A one-time school project gone terribly, terribly wrong.

27 January 2004

Finally, an end to my thoughts on addiction

First order of business--note the snazzy new Comment link, courtesy of Halo, over there on the left.

Today, the moment for which you've been waiting with baited breath--at least those of you with an anchovy hanging from between your teeth have been waiting with baited breath.

The others have most likely been waiting with bated breath.

Today, an attempt to wrap up the whole tangled problem of heroin addiction, in one post.

When we last left, our heroes, we had come to a few basic conclusions. Namely that prohibition has been historically shown not to work, and that no-one goes out deliberately to be a heroin addict. With us so far?

My last post left me with a number of questions about heroin addiction and its effects:

1) Is it true that heroin has no effects on the body other than those associated with street drug use?

That is, if the supply were of consistent quality and the addict were able to use their drug of not-exactly-choice in sterile surroundings, would their physical condition remain fairly good, or would it disintegrate as a direct result of the use of heroin?

For answers, I tried to acess the Ministry of Health. None of the links at their Mental Health and Addictions web page worked. I'm optimistically assuming this has nothing to do with the cruel cuts of our noble premier. I phoned the local info hotline--but it's busy. I'm just glad I'm not fighting the urge to mainline an eight-ball, or something.

Oh--got through. They were very nice, and referred me to another telephone source, where I've left my number. I'm expecting a counsellor to phone me back (Much later--no dice).

But it doesn't make sense that injecting a foreign substance into the body wouldn't cause some form of damage, be it long-term or short-term. If we over-consume alcohol, even while maintaining an otherwise healthy lifestyle, we become vulnerable to cirrhosis of the liver. The regular use of cigarettes and marijuana is associated with hugely elevated levels of lung cancer. So why would heroin be exempt?

My roomate counters that the body manufactures similar compounds to those found in heroin, and that when injected it's free of the delivery hazards of smoking. Of course the body supposedly manufactures alcohol too.

Makes sense to me. I've always figured it was like diabetes: Some of us are just born a drink or two too sober, and never quite catch up.

Question #2) Is it true, as my roomie claims, that people reach a plateau of usage and can maintain their habit with the same fix each day? Roomie suggests that there's a maximum amount beyond which people won't bother administering more. Claims a study was done with monkeys. I'd hate to try to show you how hard I searched for any evidence of that study.

Found this though. Well-written and thoughtful, with a mild-wild flavour.

And this. Not what I wanted, but bloody thoroughly researched, eh?

Likewise this page, but an interesting read from a group who want to legalize ecstacy.

And as always, a contravening view--which appears to come from an online paper whose main purpose is the "defence of marriage".

(Surely, with the decline in couples getting formally married, the best way to defend the sacred institution is by opening it up to people who really want to get married?)

I'm not sure what this is, but it was a fun read.

You do realize that this blog could be written by an entirely finite number of monkeys?

So I have yet to find evidence. I ran into a number of monkey studies, but aside from being sufficiently text-dense to stop bullets fired into my monitor, they didn't appear to say anything about usage levelling off. Pity, 'cause if it were true, if addicts could be relied upon to self-medicate with clean heroin in sterile surroundings, it seems likely there'd be fewer OD's.

But some addicts withdraw the drug to chase the original high, since tolerance reduces the effect of the drug. Part of what leads to OD's is the variable quality of product. Since junkies have to guess the purity of what they're getting, of course there are OD's.

On that subject: A very pretty and interesting woman managed to turn me completely off a while ago when she said "I mean, why pay $19000 dollars to save a junkie's life if he's only gonna OD again" (Note: I don't recall her exact words, but I got the spirit dead on).

I was speechless for a minute. But it forced me to inquire whether I was somehow morally deficient in supporting continued health services even for drug abusers. My arguments run thus:

a) If I claim moral superiority to a drug dealer, or a junkie, I am obligated to believe that a life is worth living, hence worth saving. I may be wrong in many cases, but OD is not deliberate suicide.

b) In my nation, with its socialized medicine, many otherwise "productive" members engage in risky behaviours all the time, from drinking and driving (or talking on a cell phone and driving--they're functionally the same) to wandering about in the woods
carrying unwrapped bacon in a backpack. My tax dollars pay for the rescue of morons with SUV's who get lost in the woods (having GPS, knowing how to use it, and having a dead battery are all quite different things). So why are junkies any different?

Why should I object to $19 000 seven times in the life of someone who'll never cost me a dime seeing a doctor otherwise?

c) Worse yet, many people have an attitude that since "our tax dollars pay for it" they're entitled to use the "drive-through" method of health care: First you save up all your ailements for a year or two, then on your annual visit to the doctor you insist on a battery of expensive tests and treatments you don't really need, ("Lessee, I'll take an x-ray, a blood sugar test, a gram septicimia screening, a white blood-cell count, oh and what are those little things with the sprinkles? A CAT scan? yeah, I'll have one of those too") so you can tell your friends over coffee and doughnuts how good your cholesterol is.

Question #3: If the government provides safe injection sites or gets into selling heroin, isn't that tacit approval of the use of illicit drugs?

Two responses: So if we keep heroin illegal, can we also do away with Zoloft and Ritalin? Ah, says the reader, but those drugs are theraputic, right? See the difference? Well actually, no. For one thing, consider the number and nature of Ritalin prescriptions. Is there any rational reason for the number to have risen like it has? Not incidentally, Zoloft and Paxil remain fairly popular drugs among both the genuinely needy and the fashionably troubled. If these drugs constitute therapy, why should there not be theraputic heroin?

Also, the government sells both alcohol and tobacco. Is that a tacit endorsement of alcoholism and smoking? No. It's because people think that there's a need for control of these mildly psychoactive substances. Besides, the government provides addiction control by attempting to make it no fun to drink or smoke once you're past legal age.

(While we're here: Why is it that an 18-year old in the US is old enough to be drafted, to drive, own a gun in most states, and vote, but apparently unable to handle a can of Coors light? At one time, 16-year-olds could drink beer with a meal in a British pub)

The person who made the "why bother" statement had herself recovered from a mental disease. I wish I'd had the presence of mind to say "why give people Paxil?" or something similar. The Health Ministry at least seems to regard addictions as a mental health issue. But is that the way to perceive it? Maybe we just aren't leaning hard enough on the addicts and the salesmen.

There are several ways to address heroin addiction:

1) Increase the penalties for posession. Treat heroin addicts with jail time and compulsory rehabilitation. Remove the children of addicts before their parents behaviour can corrupt them.

2) Why change anything? It's a criminal behaviour now and they ought to know better. People who take heroin should know what they're getting into nowadays and if they wind up addicted, well what did they expect? But we need an education blitz in schools to keep our kids from getting hooked. This generation may lose a few members, but the next one doesn't have to.

3) We should create "zones of tolerance" so that they can live their lives free of harrasment. otherwise, things should stay the same.

4) We need to introduce safe injection sites and provide support and education for addicts at those sites.

5) Heroin should be legalized. It's the user's choice what drug to take, and by legalizing it we turn the problem into an entirely social one, not a legal one. It'll save us tons of money.

O-kay. After many days and a lot of thought:

Answer to #1: Useless idea. "It's already illegal--what we need is to make it more illegal!" ? It's already done in hiding, and the cops admit they haven't got any way to stop it. As cited earlier: Prohibition simply doesn't work.

#2) Well we could certainly let things stand as they are, but aren't we sort of obligated to do the best we can for the addicts? And if whatever we go with reduces crime, reduces fatalities, and provides and environment in which junkies may be able to get clean, shouldn't we at least try it?

3) The Swiss and other nations have tried this. Basically it does for addicts what the Warsaw Ghetto did for Polish Jews.

4) This seems the smartest choice. Better yet, let's do what Switzerland did and provide clean, quality heroin at about $10 a hit. That'd take the business away from the dealers and pimps, remove the normal hazards of collapsed veins, abscesses, getting ripped off, raped and/or killed during a deal, heroin cut with rat poison, and overdose.

There have been overdoses at the Swiss and Australian sites, but no deaths--even though ambulances had to attend six times the day the Sydney clinic opened its doors. That's lives saved, and those lives are worth something. At least, I think they are.

By having a clean and safe space, junkies also may be able to get their lives under control. Some harm-reduction clinics provide day-labour contracts, so that once the addict has fixed, he or she can earn some money. None of them will ever be Ken Lay or Donald Trump but. . .

Actually, maybe that's my point.

And here's the interesting bit: The Swiss study found that there was a net benfit of about $300 per addict--and they were supplying the heroin!

5) I'm not comfortable with the idea of legalizing heroin. I must say though, that that's only an uncomfortable feeling. I really can't rationalize it. Or maybe I can:

We recognize that certain people are at risk of alcoholism due to genetic factors, as well as social ones. But heroin appears to be an equal-opportunity addiction drug. If alcohol were fundamentally addictive to 90% of the population we'd probably ban it.
We have education programs in place against tobacco and drugs (which also provide a significant share of "sin tax" revenue for the government coffers), and those who are addicted have both rescources and motivation to quit. If heroin were legal, we'd have to create "Her-o-non". It would also increase social acceptance.

Why wouldn't handing it out to addicts increase social acceptance? Dunno--Doctors prescibe drugs all the time. Are those drugs "socially accepted"? Has their use increased because it's somehow fashionable to use them? Perhaps. But not at the rate I suspect they would if they were over-the-counter medicine.

Heroin users currently must break out of their addiction sufficiently to leave their comfort zone and seek treatment. In a safe injection site, they would have continual access to help, even while they were fixing. This would bring therapy and alternatives within their comfort zone. Better yet, the addicts using the facility could be monitored better to ensure their general physical and mental health, frequency of use, and relapse rate when undergoing treatment.

So the more I think on it, the more it looks like number 4.

The health authority should create harm reduction sites where addicts can buy and use a hit in a clean and safe environment.

To you, dear reader, my thanks for having followed along with me. We have reached the logical conclusion in safety. If I have not persuaded you, or my arguments seem thin to you, please remember that this is only my opinion, backed up with logical thought and a few figures. Honest, logical, critical counter-argument will be welcomed.

I know this took a very long time. It's called the thought process. It's something many politicians devote little time to. So we must do it for them.

This blog has been brought to you today by the letters "H", and "M", and by the number 8.


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