you have airbags. The human race, and with them you, know of what precautions you have to take to avoid certain fates. The higher the risk, the less optional they become. You might spend a day in the sun without sunscreen, the increased risk of skincancer might however be minimal if its not a regular occurrence. The risk of sharing a needle or the same watercup during cooking however is just to grave for being stupid.
Your point seems to be, that people make mistakes. I agree, but they dont have to make mistakes where they know better. There is a difference between an "ups" mistake and just a stupidly destructive choice. Unless there is a severe lack of information they chose to do something stupid for little to none benefit. Thats no mistake, thats action and reaction where you decided to no longer care for the reaction. It is people making the unfortunate decision to go from seeing themselves as addicts to seeing themselves as junkies where the tomorrow doesnt matter anymore. Sure, you can argue that there are clean people with a similar disregard for their future. Just pick people who actually live after the motto "live fast and die young". Or who are eating or drinking themselves to death. They however are making a problematic choice too.
>My main point is that, as a health problem, drug addiction doesn’t look that much different from a lot of other health problems.
I kind of agree. However different to being an addict, being a junkie is a separate kind of problem stemming from deeply destructive choices you make consciously or unconsciously. You can become an addict, there arent however good reasons and rarely good excuses for becoming a junkie. I think a vastly different approach has to be taken to help addicts then ro help people who see themselves as junkies. If you are ODing regularly, changes are you should be treated as a suicide risk who lost your will of self preservation. I dont disagree that there are other people who dont use illegal drugs where the same applies, but thats why we as a society run mental health emergency wards. Differently put, if you are ODing regularly or no longer care that you share syringes you are having a second much more dangerous problem next to your deeply unhealthy habit of injecting unknown illegal drugcocktails to escape whatever. You are having a death wish.
Well, if you're spending $50 over and over to save the life of someone who then immediately gets back up and goes off to find more heroin, then "what price is a human life worth" is an interesting question indeed. There are billions of us, and some cost a lot more than they contribute.
The answer is to provide more healthcare in the form of addiction treatment, not to abandon people to die. Because those abandoned people will continue draining budgets even if you're not providing healthcare for them.
While this is true, trying to figure out ahead of time if they’ll cost more than they contribute is the path to madness. (And even trying to figure it out after the fact is pretty ridiculous for the vast majority.)
A person who eats poorly and doesn’t exercise can easily rack up millions of dollars in treatments for heart attacks and strokes. Yet they don’t seem to get anything like the same derision. Why?
> While this is true, trying to figure out ahead of time if they’ll cost more than they contribute is the path to madness.
I'll point out that people rescued from the brink of death are usually grateful for it, whereas these poor individuals, as noted in the article, often take a swing at their rescuers. I think that pretty much answers the question of whether they cost more than they contribute.
> A person who eats poorly and doesn’t exercise can easily rack up millions of dollars in treatments for heart attacks and strokes. Yet they don’t seem to get anything like the same derision. Why?
What makes you think people don't? Have you never observed someone or even yourself doing something unhealthy and thought glumly "Yep, eating/drinking this is going to put him/her/me one step closer to death by a lifestyle disease. Foolish of him/her/me."
How does them taking a swing at their rescuers tell us anything about their relative costs and benefits to society?
What makes me think people don’t? The fact that you begrudge $50 to save an addict’s life, while your theoretical reaction to someone eating themselves to death is “foolish of him” seems to back that up pretty strongly.
I suppose one could frame it as “play stupid games, win stupid prizes.”
To be frank, and I say this having addicted family members, sometimes it’s rather hard to care about a junkie.
I’m not exactly in the “fuck ‘em” camp, as a society we should have a better answer than leaving them a nuisance, but the idea that we should give up at a certain point is scarcely exotic.
Agreed, of course. Bringing up agency is on point, as well. I should have included that in my own comment, in short: the US has trouble being socially effective due to wonky "will power"/moral accountability bias--it cannot politically see bounded agencies, and therefore generates fails that strain the lower systems.
Addiction isn't caused by heroin or oxy or any other drug by itself. It's caused by people having hard, unfulfilled lives in a society that doesn't care about and actively tries to hurt them. A society that doesn't care, that doesn't provide purpose, jobs, homes, food, friends, relationships, nature, or any kind of help. Fulfilled people with good lives who aren't in constant pain don't get addicted. They might be dependent for awhile while the pain from their surgery goes away but then they'll go back to their lives. People who have no lives on the other hand will get addicted. If it's not heroin, it's oxy. If but oxy meth. Or coke. Or even weed. Too bad we as people and as a society still don't understand this and pretend like heroin is some magic substance that everyone gets addicted to. Most users do not get addicted. Usually around 90%. You never hear about them. You also never hear about the addicts shooting up legal heroin for decades who don't overdose, don't get sick, and have normal lives. Only the stupid drug war mantras live now despite us knowing better from real experience with helping addicts and not making them into criminals. Experiments have been happening all over the world for decades but the drug warriors are the only ones that get the press. It's sad that so many people's lives have to be ruined by their insanity. One day we'll look back and wonder how we could have been so cruel and so stupid with all the solutions already known to us.
I agree, drug withdrawal is painful with opioids and unbearably hellish is GABAergics, and quitting can be very hard. But having purpose in life is what defines if one will stay clean forever or will relapse time after time. I can also add that some people no matter of their actual conditions just don't have any meaning in life and they don't have any drive to participate in the routine and maintain proper life because they either have poor chances for good life or simply because they never asked to be born. Probably the strongest urge to use a drug comes, in fact, from boredom. Some people just need to kill time. To get by from the morning till the evening, when they can go to bed and sleep.
Kind of. A big issue is that drugs make it hard to get back out. Like, say you're a happy/fulfilled/high functioning clean person. Something bad happens (accident/hospitalization, bout of depression, other mental or physical trauma).
In that situation, no matter how fulfilled you might be most of the time, you're at a super vulnerable low point. You feel damaged, like your resiliency is compromised.
Then you take drugs, prescribed or not, while at that low point. Many substances can pattern compulsive, addictive behavior after just weeks of use.
Now you're regularly under the influence of substances that actively oppose your
returning to a fulfilled, resilient lifestyle. Not only do you have to recover from what happened to you, you have to do so while also ceasing use of chemicals that tend to pattern "just do this instead of expending effort on other things" behavior.
True, many people do bounce back. And there are many cases where drugs' side effects are worth it.
But the compounding effect is real, and handwaving it away with "happy, healthy people don't abuse drugs" is missing the point. What if someone takes those drugs during a moment when they're not happy or healthy?
Relatedly, there's a feedback effect here. You know what makes it really, really likely that you'll have an unfulfilled, hard life and feel like you're on the outside of society? Being around people who feel that way, which, as you point out, can often be heavy drug users. Now you have questionable behavior modelling (often starting young) as well as an emotionally unhealthy environment that makes it likely that you won't be resilient to the addictiveness of anything you try.
This applies equally to transgenerational drug abuse and to people who just live in/around communities with lots of drug abuse. If you spend a lot of time in a household/group/community like that, you're more likely to abuse drugs as well* .
This is part of the reason that radical decriminalization programs are great ideas: they focus on improving quality of life and everyday function of drug users with the goal of both reducing immediate likelihood of overdose etc., and of reducing the ingress rate--the number of new users of a given drug.
* This should not be taken as an assertion that drug abuse is the only, or even the primary, reason that people in many communities/groups/households are marginalized and feel unfulfilled, just that it is a single factor with a negative feedback cycle that can be broken.
Edits: grammar, clarified the idea of transient unhappiness.
had a friend in college (late 90s), very smart, very successful but addicted to pills. I have a joint disorder that puts me in a lot of pain so I always had a prescribed rx of hydrocodone. He'd offer me $50 for one pill if he didn't have his. I'd never seen real addiction until I met him. I've taken just about every oral painkiller at some point but have managed to never become addicted. Once I stopped growing the pain subsided and the rxs stopped. I consider myself very fortunate in that regard.
Holy hell this is great writing. I was a rural EMT in an area without a big addiction problem. We had our share of repeat customers but nothing -- nothing -- like this. I'm not sure I could do what the author does every day. The mixture of joy at saving lives coupled with the utter futility of saving the same ones over and over. This is gut-wrenching.
Reading this leaves me so confused: why have we as a society (roughly - I know there are exceptions) decided that things like heroin and cocaine are illegal and worthy of criminal punishment (jail, etc) and things like opioids are ‘prescription painkillers’ and fully within the bounds of our laws. It’s absurd.
Because heroin is so addictive and powerful that it changes the structure and function of your brain. It will destroy and kill a person in the blink of an eye. People will steal from the parents and kids, prostitute themselves, or just about anything to satisfy their addiction.
You lump in cocaine as though all schedule 1 drugs are equal. You are having two different conversations. One of them is complicated (why are LSD, peyote, and marijuana classified with opioids? why are they enforced and punished so unevenly along race and class lines?)
Opioids are critical medical tools for pain management. The solution is to have doctors decide when it is necessary and to have pharmacists manage its distribution. Why this works is that doctors and pharmacists will be delicensed and possibly go to jail for this, and they generally have a highly asymmetric amount to lose from doing so.
Opioids are unlike any other drug. Look at national death statistics. Read this article. If they weren't so necessary for critical pain management and hospice care they'd be completely illegal.
Heroin is dangerous because of cuts like fentanyl and various contaminants, not because you just inherently die randomly after using it.
One could use heroin your whole life with no ill effects. In that way, it's comparable to coffee.
Addicts simply need cheap access to legal heroin to stop using. Only after that's taken care of can they start getting their life back on track and to be about something other than drugs.
Not sure why you're being downvoted, you're completely correct. The only significant negative effect heroin use has on you besides addiction is constipation. For a heroin addict, the problem isn't the heroin, it's the absence of heroin.
To anyone who reads the above comments minimizing opioid addiction: heroin will eat you from the inside and kill you eventually. It is the most evil drug that has ever existed. Before it kills you it will ruin your mind irreversibly. Constipation is the least of the problems. Never use it, ever.
> heroin will eat you from the inside and kill you eventually. It is the most evil drug that has ever existed. Before it kills you it will ruin your mind irreversibly. Constipation is the least of the problems. Never use it, ever.
Heroin and especially heroin addiction is extremely dangerous, many people die. However, it doesn't have the deteriorating affects that you describe. Heroin users that don't die and are able to get over their addiction have few long term health affects. It's not at all like smoking or alcohol.
That's just not true. One habituates to it and they need more to achieve the same feeling that they had before. They need more, and the dynamic changes from trying to stay high to trying to avoid withdrawal. They reach a crisis, and then either die or go clean for a while. It changes the function of your brain, and you remain at a high risk for relapse the rest of your life (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5046044/ and countless others). There is a reason the disease model works and health system vs criminal system has better outcomes.
It eats you from the inside because everything else in life fall away in importance of being high, and if manage to get clean you are essential on a tightrope the rest of your life and the temptation haunts you all the time. It ruins your ability to feel truly happy or fulfilled by anything besides heroin. You are a day or two away from the morgue the rest of your life.
The addiction cycle usually ends in a place where Hep, sepsis, and HIV are comorbidities. But the long term health effect is the addiction and brain structural changes. Just because it's mental health doesn't mean it's any less real than lung cancer or cirrhosis.
> Users are currently resorting to crime to acquire their heroin because it's illegal, not because heroin inherently makes you evil.
That's not quite right. Heroin users definitely resort to crime to fund their addiction. They are not "evil" for being addicted, but they do become desperate. And if you're desperate, you're more likely to do "evil" things.
Most do not immediately resort to crime. Imagine you were addicted to some expensive substance. You'd likely try hard to keep whatever job you had to fund the addiction, then if that fails you'd pressure family to fund it. If family stops paying, then you'd sell whatever property you had. When that's over you may turn to illegal "jobs" such as prostitution or dealing drugs yourself. Only finally, as a last desperate resort, would you try to steal or commit other crimes.
Addiction is not "evil", but it results in desperation. When one is starving for bread, they're more likely push the boundaries of their morality to eat, maybe steal, and in extreme cases maybe worse. Desperation can make people do evil things.
That's exactly it, because it is illegal, it's also extremely expensive, and it's hard to afford daily heroin with a regular job without resorting to crime.
If heroin was not illegal, and therefore not extremely expensive, users would not have to resort to crime to afford it.
Now imagine heroin was legalized and/or freely available: noone would bother to commit crimes, and would be able to start living a regular life since they don't have a single reason to exist anymore. One of their basic needs are taken care of.
It's amazing how quickly we've forgotten prohibition. When you make something illegal that there is a demand for, an illegal market pops up.
> If heroin was not illegal, and therefore not extremely expensive, users would not have to resort to crime to afford it.
If heroin was legal, it's does not necessarily follow that it would be much less expensive. In states that have legalized marijuana, the price is roughly the same (and often more) than black markets.
> it's hard to afford daily heroin with a regular job without resorting to crime.
Regular jobs typically pay more than petty crime. The reason that heroin addicts resort to crime is not because their regular job doesn't pay enough, it's because they can't hold a regular job because they're addicted to heroin.
> Now imagine heroin was legalized and/or freely available: noone would bother to commit crimes, and would be able to start living a regular life
I'm not sure that many heroin addicts (legal or otherwise) can live a regular life.
> If heroin was legal, it's does not necessarily follow that it would be much less expensive. In states that have legalized marijuana, the price is roughly the same (and often more) than black markets.
Heroin is extremely cheap to manufacture, and it's of course also not patented anymore. There's no point to discussing this, really.
> Regular jobs typically pay more than petty crime. The reason that heroin addicts resort to crime is not because their regular job doesn't pay enough, it's because they can't hold a regular job because they're addicted to heroin.
This is partly true. It's a large topic. A heroin habit will take a lot of time, since you're doing a lot of waiting around for dealers. But it depends on the job, though. These days, Americans are very close to losing everything in the time of one or two paychecks. Add a heroin habit of hundreds of dollars a day on top of that, and you need something else.
> I'm not sure that many heroin addicts (legal or otherwise) can live a regular life.
I think far more people are using heroin and keeping a regular life than you realize.
> All the ways heroin can kill you are direct consequences of its prohibition.
Most people die from heroin by overdosing (taking too much). Very often, this is a result of mixing heroin with other drugs and pushing the limits of what a human body can tolerate. If it were legalized and regulated, maybe some accidental overdosing could be prevented, but there would be plenty of deaths.
Heroin is pretty different from other drugs because it's pretty easy to die from it. It's nearly impossible to die from smoking marijuana. Even alcohol is safer if you're not driving a vehicle: you're far more likely to pass out before you get alcohol poisoning.
Heroin is significantly more dangerous. A slightly higher dose or a new formulation can easily kill you.
People rarely just die due to random ODs when their heroin is pure, like you're suggesting. It takes more than that, especially when one has a large tolerance like all long-term users do.
There's 2 groups of heroin overdoses.
1) Varying amounts of cut like fentanyl. Due to heroin being illegal, users have no way of knowing whether their drugs are pure, so it's hard to gauge the dose. The exact same dose can kill you if there's a little too much fentanyl.
2) Taking the same amount after e.g. rehab or tolerance break. Due to the way heroin tolerance works, after a while of not using it, your body will reset the tolerance. So you come out of rehab and of course you want to do heroin again, and many unfortunately start right at their old (extremely high) dosage.
Legalization would obviously help no. 1, but I also think it would prevent deaths due to no. 2, since users would not have to go through rehab until they're actually ready for it. When the system forces you to stop, most users will just immediately start again when they have the possibility.
You're making an assumption and also ignoring a large side affect.
First, you're assuming that legalizing heroin would result in a high quality pure product. Considering that heroin addicts are desparate for heroin, it's pretty likely that they would go to cheaper black market sources with the same quality problems we have today.
Second, legalizing heroin would dramatically normalize it, very likely resulting in many more people becoming addicted to it. Even if the danger of the drug decreased, it would almost certainly be offset by the large increase in new addicts.
In terms of saving lives, I don't see how legalizing heroin can help.
> First, you're assuming that legalizing heroin would result in a high quality pure product. Considering that heroin addicts are desparate for heroin, it's pretty likely that they would go to cheaper black market sources with the same quality problems we have today.
I don't feel like this is a genuine argument on your part. If it was available in an affordable, high-quality manner, very few people would continue to use dirty, cut and illegal versions.
I think legalizing it is a good start, but an ideal scenario are heroin treatment clinics like we see in Switzerland or Denmark. They are 100% free and obviously use pure drugs.
> Second, legalizing heroin would dramatically normalize it, very likely resulting in many more people becoming addicted to it. Even if the danger of the drug decreased, it would almost certainly be offset by the large increase in new addicts.
I don't think that everyone would start using heroin after it was legalized. Most people are still extremely afraid of it due to e.g. media characterisations. Even so, as I've already postulated, I don't think there's any inherent danger in using it, so it's really a moot point to be honest.
3) Users take the same amount of heroin with the same purity as previous cases, but combine it with other CNS depressants and die.
This was probably the main cause of overdose deaths before fentanyl came along. In one study 45% of the deceased also had a blood alcohol level, and 30% were on Benzodiazepines (one Swedish study had benzos present in 55% of fatal overdoses).
>The majority of cases involved heroin in combination with other drugs: alcohol (40%), benzodiazepines (30%)and antidepressants (9%). In only a third of cases was morphine the sole drug detected.
>Fatalities involving only heroin appear to form a minority of overdose occasions, the presence of other drugs (primarily central nervous system depressants such as alcohol and benzodiazepines) being commonly detected at autopsy.
Heroin is an opioid. In the US, it isn't used medically, apparently the reasoning is that there are less additive opioids that are similarly effective for managing pain.
They prefer heroin likely due to the fear of overdose. I pushed the button as often as the Dilaudid dispenser would let me after surgery. It's a pretty magical warm blanket. I understood the appeal immediately. All your worries melt away, and you're floating in a cloud.
Heroin produces a stronger euphoric effect than synthetic and semi-synthetic opioids like Dilaudid and fentanyl relative to its less desirable effects like respiratory suppression. Studies have shown that recreational opioid users prefer heroin to other opioids for this reason.
>Some specifications for variants of Brompton cocktail call for methadone, hydromorphone, diamorphine (heroin), or other strong opioids in the place of morphine.
I don't think heroin is used medically in the US. It's schedule I. It might be used in extremely limited circumstances, but it isn't in use at most hospitals.
Like others are saying, other powerful opioids are used instead.
Very common in the UK in hospital settings. Probably the one of the most used strong painkillers - most people I know who have had painful surgery got it post operation.
A GP could also prescribe it no problems. Indeed there are a small number of people that get it prescribed if other drug treatments have failed.
Because making “street” drugs illegal allows you to jail any race you don’t like. And making the same drugs available as a prescription allows drug companies to make billions, negative externalities be damned.
Selling cocaine/heroin at the corner grocery shop would bring in billions of dollars of sales. Just imagine tens of millions of people buying their daily does.
So if following the money is the answer, why doesn't this happen?
Because it's really deadly and addictive. Legalising it would bring untold number of deaths.
We've been there before, opium, laudanum and heroin were available without prescription one time...
IMO, it's not follow the money, it's follow the power. The power to lock up anybody doing a common thing because you don't like them for some reason is intoxicating. Maybe power is the most dangerous drug of them all.
This has caused a lot of problems with pain treatment. We used to think heroin was okay, then we realised it was addictive. So we moved to other opioids thinking they weren't as addictive, but they are all about as addictive as morphine and diamorphine. We started reducing the quantities of the opioids and adding other meds like paracetamol / acetaminophen. This led to fucking stupid meds like coproxamol -- a mix of dextropropoxyphene (an opioid) and paracetamol. This opioid is very toxic, and it was killing many people in the UK until the licencing changed. And then we tried other meds like NSAIDs and etc. Some of them sort of work for some pain, some are very good for a specific type of pain. But they all have side effects.
We split pain up in different ways. We talk about chronic (long term) pain or acute pain. We talk about medically unexplained pain, and the implication is that the other pain has a medical explanation.
The public have three incorrect beliefs about pain treatment.
1) Opioids are effective
2) Pain is either real or imagined, and imagined pain isn't real pain.
3) The aim of pain treatment is always to eliminate all pain and anything less is a failure.
Turns out none of these are true.
Opioids are a good choice for a limited number of patients. It's really important that people get all the opioids they need at end of life, for example. Or that people going through surgery have them available if needed. But for long term pain they're a bad choice. The person in pain ends up taking very high doses of opioids, with all the side-effects that causes, and they're still in pain. We can see their function - the stuff they do every day - is much reduced. We also see some conspiracy-theory style thinking here - "morphine is dirt cheap and this non-opioid you've got me on is really expensive, because you're in the pocket of big pharma".
We know that patients reject psychological treatment for their pain. They'll say "but my pain is real, it's not all in my head". But many pain patients experience benefit from psychological treatment. (Imagine a purely physical disease like t1 diabetes. Even these patients will get benefit from a psychological treatment. Clearly I don't mean that mindfullness will control blood sugars, but the 3 questions "can you do your bloods every day?", "can you take your insulin at the right dose and right time every day?" and "can you adjust your diet and lifestyle?" -- these are all firmly psychology).
Sadly, lots of people in pain will not experience relief from that pain even if we give them high dose opioids. So pain treatment should be looking at function. The aim should be to allow someone to live their life even if they still have pain.
What a beautiful essay. It's so difficult to see human suffering with a mix of clear-headed honesty, empathy, and pragmatism. The author navigates this impossible landscape with grace and sincerity. I'm glad they shared.
If you give someone Narcan, it is likely that they will be antagonistic towards you, and could even attack you.
The addict will look like they will be OK after getting the Narcan, but the opioids are still in their system. The Narcan will wear off any they could get an OD from the drugs in their system.
"[Venture Capitalists and engineers in the Valley] wanted [to outdo one another and buy more things] and couldn’t find enough [creative means to generate truly useful inventions to make enough money] to pay for it all, so [social media and gaming companies] flooded [the internet and internet-connected gadgets] with [profoundly addicting software that was optimized for maximizing the numbers of ads user saw, regardless of the value of the media that attracted and held attention] instead. The addiction spread quickly, the need grew, and soon [the minds of many] began to writhe and cripple under the... curse."
>> “Is there anything, you think, that anyone could do for you? A program, a counselor, a friend? Is there anything that we could do? You seem like someone who could fight this. What would work, do you think, for you?”
>> He stares at his hands for what seems like a long time.
>> “No,” he says finally. “I don’t think there’s anything that would help. It’s a hell of an addiction.”
It's a travesty that iboga[0] isn't widely available (or even known).
