Apparently there's a nasal spray called Narcan that can reverse the impact of a heroin overdose. Doctors give it to patients, but it doesn't actually require training to use effectively, so public health workers around the country have started giving out OD kits to drug users, saving thousands of lives. Naturally, the Office of National Drug Control Policy wants to shut this down. As Mark Kleiman observes the logic here seems to be that we should make heroin use as dangerous as possible, the better to scare off potential users: "Why not just go all the way and poison the heroin supply? If withholding Narcan in order to generate more overdoses in order to scare addicts into quitting were proposed as an experiment, it could never get past human-subjects review. But since it's a failure to act rather than an action, there's no rule to require that it be even vaguely rational."
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Die for Your Government
26 Jan 2008 01:23 pm
Comments (49)
Narcan has considerable side effects, including ventricular tachycardia (i.e. cardiac arrest), and in the hospital I often give it in a drip. In other words, it's diluted down in a bag of saline and given a pinch at a time, very slowly, to reverse opiate overdose. You can give it faster but that's when you see more of the serious side effects.
I'm not familiar with the nasal spray. Maybe it's safer. But there's a reason why narcan is generally a controlled substance.
Remember the conservatives use the same reasoning to prevent hpv vaccines. They want sex to be as dangerous as possible. Who cares if women get cervical cancer. Sex must be scary! They are a nasty mean people.
I don't really blame the Republicans too much. The whole attitude in this country towards behavior we don't like can be summed up as follows:
"The beatings will continue until morale improves"
In the netherlands heroin addicts can get heroin for free at local centers. The only catch is that they have to stay a whole day there. Black market trading in heroin is non-existent and the heroin population in the netherlands is slowly getting older and smaller. And you don't see overdosing. Solving the drug problems in this country wouldn't be impossible. It's just difficult given the political environment.
I am continually shocked by the utter cruelty and evil of these people. They really are just the most disgusting people on earth.
I'm a liberal and I'm not a fan of narcan programs. (Which isn't to say I'd obstruct one.) Narcan programs are a symptom of our pathetic response to addiction. Given access to meaningful treatment (Not just once a week outpatient or methadone.), most addicts would prefer recovery. Addicts hate their lives, they just see no hope for a different life. Narcan distribution in the context of a system in which only the rich can access high quality treatment is a sad statement about our collective values. I'd have more respect for narcan distribution advocates if they were working hard to facilitate recovery and advocating treatment on demand.
Speaking as a medical-surgical nurse who's worked on hospital floors and in community urgent care, I think Jonathan's comment is really misleading. Yes, slamming in a big dose of Narcan at once is a physical shock, and the best practice is to push it in slowly till the person wakes up (since you can't tell how much it'll take); then, if you're in a hospital, it makes sense to maintain them on a slow drip because you don't want them to conk out again if the Narcan wears off before the heroin does.
But if you're in the field and someone has overdosed and is breathing five times a minute, cardiac side effects are hardly your main concern - you need to wake them the hell up and too much Narcan is better than nothing. You'd be right to say that CPR is a dangerous procedure too, but you still have to try. And the severe cardiac events Jonathan mentioned are (a) pretty rare and (b) mostly in postoperative patients with cardiac problems, not in young junkies. (Also, just to nitpick: ventricular tachycardia certainly isn't the same thing as cardiac arrest. And Narcan is not a controlled substance; it just requires a prescription. Maybe Jonathan was just writing hastily.)
I agree with David that the White House position, despite being dumb, is just political posturing - they're not shutting anything down. Public health workers have been pushing for years to get these kits into circulation and I trust they will raise holy hell if anyone tries to stop them now. If someone asks "won't it make the junkies more reckless, because they'll think ODing is no problem," what they need to know is that receiving Narcan - which induces immediate opiate withdrawal - is one of the most unpleasant experiences you can have in your life; imagine the amount of pleasure and relaxation you would get within a few seconds from shooting heroin, now imagine experiencing the exact opposite of that for half an hour. You might as well say that a teenage boy would be encouraged to have more unprotected sex if you told him "If she gets pregnant, no problem, we can magically fix it... we'll just have to kick you in the nuts fifty times."
Well I'll tow the hard/contrary line here and ask why isn't heroin commonly equated with poison in the first place?
Kind of along the lines with what mpowell discusses above, the ultimate societal preventative in this case appears to be reputation and association, which all good intentions aside works out to be a sort of soft leper colony approach like in the Netherlands.
Forms of suicide will never disappear, but those pulled in by lack of awareness are the real tragedy in this case.
Sure, because every heroin addict is swayed by a Narcan incentive. What BS. This is reminiscent of the death penalty as a crime deterrent argument.
In response to Hob, your point that trying narcan is better than letting someone die of an opiate overdose is certainly a fair one. It's also a bit obvious; if you define things in those terms than of course it's a good idea.
I never said I was opposed to the program. My point is that the drug has serious side effects, and I would be hesitant to distribute it in a completely unregulated way. By the way, ventricular tachycardia, when pulseless, certainly is cardiac arrest. And if it's with a pulse than it's what we refer to as a "pre-code" situation, i.e. better act fast to prevent cardiac arrest.
I understand why someone would support a program like this, and if I learn more details about the nasal spray, I may well support it too. But people in the field really shouldn't be flippant about the side effects of potentially lethal medications, even when using them is justifiable and appropriate.
If Narcan had been widely disseminated in past years, we might still be listening to Sid Vicious's bass playing.
Not sure if that's an argument for or against..
The WH Drug Policy person who was interviewed on NPR and is quoted in the 'original posting' about this issue implies that providing Naloxone to addicts would make it possible for an addict to have on overdose, treat it at home and survive without ever coming to the attention of the EMS and health-care-system (such as it is).
For the reasons the Jonathon and HOB discuss, she is full of shit. Heroin is a long-acting opiate. Naloxone is a short-acting antagonist. Given as an aerosol, it is shorter-acting.
Naloxone is a bridge to keep someone alive until the EMS arrives. It keeps you from having to do 'Rescue Breathing'.
These Repubs!!! An American 'Party of God'. Either stupid, or evil, or both.
Excellent logic.
Just as we should encourage petty criminals to engage in successively more egregious crimes so that ultimately we put all the bad guys in jails and make the country completely free of criminal activity as well as free of those prone to commit criminal acts.
Condor: "Why isn't heroin equated with poison?" Well it depends who you ask - some reckless kids may think it's no big deal, but there's hardly any message of heroin approval coming from government or schools or parents, and it's debatable whether just putting out more commercials on the subject is going to change the minds of those reckless kids. One thing that might help is if the authorities stopped pretending that all drugs are the same; if you go around saying that marijuana makes your brain fall out, young people who know that to be BS won't put much stock in your opinion on heroin.
I can't tell what your point is in the second paragraph. When you say "all good intentions aside", do you mean that the Dutch approach doesn't work, or it works but it's distasteful, or what? What does "a soft leper colony approach" mean? They're not putting addicts in camps. Those who want to quit can try to quit, and those who don't quit can use under safer circumstances, they can still carry on with the rest of life too, and there's clear evidence that that is not encouraging new users. "Reputation and association" seem to be working pretty well in that case; either that, or they've just done a very good job in raising awareness.
mpowell,
In the netherlands heroin addicts can get heroin for free at local centers. The only catch is that they have to stay a whole day there. Black market trading in heroin is non-existent and the heroin population in the netherlands is slowly getting older and smaller.
According to the latest national report on the Netherlands by the European Monitoring Centre for Drugs and Drug addiction, drug use of all kinds, including heroin, in the Netherlands increased significantly between 1997 and 2005:
The lifetime and last year prevalence rates of drug use in 1997, 2001 and 2005 are given in table 2.1. In 2005, cannabis was by far the most commonly consumed illicit drug in the past year, followed at distance by ecstasy, cocaine and amphetamine. LSD and heroin are hardly used in the general population. A trend analysis showed that the lifetime use of cannabis and ecstasy was higher in 2005 compared to both 2001 and 1997. Lifetime prevalence of ecstasy showed a steady increase between 1997 and 2005. For heroin a significant increase between 1997 and 2005 was found.
How could we poison the heroin supply?
I don't get how that's possible.
How could we poison the heroin supply?
Buy the poppy crop wholesale from the Afghan warlords?
Mixner, some other findings in that report (which can be found on the EMCDDA site)
For instance:
Since 1988 the estimated number of [opiate] addicts [in Amsterdam] has declined (with a minor fluctuation in the early nineties).
The only mention of an increase in heroin use is in the discussion of nationwide prevalence that you quoted. The report doesn't say much about what that might mean, except for a suggestion that many users start off with crack and pick up heroin after that. And far from blaming the medicalized heroin policy for encouraging use, EMCDDA says this:
An evaluation of the experiment with medical heroin prescription for treatment refractory opiate addicts showed that for more than 75% of the initial participants, the physical and psychosocial health situation improved substantially during the two years after the experiment. Criminality had become almost absent among this group. Moreover, thirteen percent voluntarily entered abstinence-based treatment or methadone maintenance treatment (Van den Brink et al. 2002). Therefore, medical heroin prescription will be continued and enlarged for three years.
Otherwise, the report doesn't say much about heroin because compared to other drugs, heroin is a very small problem in the Netherlands; the 1997-to-2005 increase you're talking about was from 0.3% to 0.6%, compared to cocaine at 3.4%, or ecstasy (which is entirely prohibited there) at 4.3%. And that's lifetime use, as in "ever"; the "used in the last year" figure was too small to measure, and is shown as zero in both 1997 and 2005. How accurate these self-reported figures are, who knows, but it's not unlikely that people have been more willing to admit to heroin use since it was fully medicalized in 2004.
Also note that EMCDDA appear to agree with mpowell's view that "the [heroin] addicts are getting older" in this statement:
Data from Amsterdam point at an increased mortality rate among opiate addicts, which is probably related to the progressing ageing and pathology in this group. [my emphasis]
I don't know how that squares with an increase in overall lifetime use - it may be just a regional difference - but the report doesn't break down the figures that way, so it's impossible to say. In any case, your selective cite gives the impression that they're calling the Dutch policy a failure, and that's not true.
I hate to try and convince anyone of this, because heroin simply has too powerful symbolic value in our culture. But like many drugs, the dangers of heroin have been significantly exaggerated. I don't do heroin, I hope none of my friends and loved ones don't do heroin, I hope none of you are doing heroin. However, overdosing is rarer than is widely assumed. The pain of withdrawal and the difficulty of rehabilitation are routinely exaggerated. There is no evidence to support the commonly held notion that a user can be addicted by a single dose. Again, I'm not advocating heroin use. But these comments are in line with the general understanding of heroin use, and as such significantly overstate its dangers.
shutting down is not 'a failure to act rather than an action'.
Isn't this an example of where single payer or at least universal health care might lead to more sensible policy? Wouldn't some conservatives be more likely to support policies like Narcan distn. if the government or their buddies in the insurance industry were bearing the costs when people who suffer a heroin overdose show up in the ambulance or ER?
Heroin users are subversives. They don't buy beer or cars in an attempt to get them some sex, and in fact generally don't care about sex---itself admirable, since Real Men find women suspiciously effeminate, and Real Women know that all men are children and not worth their time---but as this removes one of the engines of our economy it must be punished.
They don't work hard at jobs they hate to get the myriad things they're supposed to want; they work hard at jobs they hate, and they also steal and rob, just enough to get the one thing they want. Even if they're not stealing, they're committing a crime against the rest of us by parodying how we're supposed to live, and so they must be punished.
(Yes, heroin does actual damage to people, but lots of potentially damaging things are legal. I think the law is brought in when an activity is considered subversive enough of the prevailing orders to require being stamped down in an act of societal self-purification.)
hob,
The only mention of an increase in heroin use is in the discussion of nationwide prevalence that you quoted. The report doesn't say much about what that might mean, except for a suggestion that many users start off with crack and pick up heroin after that. And far from blaming the medicalized heroin policy for encouraging use, EMCDDA says this ...
I'm not sure why you think they need to mention it more than once. The report states that heroin use has not just increased, but doubled. And I didn't say they "blamed" the increase on the medicalized heroin policy. I didn't say anything about what caused it. But the fact that heroin use seems to have doubled in the Netherlands between 1997 and 2005, and that the use of other drugs has also increased significantly over the same period, does not exactly reflect well on their drug policies.
In any case, your selective cite gives the impression that they're calling the Dutch policy a failure, and that's not true.
They don't call it either a failure or a success. That's not the purpose of the report. But the increase in drug use is hardly consistent with the idea that their policies are a success. mpowell asserted that heroin use in the Netherlands is declining, and this report contradicts that claim.
The opiates are generally misunderstood, and the reason for this is simple- drug companies make a killing selling their substitutes, police can "wage war" on drugs, and doctors are bullied into silence by charges of overprescribing.
Heroin is a black market product nobody would use if they could get pharmaceutical grade morphine. Morphine is just as effective if taken as a pill. Used in moderation it takes many years for problems with the liver to develop. Tens of millions of Americans have used serious amounts of morphine to control pain and almost none of these people become addicted. Morphine users who can get prescriptions from a clinic look and act pretty much like anyone else.
Having studied these matters for years, I can only imagine that as long as people in general choose to remain ignorant, there will be drug companies and police to take advantage of that fact. You can't expect that "the guy in charge" is going to end a police state. As Bush said, they always find it mighty convenient, when they're the dictator.
O fer gawds sake. It "doubled" from 0.3% to 0.6%- numbers so small that unless you have a very firm grasp on your statistics you can pretty much ignore them because they could be simple static.
Which, in fact, is what the report Mixner is referring to did with the figures for "used last year".
IOW, we're basically talking about a "doubling" from 0.3% to 0.6% of people who admit to ever having used heroin- an increase that might easily be explained by the medicalization of the problem.
So, on the balance, Mixner appears to be saying there was an increase in use, and that does not appear to be what the report really says.
But like many drugs, the dangers of heroin have been significantly exaggerated.
Here is what the National Institute on Drug Abuse (part of the federal National Institutes of Health) says about the health effects of chronic heroin use:
Medical consequences of chronic heroin injection use include scarred and/or collapsed veins, bacterial infections of the blood vessels and heart valves, abscesses (boils) and other soft-tissue infections, and liver or kidney disease. Lung complications (including various types of pneumonia and tuberculosis) may result from the poor health condition of the abuser as well as from heroin's depressing effects on respiration. Many of the additives in street heroin may include substances that do not readily dissolve and result in clogging the blood vessels that lead to the lungs, liver, kidneys, or brain. This can cause infection or even death of small patches of cells in vital organs. Immune reactions to these or other contaminants can cause arthritis or other rheumatologic problems.Of course, sharing of injection equipment or fluids can lead to some of the most severe consequences of heroin abuse- infections with hepatitis B and C, HIV, and a host of other bloodborne viruses, which drug abusers can then pass on to their sexual partners and children.
Addiction itself is recognized as an independent disease:
One of the most detrimental long-term effects of heroin use is addiction itself. Addiction is a chronic, relapsing disease, characterized by compulsive drug seeking and use, and by neurochemical and molecular changes in the brain. Heroin also produces profound degrees of tolerance and physical dependence, which are also powerful motivating factors for compulsive use and abuse. As with abusers of any addictive drug, heroin abusers gradually spend more and more time and energy obtaining and using the drug. Once they are addicted, the heroin abusers' primary purpose in life becomes seeking and using drugs. The drugs literally change their brains and their behavior.
Mixner, do you find the federal government to be a generally credible source when it comes to information on illegal drugs?
catowner,
It "doubled" from 0.3% to 0.6%- numbers so small that unless you have a very firm grasp on your statistics you can pretty much ignore them because they could be simple static.
Do please show us your statistical analysis supporting this claim. What is the margin of error in the statistical methods used to produce these estimates? Do you know? Of course you don't. You're just spinning, because the report says something you don't want to believe is true.
A 0.3% increase in the population of the Netherlands is 48,000 people.
.... an increase that might easily be explained by the medicalization of the problem.
And might easily not be explained by that. I'm not interested in your guesses. Show me your evidence.
Actually, on giving your comment a second read, I think I may have misunderstood your point. Are you demonstrating that many of the dangers from heroin, according to that information, stem from problems of purity and delivery? Because that's what I take from that information-- the dangers listed there could be largely mitigated by legalization.
Mixner, do you find the federal government to be a generally credible source when it comes to information on illegal drugs?
I find the National Institutes of Health to be a highly credible source of health and medical information of all kinds.
If you think the information I quoted is false, you're welcome to try and rebut it.
Doesn't anyone else remember Paraquat?
At the risk of revealing my advanced age, I would like to point out that the idea of poisoning the supply of an illegal drug in order to deter use has not only been thought of before, but actually carried out. Our very own gummint sprayed Paraquat on marijuana fields in South America in the 60s, then announced that this potentially toxic herbicide had thereby entered the marijuana supply stream.
If they try this with poppies, they'll have to go with something other than Paraquat, because it turned out later on more careful study that the Paraquat didn't really pose a threat to users downstream.
Mixner is known to find the federal government and right wing Web sites to be credible and anything else is considered not credible.
Mixner thinks that any margin of error is going to be smaller than 0.3% - three-tenths of one percent - which shows what a complete fucking idiot he is. Show me any statistical study involving demographics where the margin of error is that small.
Plus he does this stupid shit: "I'm not interested in your guesses. Show me your evidence."
Well, we're not interested in your guesses, nor your lack of evidence that three tenths of one percent increasing to six tenths of one percent is of any consequence in any way as a commentary on drug policies. The poster who described the full report crushed your initial bullshit and now you're nitpicking, as usual.
Take this troll shit down the road. Go back to arguing for torture.
I find the National Institutes of Health to be a highly credible source of health and medical information of all kinds.
But again... say I take that information at face value. It seems clearly like an argument for legalization to me. Scarred and collapsed veins, abscesses and other soft-tissue infections could be mitigated by safer injection. Damage from contaminants and additives is a problem of illegal supply that could be easily solved through regulated industry. The dangers of sharing needles, again, is a facet of the illegality of the drug use which could be almost completely eliminated through legalization.
Honestly, the text you posted seems to support my opinions more than anything.
Freddie,
No, it's an argument against the non-medical use of heroin, period. First, many of the medical problems caused by chronic heroin use, including addiction itself, are not the result of "problems of purity and delivery," but are a consequence of the nature of the drug itself. And second, "legalization" (whatever that vague term is supposed to mean, exactly) will not necessarily reduce, let alone eliminate, those problems anyway. If "legalization" means simply decriminalizing the possession of small quantities of the drug for personal use, it is unlikely to lead to safer supplies or usage practises. And if by "legalization" you mean decriminalization of dealing the drug, that is likely to lead to an increase in its availability and an increase in users and addicts. And any kind of decriminalization is likely to cause use of the drug to increase by removing the deterrent of a criminal sanction on the decriminalized behavior (possession, dealing, trafficking, producing, or whatever).
This all started with Reagan in 1964.
Do you guys think maybe this 'moral hazard' crap will come to an end with the specter of Wall St. banks being bailed out by generous Ben?
HRC mentioned this in a debate.
Like, a zeitgeist thing... only Guiliani has talked this way during this cycle.
hob,
There is no consensus among drug policy experts that heroin prescription to heroin users is beneficial even for the users themselves, let alone for society as a whole. Studies on the effects of prescription are inconclusive, and many experts believe the policy simply perpetuates the addiction by treating the symptoms. See this very recent BMJ article for a description of some of the problems with the policy.
If one reads the article Mixner cites, you see that it establishes nothing that Mixner has said.
What the article's author basically complains about is that heroin prescription does not necessarily lead to reduction of dependence.
That would be a "duh!"
By definition, heroin prescription cannot eliminate dependence. What it does is attempt to reduce the negative effects of obtaining the drug under criminal conditions. And the article's author admits that, while at the same time complaining, again, that this should not be a primary treatment strategy - which, again, is fucking obvious.
Which makes the entire article ridiculous. The author would seem to prefer methadone because the cost is less, which might make some sense if it weren't for the fact that many addicts don't like methadone.
William Burroughs got off heroin using apomorphine treatments and advocated it for years as the best solution. About seven treatments of apomorphine over a week, and the addict is completely free of addiction and withdrawal symptoms and, according to Burroughs at least, no interest in heroin at all - indicating that even psychological dependence is affected. Now it's been resurrected as a treatment for erectile disfunction. Given that, as Burroughs put it, heroin users have zero interest in sex, that probably won't help sales any to addicts.
"But like many drugs, the dangers of heroin have been significantly exaggerated.... However, overdosing is rarer than is widely assumed. "
This is a very wrong assumption. Cheap black tar heroin from mexico is all around the high schools and many silly teens are trying it out. I am not sure the how the mind-set has changed to allow rationalization for experimentation, but it has. In the 70's, heroin was considered taboo.
In our community, a young college woman, full of promise, has just overdosed and died alone in her room. Apparently, many kids try cold turkey but can't make it. Tolerance declines rapidly and relapse at the same dosage can be lethal. From personal experience, I know how utterly irrational and terrible this disease can be. I used to be liberal about pot use, based on my college experiences. I have been taught the hard way that substance abuse is a very serious emotional response to life which will kill many.
Ironically, the threat of incarceration has saved many families and young lives because it forces discovery, intervention, and treatment. Drug court is a very, very positive development as opposed to immediate incarceration.
The nasal spray probably should be readily available for saving lives.
Here's a (very) little statistical analysis for the report on heroin use in the Netherlands cited by Mixner and others:
Mixner claims that the report shows that heroin use "doubled" from 1997 to 2005. This is not correct, and I can't see anywhere that the report claims this. It does show a (statistically) "significant" increase in this period, though. The 1997 sample size was 21959, which implies given the rate of lifetime heroin use that there were roughly 66 people in the sample who claimed that they had ever used heroin. The 2005 sample size was 4516, giving roughly 27 lifetime users in the sample. Using a simple 2-sigma estimate for 95% error bars, the sampling error gives a range of 2.26-3.74 users/1000 for 1997, while the 2005 range is 3.69-8.31 users/1000.
Note the these ranges actually overlap slightly, but presumably the report writers did a more sophisticated statistical analysis to show that the difference was nonetheless significant. But given that the overlap in the ranges shows that the difference was just barely statistically significant, to claim the the report showed that the use rate "doubled" is incorrect.
Finally, this analysis *only* discusses sampling error, and not any errors due to possible changing rates of response, or willingness to honestly answer questions about activities that are, even in the Netherlands, illegal.
I think anonomoose's statements above should be listed in college textbooks as an example of faulty argumentation.
I never claimed that heroin is without dangers. I never claimed that no one is getting addicted. I never said anything that is contradicted by "I know someone who overdosed." What I have claimed is that, in the popular consciousness, A)the physical damage done to the body by heroin use (and not from problems of delivery like sharing tainted needles) are overstated; B)the ease of addiction and strength of addiction are dramatically overstated; C)the difficult of withdrawal is dramatically overstated. Surely, all of those things can be true, and one can still strongly favor the continued criminalization of heroin (though I don't.)
Well, there's the 'tell' on Mixner- in a reflexively dishonest way, he tries to prove that opiate addiction is dangerous by citing an article about heroin addiction- an article which also bamboozles by conflating the respiratory dangers of being homeless and living on the street with heroin addiction.
All of which has nothing to do with an opiate addict, employed and in their own house, taking a USP-grade pill that cost them maybe 45 cents.
And spare me the B-S about "what if he drives a car?" Any society that can let people use their cell phones while they drive has got bigger problems than the tiny number of drivers who are not paying attention because they took a pill.
And now a note on treatment- there isn't a state in the Union that funds treatment on demand with no stigma, and even if they did, who would apply, knowing that our medical records are passed around to every Tom, Dick and Harry when we apply for a job or entrance to a college?
Treatment programs today are just a cheaper kind of jail, usually with no job training, housing assistance, or even food stamps or transportation vouchers to help the 'client', who is left to stew in his own juices. This is the social equivalent of judging the automobile by taking a 72 Pinto and, without making any repairs, trying to cross the Rocky Mountains on logging roads.
So let's give credit where credit is due- it's people like Mixner, with their bamboozling skills, who support spending our public money to lock people up in prisons where they are beaten, raped, exposed to infectious diseases, forced to work in prison industries for 10-15 cents an hour, and finally released on probation without enough money to even rent a room.
It's the recipe for the social disaster we're experiencing today- living in a police state with constant cries from people like Mixner who demand we arrest even more people- not because it has ever worked, but because it makes people like Mixner feel good about themselves.
It's time for a change.
Freddie,
What I have claimed is that, in the popular consciousness, A)the physical damage done to the body by heroin use (and not from problems of delivery like sharing tainted needles) are overstated; B)the ease of addiction and strength of addiction are dramatically overstated; C)the difficult of withdrawal is dramatically overstated.
Well, since you provided no description of what you think the "popular consciousness" is on these questions, let alone any evidence that your beliefs on this matter are accurate, your claim is utterly meaningless. I'm sure that someone, somewhere has an exaggerated view of the harm caused by heroin. Whether people in general have an exaggerated view is a completely different question. You have provided nothing to support the conclusion that they do.
The fact is, heroin use causes many serious physical and mental health problems, not least the disease of addiction itself, which essentially destroys people's lives.
Alex R,
The small sample size does reduce the confidence of the findings, but the best estimate of the trend in heroin use in the Netherlands is that it doubled between 1997 and 2005. Even if the true increase is smaller than that, the finding simply contradicts mpowell's claim that heroin use is declining. And of course, the uncertainty attributable to sample size limitations cuts both ways: the true increase might be much lower, but it may equally well be much higher.
And independently of the trend, the true number of heroin users is likely to be higher than the estimates, because the sample is likely to miss the subpopulations most at risk of heroin use. As the National Drug Monitor report says:
These figures are likely to be an under-estimate, because problem users of hard drugs are under-represented in the NPO surveys. Many users of illegal opiates or methadone clients are not reached through random sampling, because they may be homeless, in prison, or otherwise out of the picture.
Surely, all of those things can be true, and one can still strongly favor the continued criminalization of heroin (though I don't.)
What, exactly, is it that you want to decriminalize? Possession of small amounts of heroin for personal use only? Possession of any amount? Retail sale of heroin (dealing)? Import/Export of heroin (trafficking)? Manufacture of heroin? Advertising of heroin? What legal restrictions, if any, would you retain on the possession, distribution, sale, and advertising of heroin, other opiates, and other drugs?
Do you actually like anti-flag?
Given the conservative resistance to needle exchange programs, a resistance to OD kits would seem to me to be a given.
Instead of giving them away, why not sell them? I don't really like the idea of enabling junkies.
I ask myself: if a charity was doing this, would I donate to that charity? No. I'd rather donate to the Sierra Club or Planned Parenthood.
Heroin addiction sucks (after the first few months, when it is really quite lovely, which is why people become addicted, after all). But it tends to be temporary. Only 30 percent of ever-users become long-term, chronic addicts. And overdose is far more common among occasional users than among long-term addicts. So it seems like it would be a good idea to keep users alive until they can stop using (and indeed until we can begin to meet the demand for quality treatment programmes).
Arguing as Madras did that overdosing provides users with a reality check that will encourage them to give up drugs is like arguing that going through the windscreen can provide a reality check that will encourage people to give up driving fast. I'm just waiting for the administration to come out against seat belts. For more, see http://www.wisdomofwhores.com
Comments closed February 09, 2008.
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Heads in the Sand
OK--One person in the White House is quoted as opposed to this program. She was not quoted as "wanting to shut this down"; nor, as far as I can tell from this, is her office taking steps to shut it down; nor, indeed, do I see any indication that her office has the authority to shut it down. You're right--it's an outrageous sentiment, and the kind of stuff we're all too used to from this White House. But, as far as I can tell, it's just a sentiment--not a threat.
Posted by David | January 26, 2008 1:41 PM