Azrayne's drug geek thread

It's already been demonstrated by certain European countries that when medical grade heroin is administered to long term addicts (those who don't respond to other forms of treatment) in a supervised setting, not only does the mortality rate drop close to zero for those addicts (technically, it's possible there might have been a handful of deaths from patients who were dosed with heroin at the clinic and then went home and consumed large quantities of alcohol or other sedatives, but I've never heard of it), but the social functioning and medical condition of these addicts improves immeasurably, and the number of less severe addicts and new users in the community decreases considerably (basically the medical clinics jack the most profitable customers from the dealers, making it less profitable to sell heroin, so there are far less dealers in the community who can expose new users to the drug - the medicalization of heroin addiction also de-romanticizes it).

On a purely chemical basis, heroin is a lot less toxic than alcohol. Alcohol is a known carcinogen which damages more or less every major system in the body with regular use (brain, heart, GI tract, and of course liver). Addiction to alcohol, although less frequent than addiction to heroin, is also a lot more dangerous. The statement than withdrawal from heroin is "not much worse than a bad flu" is flat out not true, but alcohol withdrawal is not only more unpleasant, but can cause potentially fatal seizures and long term damage to the nervous system.

Not that even medicalized heroin use is good for you - long term opioid depency messes up your hormones, your digestion and your emotional state, as well as interfering in your life in dozens of small, subtle ways which ineveitably add up to a less fulfilling existence, and detoxing is a painful process, but in terms of destruction caused, it's not even in the same ballpark as alcohol. And that's not even touching on all the dangerous behavioral problems alcohol causes (even in those not necessarily addicted).

The reality is that the most dangerous part of heroin addiction - the risk of overdose - comes from it's black market status (which, again, leads to an unintuitive increase in the number of users). Even then, heroin itself is rarely the sole cause of death. Overdose generally happens as a result of one of three causes - adulterated heroin (this is a major contributor to the current spate of deaths in the US, where the emergence of the dark net has lead to the easy availability of fentanyl, a much more dangerous synthetic opioid frequently used to cut, or entirely replace, street heroin), polydrug use (heroin combined with pharmaceutical sedatives or alcohol - this is hard to combat except through education, although integrating either supervised or medicalized administration centers for addicts would help considerably), or reduction in tolerance (an addict goes to jail or rehab, detoxes, their tolerance to the drug goes down, then they emerge from the facility and immediately administer the same dose they were taking before).

Another major contributing factor is the way that illegality drives up the price of heroin, forcing addicts to eventually progress to the far more efficient, but dangerous, intravenous use, over safer but more expensive routes of administration like smoking, snorting or even swallowing (in the case of pharmaceutical opiate pills - which are where many addicts start their addiction before moving to cheaper, black market heroin).

Anyway, I'm not saying heroin is great, that people should go around using it or that we should just park anyone who has a problem on a medical administration program indefinitely, but the current approach of criminalizing the drug and focusing on abstinence based, moralistic treatment programs instead of medical intervention and harm reduction is making it a much larger problem (both in terms of danger and the number of users) than it should be.

The comparison to alcohol is sometimes a bit of an apply/orange thing, given the legal status difference and the way alcohol is ingrained in Western culture, but these numbers are a good starting point:

Alcohol Facts and Statistics | National Institute on Alcohol Abuse and Alcoholism (NIAAA)

Overdose Death Rates

He's not wrong about heroin being fairly benign when used responsibly. The problem is, most people do not have the willpower to use it responsibly.

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I think willpower is a lesser factor than education. A lot of addicts make their drug use significantly more dangerous than they have to just through sheer ignorance (although desperation also plays a factor). You could argue that it's their own responsibility to research harm reduction and safe use, but I think at the end of the day the reality is that there's a lot more society could be doing for addicts even without changing the legal status of drugs, if it weren't for the deeply ingrained concept of drug addiction as a moral failing and not a medical issue, or the absurd idea that helping someone with an addiction is somehow 'enabling them,' as though reducing drug use through making it more dangerous isn't missing the point entirely.

Yeah, no... you people are fucking delusional. Yes more people die from alcohol related causes... because literally everyone in the world drinks alcohol.

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Nobody disputed that. What we said is that chemically speaking, pharmaceutical heroin is biologically less toxic than alcohol, and that a lot of the dangers related to heroin use are caused by it's legal status and society's stigma towards it, and not necessarily the drug itself.

Put it this way - you could give someone a lifetime supply of pharmaceutical heroin and as long as they carefully measured their doses in relation to their tolerance and didn't consume other sedatives, they could go around every day high as a kite and the damage would be limited to some hormonal and digestive problems. Realistically, a lot of users likely wouldn't be able to pull it off, but it's possible.

There are people who are put on morphine (which is all but indistinguishable from heroin in terms of the effects on the body) for years or decades without any major problems other than having to taper off at the end of the process (assuming they aren't in palliative care, in which case tapering isn't an issue I guess :/ ). In the 19th century plenty of people who become addicted to opium, and then later morphine, would simply continue to maintain their habits on a cheap legal supply and go about their lives. Not great, but not even a scratch on the havoc alcohol causes in your body (and behaviorally). Someone consuming alcohol to the same degree would almost certainly die a slow, agonizing death of some kind as a result.

Only a small subsection of colossal fuck ups mess around with opiates.

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That's just straight up not true. Fucking around with opiates will almost certainly mess your life up to some degree, although again, a large part of that is caused by prohibition and not the drug itself, but plenty of otherwise normal or successful people have used, or developed problems with, opiates. Yes, there's also a subset of people who are self medicating severe problems or just generally fucked up and using opiates as a coping mechanism, but the same is true of alcohol.

Show me some statistics over mortality rates for alcohol users vs. heroin users.

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Heroin There's prevalence for heroin in the same year, although it doesn't include prescription painkillers (an extremely murky area, as they're also used medically, and it is medical use of opiates which frequently leads to non-medical use, and then to heroin). You can do the math.

Nobody is saying heroin is safe, or an awesome lifestyle choice, but the danger is in large part caused by society's approach to the drug, and not the drug itself. Those dangers could be massively mitigated through a change in policy towards treating opiate dependency as a medical problem, and not a criminal one (as has happened in many parts of Europe). None of this is hypothetical, just look at the programs in countries like Switzerland or Denmark.

It's ok bro, show me on the doll where the junkie touched you.

"Waaaah the war on drugs has made my life as a heroin junkie so hard!"

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I wonder how you'd feel if your government re-implemented alcohol prohibition? Cause that was so fucking awesome, right?

Personally, it's a nonfactor for me now, I haven't been a regular user in over 4 years and haven't gotten high on opiates in over 2. But it's a major social and medical issue and I'm not going to apologize for advocating scientific, evidence based approach to it over backwards moralizing and fear mongering, just as I would for any other social or medical issue.

Grow up. You made your own shit decisions in life. Your life being in shambles is the fault of you and no one else.

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Never said otherwise. I can live with the choices I made, everything I've said is in the context of addressing the issue going forward in the most sensible manner possible.

You also completely failed to provide any data related to mortality rates.

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You mean other than that one link which provided the mortality rates for all the major drugs of abuse in 2014, and the other one which provided the same for alcohol? And the links to prevalence data in the same year for both?

Let me help you out:

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Cool, a tiny spec of data which is 20 - 50 years out of date. That's handy.

i dont understand this "medical grade heroin administered correctly is less harmful than alcohol" argument. you mean less harmful than alcohol abuse? alcohol conumed correctly, say a glass or two of red wine with dinner, must be better for you than shooting up any sort of heroin....

i dont understand this "medical grade heroin administered correctly is less harmful than alcohol" argument. you mean less harmful than alcohol abuse? alcohol conumed correctly, say a glass or two of red wine with dinner, must be better for you than shooting up any sort of heroin....

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It works pretty much however you scale it. If you want to go with full blown addiction, compare a raging alcoholic who drinks from waking till sleep and gets the shakes within a few hours of stopping, to a heroin addict who visits a clinic 2 - 4 times a day to smoke or inject heroin (which is probably representative of the "ideal state" for a heroin addict, as demonstrated in Switzerland, Denmark, etc).

The alcoholic is trashing basically every major system in his body - brain damage, cardiovascular damage and liver damage being the most prominent. as well as the carcinogenic effect. Eventually one of those is going to catch up with them, if they're drinking at the rate described, probably within a decade or two at the longest. Detoxing from alcohol is not only extremely painful, but can cause potentially fatal seizures. All of these are caused directly by alcohol consumption, not by secondary factors.

By comparison, the heroin addict can get high as a kite all day, every day, and on top of developing a dependence, the only real long term side effects will be impaired hormone production (mainly testosterone), constipation, and digestive problems secondary to constipation. No brain damage and no major organ damage, and the problems it does cause will revert if the user reduces and eventually eliminates their heroin consumption.

Withdrawal from heroin is painful, but much more manageable than alcohol withdrawal, and almost never fatal (there are probably occasional cases where someone is already extremely unwell, and the stress of the withdrawal throws them over the edge). Again, not saying this would be an awesome life to live, you'd be forced to revolve your existence around visits to a clinic, but there's just no comparison when it comes to the damage caused to the body by alcohol on the body v. that caused by pure heroin.

The majority of the dangers associated with heroin in the media and popular culture (infection, collapsed veins, blood borne viruses, overdose), are largely or entirely the product of heroin being a black market drug and existing on the fringes of society as a result.

Infection can be almost entirely mitigated - firstly, because injection is only a necessity when the addict has to be as efficient as possible with their supply. Very few heroin addicts start out injecting - it's something which most escalate to reluctantly as a result of their tolerance to the drug building. If their supply is affordable, then they can easily consume the drug through smoking, snorting, or through replacing it with other opiates which can be taken orally (heroin when taken orally breaks down into morphine, which itself has a low oral bioavailability).

Even if the addict chooses to inject, the availability of clean injection equipment (ideally at a clinic, but it can be replicated fairly safely at home as long as you're careful), the use of pharmaceutical grade product which hasn't been handled by dealers and repackaged constantly, and the use of alcohol swabs and micron filters (which remove bacteria, as well as any other undissolved contaminants, from the solution prior to injection) reduces the risk of infection by orders of magnitude. Infections happen almost exclusively when addicts are forced to use dirty equipment to shoot up improperly filtered heroin in unhygienic locations.

All of the above applies to blood borne viruses. These are more or less nonexistent among the majority of IV drug users in countries where needle exchange programs were implemented early (with a fairly small exception among the gay community - where there's a crossover between IV meth users and men who have unprotected sex - and among long term prisoners, who share needles which have been smuggled in).

Overdose is the trickiest one - you can avoid it almost entirely if addicts are getting high in clinics (theoretically, they could get high, leave the clinic, consume some other drug on top of heroin and overdose as a result, but I've never heard of this happening). Fatal overdoses in clinics just don't happen - opiate overdoses are extremely treatable if medical staff are on hand to reverse the effects with naloxone.

If people are using outside of clinics (which isn't something I'm advocating, but for the sake of argument...), then it's trickier. But just having access to cheap, pure heroin makes a huge difference, although I know it seems counterintuitive. If it's cheap, people can smoke it instead of injecting it, which is far less likely to cause a fatal overdose (the smoker almost always falls unconscious before being able to smoke enough heroin to kill them, unless they have other downers in their system). If it's pure, people can measure their dose precisely, instead of getting varying potency from one dose to the next, allowing them to carefully track their intake and tolerance.

That leaves the other two major causes of overdose. Using with other downers can primarily be addressed through education and constant contact with health services - which of course is going to happen if the addict is getting their heroin from those services. Using after a period of abstinence can also be helped in a big way through education and through access to health services - all it would take is a reminder from the clinic that the user hasn't dosed themselves in a while and should slowly escalate their dose to make a big difference, and of course the reduction in IV use and the ability to be certain of exactly how much is being consumed would help enormously. A lot of difference could be made through a change in culture, through bringing addicts into contact with medical professionals who can teach them to be safe and monitor their use.

Anyway, I rambled on a bit, but none of this is radical. These systems have already been implemented and had massive success in certain parts of Europe.

If you want a comparison to "a glass or two of red wine with dinner," probably the best would be someone who occasionally takes a moderate dose of pharmaceutical opiates, either to relax or to treat pain, and these people absolutely exist. Not everyone who uses opiates is an addict, even if you exclude those who use them only under direct medical instruction - it's just the addicts who are visible, and the more desperate they are, the more visible. Especially with heroin, since it takes a certain amount of desperation to drive most people to go through all the barriers and the stigma against heroin use. Just how society works I guess.

There is nothing about mortality rates in what you linked you drug addled dipshit.

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Wow, you're really mad. Which part of taking a scientific approach to a major social and medical issue is it that pisses you off so much?

Technically you're right, I linked to fatality rates, and to the levels of exposure for alcohol and heroin. Do the math for yourself. If you want to include non-heroin opioids, use google. It's not hard dude.

kegkilla said:

These are the words of a junkie trying to rationalize his opiate dependency. Fuck off with this stupid shit before you get someone killed.

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Couldn't be more wrong! Heroin is just a perfect example of a drug made significantly more dangerous via prohibition. I am in no way advocating it's use, I am just using it as an example of what kind of risks people think are acceptable contrasted with ones they aren't and how illogical their positions actually are when you look at the facts.

Azrayne said:

The statement than withdrawal from heroin is "not much worse than a bad flu" is flat out not true, but alcohol withdrawal is not only more unpleasant, but can cause potentially fatal seizures and long term damage to the nervous system.

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The book "Chasing the Scream" (Johann Hari) and "Drugs without the Hot Air" (Dr Nutt) both make references to people getting off heroin used for serious injuries in the hospital as being a very manageable experience not much worse than a flu. I have never personally experienced it, so I can't comment. Is that a statement more from personal experience or something you've seen a lot of people go through?

girls will fuck strange men to get a bag of heroin,
girls will fuck strange men after drinking to much alcohol

The book "Chasing the Scream" (Johann Hari) and "Drugs without the Hot Air" (Dr Nutt) both make references to people getting off heroin used for serious injuries in the hospital as being a very manageable experience not much worse than a flu. I have never personally experienced it, so I can't comment. Is that a statement more from personal experience or something you've seen a lot of people go through?

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Ok I see where you're coming from (although I think Hari, like Carl Hart, really overstates his case in some places).

In short: it varies.

Someone being given heroin for an injury is being given lower, regulated doses and almost certainly going through dependence and withdrawal for the first time, being tapered from the drug through a slow reduction in dose and potentially being provided other medical assistance. In this context, yeah, withdrawal could be equated to a bad flu in terms of severity.

By comparison, the average street heroin addict has probably been using longer, at higher doses with a greater tolerance and dependence, just by virtue of this their withdrawal symptoms with be equivalently more severe. It's also highly likely that they've been through withdrawal multiple times, and although I've never found any studies to confirm this either way, my own experience and the experience of basically every other opiate user I've spoken to about the subject suggests that there is an effect identical to Kindling (sedative-hypnotic withdrawal) - Wikipedia, the free encyclopedia at work when it comes heroin withdrawal - effectively, each time you undergo withdrawal, the severity worsens (relative to the dose/duration, of course).

In this situation, the symptoms can far more severe, although they're still not, in themselves, very dangerous (which I suspect is why there are no studies on the kindling effect).

Also gotta remember that the "flu" analogy leaves out the psychological effects. On top of being intensely physically painful, moderate-severe withdrawal causes intense depression and anxiety, as well as strong cravings for the drug. Combined with the physical stuff, it definitely makes for a shitty few days.

There's also Post-acute-withdrawal syndrome - Wikipedia, the free encyclopedia to contend with - basically, residual depression, fatigue and pain sensitivity as the body and brain rebalance themselves to adjust to the lack of constant heroin intake.

if you check out erowid or bluelight, I'm sure you can find accounts of withdrawal of various levels of severity which should give you a picture of what it's like.

Personally, my earlier experiences with withdrawal could probably be equated to a bad flu in terms of severity. But over time, especially once my tolerance really mounted and I started injecting, it not only became significantly worse, but would require far shorter periods of use to occur as a consequence. By the end, 3 or 4 days of shooting up would leave with worse withdrawals than I used to get after weeks of swallowing codeine or snorting lower doses of oxy.

Lol, damn. Yeah, I used to hang out there constantly, although I didn't manage to amass quite that impressive a post count. Still check in from time to time. It's a good place, I think I would have fucked myself up a lot harder without the info available there (although I also learned about a ton of drugs I would otherwise have never encountered, and met several of my hookups and drug buddies there, so...).

Yeah there's a bunch of vice people there, it's one of the places they hit up whenever they want to do a drug story. I know a few of the regulars in the Aussie section have appeared on the news or in documentaries to discuss harm reduction. It's a pretty major hub for the harm reduction movement, although not as prominent as it used to be with forums are falling out of favor with the up and coming generation.