The problem was, while not solved, massively improved by providing heroin to hardcore addicts[2]
The only argument against it, really, is that it's morally wrong to hand out drugs to addicts. Leaving this argument aside the approach was (and is) widely successful. Not only for the city, as such, but also for the addicts who get a chance to stabilize their lifes, are much healthier and actually can hold down appartments and jobs.
"
The [heroin] addicts on prescriptions, by contrast, looked like the nurses or receptionists or Dr Marks himself. As a group, you couldn’t tell.
Faced with this evidence, Marks was beginning to believe that many ‘of the harms of drugs are to do with the laws around them, not the drugs themselves’. In the clinic, as Russell Newcombe tells me, they started to call the infections and abscesses and amputations ‘drug war wounds’. So Dr Marks began to wonder: if prescription is so effective, why don’t we do it more? He expanded his heroin prescription programme from a dozen people to more than 400.
The first people to notice an effect were the local police. Inspector Michael Lofts studied 142 heroin and cocaine addicts in the area, and he found there was a 93 per cent drop in theft and burglary. ‘You could see them transform in front of your own eyes,’ Lofts told a newspaper, amazed. ‘They came in in outrageous condition, stealing daily to pay for illegal drugs; and became, most of them, very amiable, reasonable law-abiding people.’ He said elsewhere: ‘Since the clinics opened, the street heroin dealer has slowly but surely abandoned the streets of Warrington and Widnes.’
One day a young mother called Julia Scott came into Dr Marks’s surgery and explained she had been working as a prostitute to support her habit. He wrote her a prescription, and she stopped sex work that day.
"
Just a perspective, not saying right or wrong.
Edit: added this:
"
And something nobody predicted took place. The number of heroin addicts in the area actually fell. Research published by Dr Marks in the Proceedings of the Royal College of Physicians of Edinburgh compared Widnes, which had a heroin clinic, to the very similar Liverpool borough of Bootle, which didn’t — and found Widnes had 12 times fewer addicts.
"
Faced with this evidence, Marks was beginning to believe that many ‘of the harms of drugs are to do with the laws around them, not the drugs themselves’.
I believe this to be quite self-evident. A heroin addict can be quite a succesful and functioning member in society, provided that she can maintain her habit, without the hassle that comes with bad quality drugs and the stress (and invariably crime), which is required to maintain the addiction.
That all falls away when the drug is made available cheaply, regularely and even paid for by health insurance.
How is this different from what happened with OxyContin and the like —- which when made widely available and widely prescribed, resulted in a massive increase in consumption, overdoses, and deaths.
OxyContin was prescribed by doctors that believed it was not addictive to patients that were not yet addicts. The prescription is temporary and ends, so then there is a new illegal drug addict.
(1) The drugs shouldn't have been prescribed in the first place. This system was creating the cycle of dependence, not attempting to manage it.
(2) Oxy and other opiates were prescribed for specific medical issues rather than recreationally. That leads to drug-seeking behavior once the normal course of treatment wears off, and eventually when cut off from legitimate supply, illicit alternatives.
Don't forget manufacturers of "long release" versions requiring prescription of fewer higher dosage pills instead of more smaller and incidentally cheaper ones.
Yes, it increased consumption by creating new addicts. Because, as with cigarettes, addicts are good customers. But it was inability to keep getting prescriptions that caused overdoses and death. Because you had all these ~middle class addicts switching to heroin, without a clue how to use illicit heroin at least somewhat safely. That, and the increasing use of fentanyl to increase potency of highly cut heroin.
But you need some strong incentive structure to not start doing heroin in the first place. For most, that's the knowledge that heroin is going to invariably screw you over in the long term. Not to mention the long-term medical side effects of heroin usage...
Is there a young to middle aged person alive in the Western world that doesn't know that long-term drug use is bad for your health?
This doesn't deter. Besides, most folks don't intend to get addicted and only a portion do. Many more can use opiates medicinally or recreationally without addiction.
It seems decriminalisation works. Safety nets help. Offering free, medical-based addiction help would help. Prudent disussions with doctors when using opiate main meds would help - you know, what to watch out for with addiction, help if it happens, and not treating folks like criminals the rest of their lives if it happens.
I'd personally advocate legalisation of most drugs, even if I wouldn't do them, just to keep folks safe.
The painful truth to this problem seems to be that people who actively use drugs and decimate their bodies when provided a steady supply of drugs will simply die sooner?
It seems hard to argue that supporting someone's heroin habit wouldn't incur a higher than normal cost for healthcare?
You're immediately claiming truth. That blocks other viewpoints. Also 'painful' which is a weasel word.
> people who actively use drugs
as opposed to passively use them?
> and decimate their bodies
you presuppose what they do 'decimate' their bodies. Maybe they do but it's a bit short on facts innit. And related, does taking copious amounts of alcohol (which I agree does damage bodies) count, what with alcohol being legal and socially acceptable?
> when provided a steady supply of drugs will simply die sooner?
A presumption, although one I'd have real trouble disputing. But facts are needed here.
> It seems hard to argue
dude, more weasel words!
> that supporting someone's heroin habit wouldn't incur a higher than normal cost for healthcare
The article gives examples of higher healthcare (and police) costs for not supporting them. Quite explicitly.
Also
"when provided a steady supply of drugs will simply die sooner" and "incur a higher than normal cost for healthcare" may be incorrect - they may die sooner thus saving the NHS money because pensions and extended healthcare due to old age are avoided. I understand this argument has been made for smoking; smokers are claimed to cost less than non-smokers. I'll see if I can find a proper study for this.
Thanks for your feedback! This is actually more feedback & more meaningful than what I get from my FAANG manager. I'll use this to better form my arguments going forward, thanks friend.
> you presuppose what they do 'decimate' their bodies. Maybe they do but it's a bit short on facts innit. And related, does taking copious amounts of alcohol (which I agree does damage bodies) count, what with alcohol being legal and socially acceptable?
It's pretty hard to get Hepatitis C, AIDS, pulmonary infections, or collapsed veins from a few mixed drinks or beers...
It speaks well of you that you took it constructively! I appreciate that, upvoted.
> It's pretty hard to get Hepatitis C, AIDS, pulmonary infections, or collapsed veins from a few mixed drinks or beers...
I won't argue with the collapsed veins I guess, I don't know if there's a way to avoid that. I didn't know that pulmonary infections were associated with heroin, thanks for the info.
The other stuff is - I presume, and you may disagree - a product not of the drug but of the contaminants and circumstances. Hep & aids from shared needles (and see my other comment, <https://news.ycombinator.com/item?id=20165469> actually I presume it was shared needles, she was female so it may have been from prostitution). A proper needle exchange facility will fix that, perhaps.
Pure heroin is not toxic. It's living on the streets, cutting agents, constant withdrawls, additional substance use and injecting material of unknown purity without supervision that kills you. For most addicts, all of these issues can be fixed with a constant supply of medical grade heroin.
Leaving them on the streets or in a state of perpetual craving and poverty is expensive, too. The studies others cited says crime rates plummeted. Imagine how much damage local people and businesses might have suffered, imagine how much police efforts might have been spent, and emergency room visits that might have occurred, if those people were not given treatment.
My guess is that since we already have studies where people are given heroin as a form of rehabilitation, there should also be some studies about the cost of such programs. Wish someone could share some of them.
> But you need some strong incentive structure to not start doing heroin in the first place.
You really don't. You seem like a straight-laced individual, if I told you heroin were legal in the US tomorrow would you go get some? I seriously doubt it. Anyone who wants it can already get it. Anyone not using isn't going to start due to legalization.
You know what legal thing I hear is fun but bad for you? Autoerotic asphyxiation -- but you don't see me hanging from the ceiling fan.
I urge you to research the Portuguese model, where all drugs were decriminalized to massive success [1].
That argument doesn't sound well founded. The booming marijuana industry and its popularity among previously non-pot smokers should've been your first clue.
(1) Marijuana is not nearly as bad for you as tobacco or alcohol, whereas I think we all agree hard drugs are worse. This study from a few years back should put things into perspective [1]. I think it's disingenuous to compare a drug that's objectively safe to one that's broadly recognized as objectively harmful.
(2) As of October 2018 (shortly before legalization) 47% of all Canadians have tried pot. [2] Now that it's legal, people are just more willing to fess up to it. Again, it's nothing they couldn't get before if they'd wanted it. Further [3] shows that the percentage of people smoking pot in Canada did not in fact increase after legalization.
From Statistics Canada: "For example, the vast majority (98%) of those who have never consumed cannabis indicated that they would not use in the next three months. In contrast, most daily or almost daily (93%) and weekly (84%) users thought they would continue to use in the next few months at the same frequency." [1]
> that heroin is going to invariably screw you over in the long term
I understand that about 60% of heroin users can use it recreationally in the way you or I would have a few drinks then stop because we know our limit.
That figure came from a letter in mewscientist mag but I can't find it, so treat with skepticism. I get the impression its reputation for certain and terrible addiction is the from anti-drugs campaigns and they aren't reliable, by design.
It is a perspective, but I think the culture in most places in the US would render this option unviable.
I can guarantee you that if this were to be attempted in SF, they would have to have the drugs administered by medical staff. They couldn't just hand heroin and crack to the patients. Pimps and dealers would send in mules to get drugs that could be resold for cash. That would also probably cause human trafficking to surge.
Portugal's efforts to reduce addiction and homelessness sound great too, but those won't work here either. We need to find solutions that are workable for our culture... or wait for our culture to change.
> ...they would have to have the drugs administered by medical staff
As they do in the UK I believe. I was once in a branch of boots IIRC (boots is a UK pharmacist) in a midlands city where there was plenty of drugs problem. A rattily-dressed guy came in and they gave him half a measuring cup of some thick green liquid which he drank in half a minute, while he chatted with them. They were watching him carefully, 2 of the pharmacists.
I dunno but I guess that was methadone.
There's no reason to assume that they'd simply hand out the stuff, and if it was by medical staff who expected to be taken as they watched, that's ok I think.
I believe you're spot-on that culturally that would not be acceptable in the US.
I can guarantee you that if this were to be attempted in SF, they would have to have the drugs administered by medical staff. They couldn't just hand heroin and crack to the patients.
I'm not sure about the logistics, but don't think they're that complicated. Getting into those programs is tied to quite stringent conditions. Like a certain age barrier and a number of attempts to go clean. I'd wager that there's more prescribed Ritalin resold on the black market than heroin obtained through those programs.
In one sense I believe it was fundamentally successul: It turned the drug from having a "hero image" in the 70s and 80s into a complete loser drug.
Harm reduction is one of the pillars in treatment of addiction, which now is widely and generally accepted. Proven by two referendums in which the public had a say on the issue. And harm reduction is unarguably a good thing, when it comes to addiction.
When I was in my early 20's a good friend of mine (mid 30's) was on the methadone program.
He functioned more or less fine all things considered, but used to get a little more than he needed and would trade the excess for weed with a guy who used occasionally.
They were only small amounts, and it was methadone rather than heroin so all of those caveats apply, but the situation seemed harmless enough to me at the time.
I remember that sometimes he'd be a little more out of it than normal, though, and it was when he'd have his supervised "usual" dose as a part of the program rather than the takeaway prescription.
Not sure why the weed dealer didn't get on the program himself, but I don't know what's involved -- maybe he really was one of the mythical recreational users, or maybe he was selling it on (seems unlikely in such small amounts, but that would depend on how many people he had that same arrangement with).
Then let's let those other cities, states or countries deal with this. Or do you deem those others so incapable that they require a nanny?
Give out only some milligrams of decent, even "organic" stuff per person, once every day - and the logistics will make it impossible to export any amount worth it, even at the todays prices.
No, that's unproductive. This approach will only lead to the black market staying black.
Drugs are recreational. By outlawing, or otherwise restricting drugs, a government admits to a decision to not provide environment and opportunities for recreation, or any other affordable opportunity for fullfillment.
By not removing those restrictions entirely, it admits it still desires the resulting oppression. So it's pointless.
It is a perspective, but I think the culture in most places in the US would render this option unviable.
This isn't an excuse to do the right thing, though. I'm sure they've said it about gay marriage, integration of schools, and marriage between "races", women voting, and so on. Culture will move forward.
> ... looked like the nurses or receptionists or Dr Marks himself.
That would be because Dr Marks can't see himself. The difference between a high functioning, long term heroin addict and everyone else is that the heroin addicts require large support staffs that keep them high functioning.
The difference between a high functioning, long term heroin addict and everyone else is that the heroin addicts require large support staffs that keep them high functioning.
Not really. They require their regular fixes, but are then able to be quite functional, if highly addicted.
Where the requirement for significant resources come in is initially, vetting an addict for eligeability to enter the program.
After that it's only a question of controling the distribution. Pharmacies can function quite well as gate keepers in the process.
You mean all the people who make and prescribe and administer the heroin? If that’s your meaning, then “everyone else” has much the same problem: it’s a rare person in our society who isn’t dependent on some part of the pharmaceuticals / medical equipment / biochemical industry to keep their life together. You can’t just stop taking SSRIs if you’re on them, insulin if you’re diabetic, antibiotics in the middle of a regimen, immunosuppressants if you’ve had an organ transplant... and you could never be a doctor (without immediately causing a life-threatening incident) without a constant supply of scrub and pre-sterilized instruments.
>You can’t just stop taking SSRIs if you’re on them, insulin if you’re diabetic, antibiotics in the middle of a regimen, immunosuppressants if you’ve had an organ transplant...
These do not constitute such a large portion of the population that you can say that folks who do not require them are rare. If anything it's the opposite.
The point I make is that heroin addicts require everything that everyone else requires, plus medical support staff that provide them with cheap and safe sources to feed their addiction. Equating this with the tools of the trade of medical professionals is absurd.
The point I make is that heroin addicts require everything that everyone else requires, plus medical support staff that provide them with cheap and safe sources to feed their addiction.
Pharmacies serve quite well and rather cost efficient for this purpose. It's not really that far away of their core business of dispensing prescrition drugs. The substance is different, but the logistics are exactly the same.
You may think that pharmacy robberies are a concern, but it's not really an issue. I accept that this may not universally be the case.
Pharmacists (at least in the US) can give intramuscular injections, but are not licensed to give intravenous injections. That has to be done by nurses, or M.D's. I'm unsure as to a phlebodomist.
Unless you're talking Oxycodone (sp?) or oral heroine (long release) or something of that nature. At which point, my point is mute =)
I thought it clear point well made in the text that when prescriptions were given, people could continue with normal lives. Sans such support they had other major medical problems (I knew a heroin addict that got hep from needle sharing).
If they didn't need to rob for their habit then the large 'support staff' of police is reduced.
You seem to have ignored the facts in the article. That, or there's more about your position that is not obvious, perhaps you know or have worked with some addicts and have additional experience I haven't?
So you're saying doctors are doing their job properly is a problem? How many people with bad eyesight could be high functioning individuals without their eye doctor?
I completely agree. I have told this to people for years. You have this population addicted to this drug we would produce for pennies and instead of working with them we make it illegal and challenge them through theft, prostitution, and street dealing just so they can supply their habit. Furthermore, I heard that in the countries that started the dealers dry up and new heroin addicts are simply few and far in between. I suspect that laws were not originally designed to help these people but rather to exert control over them. On a side note, with all the problems alcohol causes it amazes me we sell it but worry so much about others such as marijuana.
I don't think it should be assumed that the homelessness is caused by the addiction, rather than both being comorbid to some third condition. Certainly some homelessness is caused by addiction, but for some a mental illness could be the cause of the homelessness and the drug-use may be an attempt to self-medicate that mental illness. In that scenario, providing clean and safe heroin would improve their quality of life, but wouldn't address the underlying condition or the subsequent homelessness. The family living next to the tent city will probably still feel pretty upset about the state of things.
The family living next to the tent city will be much happier without its property being constantly broken into ($300 window repair for the sin of leaving $5 in change in the cup holder), or the other acts that the opioid-dependent are willing to do to avoid withdrawals.
Patiently waiting for this to expand into a mainstream program here in Vancouver... Meanwhile, the streets near where I work are literally mayhem 24/7. Take the Tenderloin district of San Francisco, enlarge, enhance, and shittify and you're only part way to how bad parts of downtown Vancouver are these days.
The problem was, while not solved, massively improved by providing heroin to hardcore addicts[2]
The only argument against it, really, is that it's morally wrong to hand out drugs to addicts. Leaving this argument aside the approach was (and is) widely successful. Not only for the city, as such, but also for the addicts who get a chance to stabilize their lifes, are much healthier and actually can hold down appartments and jobs.
[1] https://www.tagesanzeiger.ch/extern/storytelling/needletraum...
[2] https://www.pri.org/stories/2016-02-12/us-can-learn-lot-zuri...