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Free heroin

I thought I’d share with you a post I made for my Facebook friends who generally aren’t as well-informed about drug policy as readers here. There had been so many posts regarding the death of Philip Seymour Hoffman that I felt it was important for them to hear a different perspective about heroin policy.

Free heroin.  I’ve spent over a decade studying and writing about drug policy. My friends know this and sometimes one will come up to me and say “I know you think we should legalize and regulate drugs, and I’m with you when it comes to marijuana. But what would you do with a truly evil drug like heroin?”  And I respond, “I’d have the government give it away for free.”

Yes, that does tend to elicit a shocked reaction, but let’s take a moment to look at our experience with drug policy.

The “just say no” and “drugs are bad, mkay?” approaches to drug policy (espoused by well-meaning, but clueless, outsiders) have little chance of affecting those most likely to become heroin addicts. And close to a century of experience with prohibition laws has proven conclusively that we cannot stop people from getting and using heroin (even in countries where drug trafficking gets the death penalty), plus prohibition itself adds additional harms in terms of uncertain dosage, contamination, criminal involvement, stigma, etc.

Yes, we can do some significant prevention by educating people with real facts about drugs and their effects, but we also need to understand reality. For example, consider that we could completely eliminate sexually transmitted diseases if we could just convince people not to have sex. That’s a fact. It’s also an impossible fantasy. Eliminating heroin use through prohibition laws and societal disapproval is also an impossible fantasy.

Once we accept that there will be a small percentage of the population who use (and perhaps abuse) heroin, the real question is what we can do to reduce the harm.  In the U.S., we tend to focus on abstinence-based treatment programs (cold turkey quitting), often under stressful conditions (connected to arrest, job loss, etc.).

While it works effectively for some people, that approach has two problems.  First, those who have tried to quite smoking know that the worst/hardest time to do it is when they are in a stressful life situation. Yet, heroin addicts are told to quit cold turkey when they’ve reached rock bottom (loss of job, family/children, career, freedom, etc.).  This makes relapse more likely.

Second — and way too many people don’t know this:  you are much more likely to die from a heroin overdose after abstaining for a period of time. That’s right, when you quit cold turkey, if you then relapse, your chances of dying increase. Treatment, bizarrely, often leads to heroin overdose deaths.

How is this possible?  In a nutshell, it has to do with tolerance.  When you start using heroin, your body develops tolerance — you need more to reach a target level of euphoria, but your body adjusts and can handle more. When you quit, your body’s tolerance goes back down, so if you re-start, the same heroin you could tolerate before will now stop your breathing. Studies have indicated that the majority of heroin overdose deaths occur after quitting for a time. That’s probably why you often hear in famous overdose cases that they had recently been in treatment. As an additional complication, those who relapse tend to do so in solitude (stigma/shame) and thus cannot be helped by the simple application of Naloxone, which, while painful, can reverse pretty much any heroin overdose without causing damage.

Despite all this, we rarely discuss whether our approach to heroin use (prohibition and cold-turkey treatment) is the only, or best, approach. There is a better option.  (You were beginning to wonder when I was going to get around to talking about the government giving heroin away for free… here we go.)

I call it Heroin-Assisted Treatment (or HAT). The idea is that anyone using heroin could come to a government-run clinic and get a safe, controlled dose of heroin for free. The clinic would have medical staff and counselors to help people get their lives/jobs/families back into shape, if necessary, so they can maintain their habit without heroin disrupting their lives (and with controlled dosage, it’s possible to do pretty much anything as an addict that a non-addict can do). Once they’ve got their lives in order, they can work at reducing or completely quitting when ready.

I realize that it’s counter-intuitive and sounds completely bonkers. Free heroin? Ridiculous.

But this isn’t my idea. It’s actually been done. And we have clear evidence it works. While each program has had different details, there have been successful HAT programs in Canada, Germany, Spain, the Netherlands, Switzerland, and the UK, going all the way back to 1994 in Switzerland. And every study done of these programs have shown that they work. Massive reductions in crime, improved physical and mental health, excellent cost benefit to society, and greater longevity for those in the programs.  And here’s the kicker — the existence of such programs takes away the profit potential for criminal heroin dealers, which actually can result in fewer people being exposed to heroin use.

So why don’t we have HAT here? (And why has HAT been under political attack in every country where it is successful?)  Because many people don’t like it. Despite the facts, it is politically unpopular to “provide heroin to addicts” because it sounds like we’re encouraging drug use.

 It’s the same political calculation that promotes abstinence-only sex education under the sadomoralistic belief that it’s better for children to die of sexually transmitted diseases than give them a condom (which might encourage them to have sex).

We can continue a century of provably failed prohibition approaches and continue to watch people die, or consider alternative drug policies that have been proven successes. The question is whether we are willing to learn, and whether we care more about good policy than superficial appearances.

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41 comments to Free heroin

  • A Critic

    If you want more of something, subsidize it. It’s a law of economics that is always true.

    This is a great way to grow the population of heroin addicts.

    Better idea:

    Let the market set the price.

    Since heroin is cheap to produce and popular, even a begger should be able to afford a heavy habit.

    • allan

      If you want more of something, subsidize it. It’s a law of economics that is always true.

      This is a great way to grow the population of heroin addicts.

      Really? Such is not the case I believe. In Switzerland for example the addict population is shrinking and the average addict age continues to grow older principally because heroin lost it’s mystique, it’s cool, especially for the young who now know heroin addiction in a public health light.

      Further – and pardon me if I’m mistaken but I think not – but there is NO shortage of any drug anyone wants anywhere in the United States. The black market IS a free market, untaxed and unregulated save by the laws of economics.

      And even further… tobacco use was dramatically reduced by approaching it from a fact based public health campaign.

      There are those who do and those who don’t. Pharmaceuticals kill far more than illegal drugs and they get to advertise on TV. Tobacco kills more than any of them and I can get tobacco 24/7/365.

      Besides, it’s not about the drugs, it’s about Prohibition.

      • DdC

        Tobacco doesn’t do harm, the chemicals added do the harm. So the tobacco prohibitches are just as much liars as the reefer mad ones. Also shitting on the Constitution to save their puddly asses getting funded to blast hobgoblins and another bait and switch leaving the Monsanto’s off the hook. As for heroin. The price is not the issue. Or does it have to be deadly just because prohibition makes it deadly.

        Cigarettes are adulterated tobacco products, not organic tobacco. Now kids are smoking organic and still get kicked out of apartments and prevented from working certain paranoid places. Where have we heard that before? Raising prices getting more politicians taxes only drives the limited incomes to generic brands with even more deadly chemicals added to make them cheaper.

        So kindly stop supporting any prohibition. It never stops what it is supposed to stop. It only makes it more dangerous. Yes brain dead sheep will follow the carrot whomever is shaking it at them but that doesn’t mean they are safe or won’t try something the same as rehabers quitting as long as the please bargain says they must. The fact so many people stopped smoking only says they are obedient and the stigma placed on them is more uncomfortable than their desire to smoke. If you have to bullshit people to stop something it is really a bad reflection on a supposed free country. Sheep would just as quickly start smoking if propagandists told them too. As they seem to follow more than think for themselves or use any line or reasoning. Like those making profits on Ganja or prohibition don’t listen to common sense over dollars.

        Like I’m going to stop harping on this just because it is repeated over and over? Fat chance.

        Organic Cannabis/Tobacco vs Chemical Cigarettes

        Heroin doesn’t kill. Users kill themselves through ignorance or prohibition causing adulterations and inconsistencies. Sharing needles or jail do the harm. Heroin reaches pain faster than morphine and there is no reason it should be outlawed by politicians over science. Oh and btw, the Indians weren’t savages meaning they did discover America. The Euro-peons would have us believe it was Colombus since Indians weren’t quite human. Same as making blacks 2/3rds human. How high does one have to get to come up with this shit?

        Gemma Moss: Was Marijuana the Cause of Death?
        The most recent being from a study published in the journal Science, in which researchers discovered that when the brain is consumed by high levels of THC, the psychoactive compound in marijuana, it produces an abundance of pregnenolone, preventing the effects of the drug from getting too intense. Meaning, a person can only get so high before the body starts blocking the buzz.

        Even the federal government, who appears hell-bent on maintaining marijuana’s Schedule I dangerous substance classification, does not believe marijuana is capable of killing.

        • strayan

          Overexposure to tobacco smoke causes immense harm. It is mainly the process of combustion and tobacco curing methods that create tobacco specific nitrosamines.

          If you smoke tobacco you should seriously consider switching to a smokeless tobacco product, probably Swedish snus or an electronic vaporiser if you want to keep consuming nicotine.

        • DdC

          Bullshit. No record in hundreds of years of tobacco use, smoking it. We lived around camp fires and fire places. This is just propaganda and you even named the culprits, the curing and adulteration chemicals are the cause or harm. Yet you leave them out and blame the tobacco? Like igniting flame retardants doesn’t matter? Such intellectual dishonesty avoiding the reality just to win a debate. Vapes are not proven long term and as I said all this Bullshit does is create another prohibition doing more harm.

          In the long run you are killing people with your bait and switch demonizing the very same as Sabet. There is no proof of second hand or third hand smoke causing problems outside of the propaganda machine. Organic tobacco should not be in the conversation anymore than hemp. Your lungs will be damaged more from fossil fools exhaust driving to the market than being around a smoker, especially one smoking organic tobacco like the Indians, Jefferson and Washington, Sir Walter and Egypt, China and Turkey. Hobgoblins are ugly. Big tobacco has doubled in the foreign market still selling their chemical adulterants prohibitches don’t seem to mind. Still left out of the conversation and left in the shadows also because of paranoids afraid of the bogeyman cigarettes. Same ones selling vapes. What humans will sink to just to sell something is beyond LSD hallucinations.

          Same prohibitches propaganda and the same reasons, profit. Only the anti groups spew this nonsense, with the government who just happens to get more tax from higher prices. I saw the anti tobacco czar and couldn’t tell any difference than the drug czar. Sounded the same. Taking Constitutional rights and justifying it in the same lame name of saveding the kids. Geesh we are a gullible nation.

          Study Finds No Link Between Secondhand Smoke And Cancer

        • strayan

          DdC

          People did not have access to matches and lighters hundreds or thousands of years ago or neatly packaged and stylised tailor made cigarettes. They didn’t have time to stop and build a fire 30 times a day, so they smoked a heck of a lot less. This meant a much lower risk of smoking related disease.

          There are carcinogens in burnt toast but you don’t eat burnt toast 30 times a day for 60 years.

      • A Critic

        “Really? Such is not the case I believe. In Switzerland for example the addict population is shrinking and the average addict age continues to grow older principally because heroin lost it’s mystique, it’s cool, especially for the young who now know heroin addiction in a public health light.”

        Economics is immutable. There are other reasons why the heroin population is shrinking in Switzerland, some you mentioned, most notably that free heroin is less effective at growing the population than prohibition is.

        You shouldn’t be comparing prohibition to “free” heroin. You should be comparing “free” heroin to free market heroin. If junkies in Switzerland had to work or beg or do something to earn their fix the levels would be even lower than they are now.

        “Further – and pardon me if I’m mistaken but I think not – but there is NO shortage of any drug anyone wants anywhere in the United States. The black market IS a free market, untaxed and unregulated save by the laws of economics.”

        Dude, study some economics. Start with “Economics in One Lesson” by Henry Hazlitt. Hint: people don’t pay 20000 a kilo for 50 bucks worth of drugs in a free market!!!!

        “And even further… tobacco use was dramatically reduced by approaching it from a fact based public health campaign.”

        Which coincided with a radical increase in taxation on tobacco. If you want less of something tax it. Economics man, economics.

        • allan

          Since heroin is cheap to produce and popular

          that’s the point – heroin isn’t popular, relatively speaking, beer, wine, sex, video games and pot are popular.

          Are you arguing to argue or do you have a point? You don’t like free heroin, great. The working, living examples of free heroin (Switzerland, etc) indicate use declines. And the savings are broad. Shared needles are the rarity and thus the spread of needle-borne disease is now virtually nil. Drug related crime is drastically reduced.

          Sounds like win-win to me.

        • darkcycle

          I think you’re making some unfounded assumptions. First and foremost is the assumption that addicts who don’t have to jive and hustle to afford their next black market fix will simply sit around and do nothing. That is far from the truth, and undermines the entire basis of your reasoning, A Critic. I’ve known and worked with dozens of heroin addicts in my life and career. They are to a person, among the most intensely creative people I have known. They are generally intelligent, highly creative and very productive at whatever they attempt. Do you think you could come up with a coupla hundred cash a day? While simultaneously maintaining your job, rent, health, and diet? And with unpredictable interruptions in supply, that make sure you’ll be too sick to do anything periodically and without warning? Fact is, many of the folks I knew would have out earned me, were it not for these strictures that meant they had no stability that might allow that. So, that I think you can throw out, it’s simply bad reasoning.
          Furthermore, I’m not sure, but I believe that there are fees attached to the Swiss program, although I was not able to quickly find what the costs to individual users were.
          In any event, the provision of safe injectable Heroin in a SAFE, MEDICALLY SUPERVISED setting (not really the job of the free market, eh?) is clearly a life saver.

        • Duncan20903

          .
          .

          Well “A Critic” you certainly are an expert with that hammer. Your problem is that it’s obvious that you’ve flunked nails 101.

          I am presuming that you actually had some formal economics training, and that your teachers weren’t competent enough to present you with your own personalized dunce cap.

        • A Critic

          “that’s the point – heroin isn’t popular, relatively speaking, beer, wine, sex, video games and pot are popular.”

          Gee, those things are not popular, relatively speaking, oxygen and gravity are popular.

          “Are you arguing to argue or do you have a point? You don’t like free heroin, great. The working, living examples of free heroin (Switzerland, etc) indicate use declines. And the savings are broad. Shared needles are the rarity and thus the spread of needle-borne disease is now virtually nil. Drug related crime is drastically reduced.”

          My point is that “free” heroin subsidizes and increases the number of heroin addicts versus the free market. That’s a bad thing.

          “Sounds like win-win to me”

          “Sounds like” as you are using it means “I don’t understand economics, logic, and unintended consequences”.

        • A Critic

          ‘I think you’re making some unfounded assumptions.”

          You misunderstood my argument.

          The rare lazy junkie who refuses to work can afford free market heroin. No need to subsidize them. A habit should be 2 bucks a day, maybe 5 if you are a long time user with a heavy tolerance.

          “In any event, the provision of safe injectable Heroin in a SAFE, MEDICALLY SUPERVISED setting (not really the job of the free market, eh?) is clearly a life saver.”

          Free market wants you to live. Otherwise you don’t have customers. People prefer to do heroin, and all drugs, in social settings. Why not have heroin bars?

          I’m not an opiates kind of guy, or even a user of anything at my late age, but I am a capitalist – and there’s more money in running a heroin bar than there ever will be in free market heroin. So ya, it is the job of the free market to provide exactly that. It’s a value added service, that’s where the real money outside of prohibition is.

          Absolutely no need to have a levithan taxing me or my mother to pay for my neighbors habit or to build them a bar.

          Or are y’all gonna start ponying up for my coffee fix? If they get free drugs why don’t I get free drugs too? After all, it’s all free right, you can afford my 10k a year coffee habit? You want to spend 150000 taxbux so I can have a place to get my drugs?

          Or is there something particularly special about heroin addicts that makes them worthy of special treatment? Or is merely the fact that you are thinking within the box, the box of state control of drug use, the box that says heroin use must be controlled by the state but coffee use must be controlled by the market?

        • allan

          dude… yourself.

          You started with this:

          If you want more of something, subsidize it. It’s a law of economics that is always true.

          This is a great way to grow the population of heroin addicts.

          But the facts of reality say otherwise! In places with free heroin, the number of users DECREASES. Live with it.

          And now you repeat your mantra:

          My point is that “free” heroin subsidizes and increases the number of heroin addicts versus the free market.

          And where is your free market for comparison? The existing free market – the black market – increases users.

          I understand economics just fine – if ya ain’t got it, ya can’t spend it. And pardon me… but, uh… kiss my ass with your insults.

          *washes hands*

      • claygooding

        The base,opium has been owned by the same bank in England since before the Opium Wars and is why they are the richest in the world,,and they will fight just as hard as they are fighting over hemp even though their number 1 cash crop is marijuana,,the opium trade is family tradition,,besides the US wouldn’t have much to always lump marijuana in with to insinuate similar harms,,they already lost alcohol because all the uproar of a President speaking a half truth people finally started looking at our science instead of dismissing it and 23 countries already legalizing/decriminalizing it isn’t us that is causing the violence and misleading our nation and people are beginning to look at every new legislation more carefully than just marching blindly into the canyons of controlled wealth the bankers have us doing. People are starting to ask them questions they have heard us ask for decades and not just about marijuana.

        When they lose marijuana because they are being so visibly arbitrary doing it id threatening every profit protection policy they think is safe.

        The realization that every since Anslinger used racial bigotry and statistics showing (falsely) that the policy has been racially motivated all along,,it is just that more blacks are poor than other races from all the policies that are racially based,,by making the fish in a barrel the policy it is shaking up a lot of policies.

        People are starting to realize,,burning leaves in their yards creates tars and carcinogens too and all the oil based fuels and coal are even more deadly and the government is subsidizing the oil companies and trying to tell America coal is now clean energy right in the middle of a climate change the government claims isn’t happening.

    • primus

      You are exactly correct; when we subsidize something we get more of it. Why is that? Because the subsidy makes profitable something which is otherwise unprofitable. In that view, drug prohibition subsidizes the drug dealer because if not for prohibition, the profits would be so small that most people would not bother to sell drugs illegally. When heroin was first invented, I believe by the Bayer company, they sold it in stores everywhere at a fair price. If someone wanted some heroin they bought it. Legally. Most use was for pain relief. Everyone knew the potency, everyone knew what the product would do to them. Nobody accidentally overdosed. Nobody was out trying to create a business by getting people hooked, because there was no real profit in it, so the numbers of heroin users was stable at a low level. Once the prohibition of drugs was in place, the market prices soared and the dealers proliferated. Once someone is a user, the easiest ways to make the money to buy the overpriced illegal product is to steal or deal, hence the increasing numbers of users. Each addict becomes a mini-business focused on increasing market share by getting more users. When the profit motive is removed, as in Switzerland, the dealers reduce and new users diminish. That is why we must end prohibition, to end the subsidization of the dealers.

      • DdC

        The hypocrisy of tax dodgers whining about subsidies for unemployed or food for single moms never bitch about the Oil subsidies keeping our fossil fools gas cheaper than europe. this is not directed at you primus We should subsidize alternatives like biomass and biodiesel. In meat subsidies or chemical farm subsidies or war subsidies or prohibition subsidies. If you subsidized heroin less people would die even if more people used it. They obviously care less and as with Ganja. Better dead than drugged. If we gave the meat and dairy subsidies to organic farms reducing the cost of the product then we would be healthier. That is not what is done so this healthy crap is just a red herring by the same who lie about war or GMO labeling or tobacco or drugs, especially cannabis. Subsidize organic tobacco and less harm would be done to the population. Oh but then the corporate housing couldn’t discriminate as easy. Or could they get rid of the questioners in the work place. Just another bit of evidence to hang the liars who do the actual harm in the name of profits.

        Where are all of the Taxbaggers and Norquest?

    • Anonymous

      I suggest doing a bit of research on the history of drug markets in various countries under various regimes of prohibition. If you actually did that, instead of presuming a perfectly linear relationship between something like heroin and something like, say, computer parts, then you would know that prohibition itself *creates* the drug markets. Of course, they are black markets and thus free of restrictions and allowed to completely regulate themselves. Now ask yourself: where have these “free drug markets” gotten us?

      • A Critic

        “Of course, they are black markets and thus free of restrictions and allowed to completely regulate themselves.”

        Prison time, the loss of your car and house and kids and money, and the other penalties and restrictions on heroin users and dealers aren’t “free of restrictions”.

  • darkcycle

    It is worthy of note that the addiction rates to heroin are similar now to what they were when the drug was legal, and sold in OTC medications. And IIRC, the biggest upswings in heroin addiction were during and immediately following times of war.

  • allan

    Spot on Pete, thank you.

  • Dutchmen

    High! ITS a good thing to give heroïne or any other drugs under supervision. Its set dealers out of work and users can buy best quality for cheap. Holland do this for many years with succes. Also methadon programs really works. Theres no differente beween heroïne and alcohol. ITS about the dose you take.
    Thats why Holland have coffeeshops for 40 years now. To Watch Our kids have good quality and separate them from alcohol and harddrugs. ITS based on public health and thats how it (in my eyes) should be with any drugs. Drugs use in the underground circuit is what you dont want.
    Good luck with your project!

  • War Vet

    Free heroin would stabilize Afghanistan significantly. Massoud was a good man when fighting the Taliban, but the problem is the dope money could be used to undermine the nation in the long run: Taliban or no Taliban . . . War Lords whose hearts are in the right place can be as dangerous (though more milder) as War Lords who are totally corrupt and evil. Even in places that grow legal opium for medicine, the money could go back to fund bad programs (like State Sponsored Terrorism; nuclear programs). Free Heroin could make it where the People of Afghanistan start farming for food more than for expensive opium. Until the price of potatoes or rice go up to $100-300 a kilo for the average American etc consumer, there is no money in substance farming and no reason to grow food. Free heroin could help teach the world to grow food, instead of growing products more valuable than food.

    • claygooding

      Until the US took over crop protection the Taliban had the opium production reduced to a level never seen in opium like we have marijuana,,hidden crops until the Taliban lost their countries tax revenues and had to “dance with the devil” to keep the money coming in to fight the infidels,,it really is amazing how similar the Moslem religion and Christianity are,,both will hum the music if no band is available.

      • War Vet

        I’ve always looked at the Taliban reduction of 2000 to be more of an attempt at stopping their rival’s funding and to decrease opportunity of the people they want to control. How much was Pakistan producing when the Taliban decreased Afghanistan’s growth? Since the Taliban comes from Pakistan, it would behoove them to destabilize the economy and defund Massoud. Even during the time they didn’t grow, Afghanistan still had the most opium/heroin in the world–stockpiled. They knew what they were doing when they drafted Osama to play Quarterback for them (how else does someone ever get to own their own province?). They knew America would come and they couldn’t have the Americans picking their cash crop out of the fields, therefore they also needed to ban opium and stockpile it and they also needed to ban opium as a way of keeping the Anti-Taliban from having enough money to control Afghanistan upon American/British arrival–a way of waiting America out as seen in Osama’s ‘Guide to Jihad Revolution’: Attack America/Europe; force them to go oversees; keep them there a long time; force their governments to pay heavy prices for war (attrition); force political change upon America by an expensive war, which stirs the political pot. We played into their hands because they had enough dope money to attack us and keep us there at great costs.

  • cj

    Pete it means more to me then you’ll ever know that you put this up. Thank you so much. To the critic, you know, im speaking not just from experience but from my current life which has been this way for a long time, the idea that its so cheap (h) that by begging homeless you can afford a major hanit well its not completely wrong what ur saying but its also not totally true. I am homeless in the heroin epicenter of nyc. If u truly have nothing and no one but ur habit, as I do, well generally and especially for us men without a canine companion, begging can yield generally several bags a day hardly a major habit and in my experiences and talking with colleagues ive found ur making about 10 bucks (a bag) every 4 hours (there are of course exceptions) but females and people with dogs yes they can make a bundle a day begging, it usually takes a while and they’re not the normal cases. Usually for big habits when ur in a position where HAT can help you your probably doing some kind of con or crime. That’s my opinion though just like I think HAT is the best option and a crime we don’t have it

  • Nick

    I’m not a big fan of the Government handling this. They fail at nearly everything they do. There would be so much red tape the operators had to deal with that it could end up taking hours for a person to even get their fix. Not to mention the waver you’d have to sign to use the HAT clinic. “Sign this waver that states you will not be around children, or if you have children they will be taken into protective custody. You will not drive a car, walk down the street, or leave your place of residence for any reason. Any other Government benefits will be suspended.” Although, I think at the local or state level, this could work, but not work well. Anything is better than what we have now.

    • Windy

      So, prohibition must be ended first; and then private organizations should be encouraged to set up these HAT clinics with private charitable funding (and without all the governmental red tape and restrictions government programs always generate).

  • DeeDeeKing

    Thanks for this post. i was in the trenches for years as an advocate for heroin prescribing the uk, and unfortunately it’s such a hot-button topic that many who eloquently advocate legalizing marijuana tend to stay away from it because the idea of legal heroin just seems so counter-intuitive and it seems to give a loaded gun to the prohibitionists.

    “Oh you think these bastards will stop at marijuana? No! If we we legalize marijuana they’ll be trying to legalize heroin next!”

    Of course no-one is suggesting that we have 8-balls of heroin on sale next to the candy and magazines. But heroin use should be something that is between a doctor and their patients not left up to free market economics, as it is now.

    If you google “The British Method” you can read about how this approach was extremely successful in the UK up until the point that the US, working through the UN, made England adopt their punitive and unsuccessful approach. If you really want to get mad, read what happened to poor old Dr John Marks in Liverpool.

    Here’s an old thread on the subject over at drugs-forum – some really interesting reading there. It covers Marks’ Liverpool clinic, plus has some examples of how heroin prescribing is still helping (albeit a tiny number) of people

    http://www.drugs-forum.com/forum/showthread.php?t=3299

    Keep fighting the good fight!

    • A Critic

      “Of course no-one is suggesting that we have 8-balls of heroin on sale next to the candy and magazines.”

      Excuse me! I am!!! That’s exactly what I advocate and want to see in my lifetime. I have no intention of buying any heroin, candy, or magazines…but the freedom to do so would be much appreciated.

      • B. Snow

        Wait, just a second…

        The heroin should be ‘behind the counter’ = you know, back with the porn and the tobacco.

        Not – “for the chitlins”…
        But for the real reason they do that = Its much harder to steal back there, the candy and other ‘impulse purchase’ items are cheap.
        They can afford to lose a bit of that stuff to the 5-finger-discount, not so much – with the tobacco & porn.

  • Jean Valjean

    Until 1968 (and indefinitely after that for those grandfathered into the scheme) Britain gave out heroin/diamorphine ampules to those who claimed to be addicted to opiates. You could visit your general practitioner for a national Health funded script for heroin and have it filled at the local chemist (pharmacy).
    By 1968 however, with increasing pressure on the British government from the US, UN and War On Drugs Inc., the government put in place restrictions on who could prescribe what to whom and concentrated prescribing in new Drug Dependency Units (DDUs). For the most part new prescriptions were for methodone only.
    The effect of ending regulated distribution and replacing it with the free for all of a black market was to increase the opiate addict population by a factor of ten and to ensure that the new illegal market was kept vibrant. Those who still received injectable heroin became a sort of junky aristocracy and were able to sell part of their supply, thus keeping the black market well supplied. Meanwhile the rest of the burgeoning addict population had to turn to property crime in order to come up with the funds to support their habits from illegal sources. Burglary and shop lifting saw a massive increase.
    It seems obvious to me that the social cost of ending “free distribution” of NHS funded heroin was much greater than if they had left things alone, and this doesn’t even begin to address the power and profits that were handed over to criminal groups in Britain.

  • NorCalNative

    cj is fighting for a kind of cognitive liberty that’s hard for a lot of people to accept.

    I’m not one of them, but he’s sticking up for and speaking out about the difference between “use and abuse,” if I’m reading him correctly.

    We’re all different and have different needs. Let’s do harm reduction up the ying yang, but’s lets also acknowledge that real democracy means letting folks make their own selections.

    And DeeDeeKing is right that defending cannabis doesn’t have to or shouldn’t preclude defending the right to do heroin responsibly.

    Tolerance levels and unknown purity of substance is a BAD combination.

  • The death of Philip Seymour Hoffman was tragic. Like many others I was a huge fan of his work and the fact that he was a fellow heroin user (a fact that I was completely unaware of) just makes it all the more sad for me. I haven’t been online in a few days and missed much of the discussion on his passing, but I do have comments on HAT.

    The thing about HAT is that these programs are usually very restrictive. It’s not as if anyone can just walk off the street and get a shot of dope at a government run clinic. HAT is limited to confirmed addicts, so free heroin would not grow the population of heroin addicts. Furthermore not only do you have to be an addict, but you must also have tried and failed at methadone maintenance. In some cases not once, but twice. This makes no sense, but HAT is considered a second line therapy reserved for those who do not respond well to methadone. In clinical trials HAT outperforms methadone in patient retention, reductions in drug use across the board, reduction in criminal activity, improvements in health, ect. And yet HAT is viewed as a treatment of last resort for the addicts who have not responded to any other intervention. This pro-methadone, anti-HAT bias cannot be defended by the available research. The bias is probably due to the fact that methadone, when taken on a stable dose over extended periods of time provides no euphoria, which makes it more acceptable from the (puritanical) viewpoint of the treatment industry, who view using opiates to elevate one’s mood symptomatic of a disease.

    The other aspect of the clinic system is the restrictions put on the clients in the program. Methadone is known as “liquid handcuffs” among addicts due to the restrictions put on methadone clients. Having to go to a clinic everytime you need to dose is a significant burden, all the more so if you must dose multiple times per day as would be necessary for HAT. You must live and work within a reasonable distance from the clinic. Sure after months you can get take-home doses, as long as you have perfect attendance (better hope your car never breaks down), don’t smoke any pot (or take any other naughty substances), don’t have a prescription for a benzodiazepine and meet a bunch of other arbitrary criteria. If Philip Seymour Hoffman were to enter a HAT program he would probably have to give up his career.

    Imagine the indignation tobacco addicts would feel if they had to go to a clinic everyday to pick up their daily ration of cigarettes or nicotine cartridges for vaporization. Or if medical marijuana patients had to go to a dispensary every time they wanted to toke up. Furthermore the clinic system requires a large bureaucracy to function, doctors to write scripts, nurses to dispense the drugs, social workers to offer counseling and so on. Despite the fact that methadone costs pennies per milligram, methadone maintenance treatment costs around $400-500 per month.

    The stated reason for these restrictions is the risk of diversion. There are two points to make here, one is that it is prohibition that makes these drugs valuable, so with legalization the problem of diversion goes away. The second is that the risk of diversion goes down when the drug used is the individual’s drug of choice. Why would someone sell their pharma-grade, measured dose of heroin to then go out and buy an unknown quantity of adulterated black market heroin?

    Personally I favor the free market, however I recognize that we’re probably a long way from being able to walk into a pharmacy and buy my opiate (or opioid) of choice without a prescription. Medicalization of opiate dependence seems to be a more realistic goal than outright legalization. The clinic system is, without a doubt, better than criminalization/prohibition, but allowing doctors to prescribe directly to addicts provides mostly the same benefits while also allowing the individual to live a normal life. There’s no reason why an addict on a stable dose should be treated differently than any other person seeking medical treatment. Clinics would then focus on the most chaotic users (usually those with serious mental health issues).

    Since HAT is limited to those who are dependent on opiates, the question remains what to do with the occasional users of heroin and pharma opioids, perhaps 90% of people who use opioids are not addicts. Do they still buy from the black market? Should “recreational” or occasional opiate use still be a crime?

    • I’m aware that the HAT programs that have existed have been very restrictive in a number of ways (due, in part, to political posturing). That doesn’t mean that they have to be.

      I can imagine a HAT-style program that is even open to recreational use (sign up, take a short training seminar, sign a paper, and get a dose). There should definitely be a non-black-market option for recreational use.

      It also wouldn’t have to be a government program – a non-profit enterprise, perhaps.

  • cj

    Thanks norcal and ur right. I love the west coast and everyone knows west coast tar is the best by far (pain in the toosh as it may be to cook) at any rate I love the discussion here and can direct you to a relatively recent uk documentary all about HAT if you youtube search the truth about heroin uk documentary u should find it. One thing about HAT that is also a crime is how little we know for example we think HAT has ended in the UK due to late 20th century US pressure but while HAT changed alot and was downsized significantly it is in fact still available in the UK and even via NHS in some cases. They also have a clinic version but it is only for 2 years. Big thing is they have options. A uk dr once told me how in America opioid substitution treatment was morally biased our only options are methadone or buprenorphine neither of which provides euphoria which is why they don’t work. The dr said to me that “its ok to have an addiction with out pleasure (in the US)” due to the Harrison narcotics act these are our only choices but elsewhere short of heroin because they don’t have the Harrison narcotics act they can use effective opiate substitution treatment with morphine, oxycoton etc I know of a clinic in london, name and address available by request that isn’t able to prescribe heroin but uses morphine instead and has used oxy and other opiods. I also have the name and numbers of two uk doctors who do HAT privately out of their office and they have the necessary heroin prescribing licenses so its totally legal. My point is while not as the band simple minds would say, “alive and kicking” HAT isnt dead in the UK. And beyond England theres the clinic/hospital model in Denmark, Switzerland, Holland and Germany.

  • sudon't

    I’m glad you alluded to the fact that opiates do not impair the user. I think it’s also useful in these discussions to mention that heroin and other opiates are not in themselves harmful. It seems very few people are aware of these two facts, and I think it’s important to state them explicitly.