11 ms·

I live in Trumbull County in Ohio, the dark red county in North East Ohio. We recently had 23 (non-fatal) overdoses in a two-day period[0]. That's roughly .01%

I live in Trumbull County in Ohio, the dark red county in North East Ohio. We recently had 23 (non-fatal) overdoses in a two-day period[0]. That's roughly .01% of the county's total population - so yeah, it's getting bad here. There were recently two shootings within a mile of my house. Several people dead. Both shootings were drug related. I can't help but look around and believe that the needs these folks are trying to satisfy are completely human, and that forcing the users to resort to black markets leads to violence and overdoses. I can't help but think this problem in my community could be solved by simply letting people get high. Maybe the answer isn't to make heroin available OTC at Walgreens, but supervised injection sites seem to be gaining traction[1]. I think a lot of the dark red spots on the map, like mine, should probably consider this option. It's not like anything else is working. [0]http://www.tribtoday.com/news/latest-news/2017/03/fri-920-pm-23-overdoses-recorded-in-48-hours-in-trumbull/ http://www.tribtoday.com/news/latest-news/2017/03/fri-920-pm... [1]http://www.seattletimes.com/seattle-news/health/safe-injection-sites-get-ok-from-king-county-health-board/ http://www.seattletimes.com/seattle-news/health/safe-injecti...

the-dude 10y ago
In The Netherlands, supervised injection sites exist for ~30 years now. Also, The Netherlands provide methadone. It seems to have worked / be working. Our heroine epidemic is far behind us, the addicts are dying out.
- cryptarch 10y ago
  The Netherlands also have a few legal highs: weed, kratom and psilocybin.
  - dep_b 10y ago
    They're not legal in The Netherlands. Magic mushrooms have been banned a while ago (but at the same truffles still are not, clueless), weed was never legal. Also all production is illegal. Coffeeshops don't pay taxes. They're just.....there? We used to think it was the crazy US forcing the Dutch to have such a bipolar approach to drugs but pot is more legal in Colorado now than in Holland and still the Dutch laws are a mess.
    - headcanon 10y ago
      The legal status IMO is less important in this case than how the state treats it. In the Netherlands (correct me if I'm wrong), drugs are seen as a public health concern, and in the US its seen as a criminal problem. When its criminalized and demonized like it is here, then politicans must "crack down" on it to appear "tough on crime", and more progressive mitigation solutions (like supervised injection and treatment centers) aren't even entertained in our lust to imprison.
    - cryptarch 10y ago
      Magic truffles have the same effects as magic mushrooms and are legal. Magic mushroom products are still sold at some smartshops, but not legal. Weed is not legal, but you can buy it in dispensaries ("koffieshops") and carry up to 5 grams without being fined or arrested. You can smoke publicly as long as you're not bothering anyone (like with alcohol). I think that's pretty sweet. You can have up to 5 plants at your home, but if the police asks you to destroy them you have to, or you can get fined, so again: as long as you're not bothering anyone or dealing you're fine. There are is also a proposed law to decriminalize the mass-production of weed (while introducing QC regulations, like those for food) and the delivery to the dispensaries. With that full legalization can't be far off. The idea that legalization is just the right thing to do is pretty mainstream here, and a progressive political party, GroenLinks, supports legalization and is currently 3rd in the polls. Edit: caps
      - dep_b 10y ago
        > You can have up to 5 plants at your home I think that's an urban myth actually. I know people that got kicked out of their house for having just three plants just growing outdoor so no tampering with electricity or fire risk. They used to be more lenient but people tended to burn their house down with illegal indoor plantations. It's weird how in a liberal country like The Netherlands where everybody wants full legalization we somehow ended up with a government that got a lot stricter instead.
        cryptarch 10y ago
        That sounds like a renters' agreement thing? Here's what the police says themselves on the matter: https://www.vraaghetdepolitie.nl/drank-en-drugs/drugs-en-straffen/hoeveel-wietplanten-mag-ik-hebben.html https://www.vraaghetdepolitie.nl/drank-en-drugs/drugs-en-str... So it's not legal but if you have at most 5 plants and let them be taken away you won't be prosecuted.
  - nyolfen 10y ago
    i have a friend (in the US) who used kratom to kick heroin. he still has an addiction to service but it's legal, relatively cheap and not debilitating. i know he's not alone in this use of it, though it's also a useful anxiolytic ime, and i had no issues with addiction or withdrawal after experimenting with it a little. i was very hopeful about the obama dea backing off the kratom ban last autumn after the public backlash but i'm worried about steps the current administration may take.
- cmdkeen 10y ago
  Even in the US heroin use was massively down, because it had moved on from the edgy rock and roll era to realising how dangerous it was. The list of dead celebrities rather took the edge off heroin chic. The US resurgence is tied to massive over-prescription of opiates who abusers turn to heroin if their supply is disrupted / their tolerance increases. The demographics of users is very different. There's an entire chapter in Narconomics covered to this. Supervised injections etc works in Denmark because its healthcare sector is set up to support it - the US healthcare sector is still actively poisoning the populace.
  - taurath 10y ago
    Given the amount of pharmacetical money sloshing around every single congresspeople's coffers there will not be any meaningful reform or restrictions for a long while. The easiest path is to just go full-bore law and order against drug users.
    - M_Grey 10y ago
      That's then 'easiest' path on what planet? It's the absolute hardest path, and utterly defeatist.
      - jasonmp85 10y ago
        I think people are taking away the wrong message here. It's the "easiest" as in "on the lowest shelf". It's easy just as it's easy to grab undocumented immigrant parents in pickup lanes at schools. There's doing what's hard (either politically, or by effort) but "best", and there's being lazy and incompetent and just doing what comes easiest. Our current administration does the latter.
        edraferi 10y ago
        Perhaps "lazy," "childish" or "naive" are more accurate words. Current policies are designed around bluster / posturing rather than effectiveness.
      - 10y ago
sdenton4 10y ago
My understanding is that the reintroduction of prescription opioids is a major source of new addicts. Once the prescription lapses, people have often become addicted and seek out other sources. It's clear that we need to do a lot more to help these problems, as you suggest. We can also do a lot to keep people from getting addicted in the first place, by choosing (and regulating) better options for pain relief.
- fdsfsafasfdas 10y ago
  Amen. Cannabis criminalization kills.
tptacek 10y ago
Isn't the counterargument to this to point out the Oxycontin abuse epidemic? Doctors are prescribing years worth of opiates to patients. There have been suggestions that Purdue Pharma's formulation of Oxy practically guarantees dependence, because of the way it's dosed. Are the people dying of heroin overdoses in white rural Ohio starting on heroin, or transitioning to it after prescription opioids become too expensive? Sam Quinones suggests that the actual trade in Mexican heroin is distinctively less violent than in other drugs; there's a pipeline of supply and distribution designed to be low-key and customer-service driven. If violence is coming from addicts and not from suppliers, increasing supply isn't going to make those people any less desperate or violent.
- jbooth 10y ago
  If you give them free H, they'll be a lot less desperate and a lot less violent, presumably. And.. why not? I've got multiple friends in my age group prematurely dead from overdose. It's not like prohibition is accomplishing anything.
  - dep_b 10y ago
    Addicts in The Netherlands get free heroin. Without the daily hustle to find the next high people have time to think instead. A lot of them find the peace to actually quit. Actually it's really hard to keep the program going as the government doesn't like to be associated with free heroin.
    - mirimir 10y ago
      Saying "next high" is just wrong. It's avoiding withdrawal aka your own personal hell.
    - misja111 10y ago
      Only very serious cases can get free heroin in The Netherlands. Some of the criteria: you have to be at least 5 years addicted, you need to have tried methadon to get over your addiction first, you need to be a daily user and need to have bad physical or mental health. None of those people quit after having been admitted to the program. But they do get a better life and are not forced to be criminals anymore.
skookumchuck 10y ago
Overdosing on heroin comes from inconsistent purity in black market heroin. Addicts have no reliable way to determine how much they are injecting. Heroin addicts get their start from prescription drugs. When the doctors cut them off, or it gets too expensive, they turn to heroin.
nicholasserra 10y ago
I'm in Youngstown. Watching the news in our area is horrifying anymore.
zkms 10y ago
> Maybe the answer isn't to make heroin available OTC at Walgreens Actually, in UK you can get actual opioids (as co-codamol) behind the counter, without a prescription. Funny how they don't seem to have a disastrous and deadly opioid epidemic like the US has. I'd so much rather live where people can get cheap pharmaceutical grade heroin at the pharmacy than where people who need opioids end up smashing windows to steal my laptop to buy some dangerous and overpriced fentanyl contaminated "heroin" that ends up making them overdose in the street (transnational criminal organisations tend to lack purity standards commensurate with those of prescription drug manufacturers, weirdly enough). Crackdowns on "pill mills" and "doctors who overprescribe" is what denies people a safe and legal source of pharmaceutical-grade opioids and forces them onto the black market of illegal, extremely overpriced, dose-uncertain, and fentanyl-contaminated opioids -- all of which make drug use a lot more problematic and dangerous (for both the user and the community) and pushes people from "drug dependence" (needing a regular, constant dose of a medication to function) to "drug addiction" (problematic, damage-causing drug use). Dose uncertainty especially contributes to the harm of drug use -- if the doses aren't uncertain (and are precisely metered like those of other, pharmaceutical-grade medications), it's a lot easier for the user to find the right dose that extinguishes the withdrawal symptoms and the pain while not ending up anywhere near an overdose. Also the ability to access pure opioids with precise doses means it's a lot easier to take the drugs as a periodic, regular dose and not have one's life disrupted by extreme highs and extreme lows and drug-craving. This allows users to maintain a normal, productive, non-criminal life with other things in their life (family, hobbies, career) than just the pursuit of opioids. In US, the "epidemic" of OD deaths only began when crackdowns intensified on legal, pharmaceutical, sources and prescribers of opioids. The DEA cracking skulls over opioids and investigating doctors is literally the only reason illicit fentanyl (and its even nastier analogues) are common illicit products now. I am so very doubtful that skull-cracking and door-kicking will miraculously work after decades of it not working. Prohibition has given us carfentanil in illicit heroin. If you don't know what that is, it's a fentanyl analogue so potent that it's been successfully used as a chemical weapon. This is not an anomaly -- it's just the "iron law of prohibition (https://en.wikipedia.org/wiki/Iron_law_of_prohibition https://en.wikipedia.org/wiki/Iron_law_of_prohibition) at work. > It's not like anything else is working. Prohibition isn't working, and has caused tremendous devastation to society, and the opioid epidemic is just another instance of this. Prohibition has to get wound down, from the top (end the Single Convention on Narcotic Drugs and the statutes that give it effect) to the bottom (make it so local police can't arrest or search people for any drugs offences (possession, manufacture, use, transport, sale, purchase) regardless of the drug or quantity).
tagawa 10y ago
You may be interested in Portugal's drug policy which has become an example of what you're suggesting. Laws were relaxed in 2001 together with increased support and therapy. Statistics suggest that drug use and related problems have reduced since then: https://en.wikipedia.org/wiki/Drug_policy_of_Portugal https://en.wikipedia.org/wiki/Drug_policy_of_Portugal

the-dude 10y ago

In The Netherlands, supervised injection sites exist for ~30 years now. Also, The Netherlands provide methadone. It seems to have worked / be working. Our heroine epidemic is far behind us, the addicts are dying out.

cryptarch 10y ago
The Netherlands also have a few legal highs: weed, kratom and psilocybin.
- dep_b 10y ago
  They're not legal in The Netherlands. Magic mushrooms have been banned a while ago (but at the same truffles still are not, clueless), weed was never legal. Also all production is illegal. Coffeeshops don't pay taxes. They're just.....there? We used to think it was the crazy US forcing the Dutch to have such a bipolar approach to drugs but pot is more legal in Colorado now than in Holland and still the Dutch laws are a mess.
  - headcanon 10y ago
    The legal status IMO is less important in this case than how the state treats it. In the Netherlands (correct me if I'm wrong), drugs are seen as a public health concern, and in the US its seen as a criminal problem. When its criminalized and demonized like it is here, then politicans must "crack down" on it to appear "tough on crime", and more progressive mitigation solutions (like supervised injection and treatment centers) aren't even entertained in our lust to imprison.
  - cryptarch 10y ago
    Magic truffles have the same effects as magic mushrooms and are legal. Magic mushroom products are still sold at some smartshops, but not legal. Weed is not legal, but you can buy it in dispensaries ("koffieshops") and carry up to 5 grams without being fined or arrested. You can smoke publicly as long as you're not bothering anyone (like with alcohol). I think that's pretty sweet. You can have up to 5 plants at your home, but if the police asks you to destroy them you have to, or you can get fined, so again: as long as you're not bothering anyone or dealing you're fine. There are is also a proposed law to decriminalize the mass-production of weed (while introducing QC regulations, like those for food) and the delivery to the dispensaries. With that full legalization can't be far off. The idea that legalization is just the right thing to do is pretty mainstream here, and a progressive political party, GroenLinks, supports legalization and is currently 3rd in the polls. Edit: caps
    - dep_b 10y ago
      > You can have up to 5 plants at your home I think that's an urban myth actually. I know people that got kicked out of their house for having just three plants just growing outdoor so no tampering with electricity or fire risk. They used to be more lenient but people tended to burn their house down with illegal indoor plantations. It's weird how in a liberal country like The Netherlands where everybody wants full legalization we somehow ended up with a government that got a lot stricter instead.
      - cryptarch 10y ago
        That sounds like a renters' agreement thing? Here's what the police says themselves on the matter: https://www.vraaghetdepolitie.nl/drank-en-drugs/drugs-en-straffen/hoeveel-wietplanten-mag-ik-hebben.html https://www.vraaghetdepolitie.nl/drank-en-drugs/drugs-en-str... So it's not legal but if you have at most 5 plants and let them be taken away you won't be prosecuted.
- nyolfen 10y ago
  i have a friend (in the US) who used kratom to kick heroin. he still has an addiction to service but it's legal, relatively cheap and not debilitating. i know he's not alone in this use of it, though it's also a useful anxiolytic ime, and i had no issues with addiction or withdrawal after experimenting with it a little. i was very hopeful about the obama dea backing off the kratom ban last autumn after the public backlash but i'm worried about steps the current administration may take.
cmdkeen 10y ago
Even in the US heroin use was massively down, because it had moved on from the edgy rock and roll era to realising how dangerous it was. The list of dead celebrities rather took the edge off heroin chic. The US resurgence is tied to massive over-prescription of opiates who abusers turn to heroin if their supply is disrupted / their tolerance increases. The demographics of users is very different. There's an entire chapter in Narconomics covered to this. Supervised injections etc works in Denmark because its healthcare sector is set up to support it - the US healthcare sector is still actively poisoning the populace.
- taurath 10y ago
  Given the amount of pharmacetical money sloshing around every single congresspeople's coffers there will not be any meaningful reform or restrictions for a long while. The easiest path is to just go full-bore law and order against drug users.
  - M_Grey 10y ago
    That's then 'easiest' path on what planet? It's the absolute hardest path, and utterly defeatist.
    - jasonmp85 10y ago
      I think people are taking away the wrong message here. It's the "easiest" as in "on the lowest shelf". It's easy just as it's easy to grab undocumented immigrant parents in pickup lanes at schools. There's doing what's hard (either politically, or by effort) but "best", and there's being lazy and incompetent and just doing what comes easiest. Our current administration does the latter.
      - edraferi 10y ago
        Perhaps "lazy," "childish" or "naive" are more accurate words. Current policies are designed around bluster / posturing rather than effectiveness.
    - 10y ago

sdenton4 10y ago

My understanding is that the reintroduction of prescription opioids is a major source of new addicts. Once the prescription lapses, people have often become addicted and seek out other sources. It's clear that we need to do a lot more to help these problems, as you suggest. We can also do a lot to keep people from getting addicted in the first place, by choosing (and regulating) better options for pain relief.

fdsfsafasfdas 10y ago
Amen. Cannabis criminalization kills.

tptacek 10y ago

Isn't the counterargument to this to point out the Oxycontin abuse epidemic? Doctors are prescribing years worth of opiates to patients. There have been suggestions that Purdue Pharma's formulation of Oxy practically guarantees dependence, because of the way it's dosed. Are the people dying of heroin overdoses in white rural Ohio starting on heroin, or transitioning to it after prescription opioids become too expensive? Sam Quinones suggests that the actual trade in Mexican heroin is distinctively less violent than in other drugs; there's a pipeline of supply and distribution designed to be low-key and customer-service driven. If violence is coming from addicts and not from suppliers, increasing supply isn't going to make those people any less desperate or violent.

jbooth 10y ago
If you give them free H, they'll be a lot less desperate and a lot less violent, presumably. And.. why not? I've got multiple friends in my age group prematurely dead from overdose. It's not like prohibition is accomplishing anything.
- dep_b 10y ago
  Addicts in The Netherlands get free heroin. Without the daily hustle to find the next high people have time to think instead. A lot of them find the peace to actually quit. Actually it's really hard to keep the program going as the government doesn't like to be associated with free heroin.
  - mirimir 10y ago
    Saying "next high" is just wrong. It's avoiding withdrawal aka your own personal hell.
  - misja111 10y ago
    Only very serious cases can get free heroin in The Netherlands. Some of the criteria: you have to be at least 5 years addicted, you need to have tried methadon to get over your addiction first, you need to be a daily user and need to have bad physical or mental health. None of those people quit after having been admitted to the program. But they do get a better life and are not forced to be criminals anymore.

skookumchuck 10y ago

Overdosing on heroin comes from inconsistent purity in black market heroin. Addicts have no reliable way to determine how much they are injecting. Heroin addicts get their start from prescription drugs. When the doctors cut them off, or it gets too expensive, they turn to heroin.

nicholasserra 10y ago

I'm in Youngstown. Watching the news in our area is horrifying anymore.

zkms 10y ago

> Maybe the answer isn't to make heroin available OTC at Walgreens Actually, in UK you can get actual opioids (as co-codamol) behind the counter, without a prescription. Funny how they don't seem to have a disastrous and deadly opioid epidemic like the US has. I'd so much rather live where people can get cheap pharmaceutical grade heroin at the pharmacy than where people who need opioids end up smashing windows to steal my laptop to buy some dangerous and overpriced fentanyl contaminated "heroin" that ends up making them overdose in the street (transnational criminal organisations tend to lack purity standards commensurate with those of prescription drug manufacturers, weirdly enough). Crackdowns on "pill mills" and "doctors who overprescribe" is what denies people a safe and legal source of pharmaceutical-grade opioids and forces them onto the black market of illegal, extremely overpriced, dose-uncertain, and fentanyl-contaminated opioids -- all of which make drug use a lot more problematic and dangerous (for both the user and the community) and pushes people from "drug dependence" (needing a regular, constant dose of a medication to function) to "drug addiction" (problematic, damage-causing drug use). Dose uncertainty especially contributes to the harm of drug use -- if the doses aren't uncertain (and are precisely metered like those of other, pharmaceutical-grade medications), it's a lot easier for the user to find the right dose that extinguishes the withdrawal symptoms and the pain while not ending up anywhere near an overdose. Also the ability to access pure opioids with precise doses means it's a lot easier to take the drugs as a periodic, regular dose and not have one's life disrupted by extreme highs and extreme lows and drug-craving. This allows users to maintain a normal, productive, non-criminal life with other things in their life (family, hobbies, career) than just the pursuit of opioids. In US, the "epidemic" of OD deaths only began when crackdowns intensified on legal, pharmaceutical, sources and prescribers of opioids. The DEA cracking skulls over opioids and investigating doctors is literally the only reason illicit fentanyl (and its even nastier analogues) are common illicit products now. I am so very doubtful that skull-cracking and door-kicking will miraculously work after decades of it not working. Prohibition has given us carfentanil in illicit heroin. If you don't know what that is, it's a fentanyl analogue so potent that it's been successfully used as a chemical weapon. This is not an anomaly -- it's just the "iron law of prohibition (https://en.wikipedia.org/wiki/Iron_law_of_prohibition https://en.wikipedia.org/wiki/Iron_law_of_prohibition) at work. > It's not like anything else is working. Prohibition isn't working, and has caused tremendous devastation to society, and the opioid epidemic is just another instance of this. Prohibition has to get wound down, from the top (end the Single Convention on Narcotic Drugs and the statutes that give it effect) to the bottom (make it so local police can't arrest or search people for any drugs offences (possession, manufacture, use, transport, sale, purchase) regardless of the drug or quantity).

tagawa 10y ago

You may be interested in Portugal's drug policy which has become an example of what you're suggesting. Laws were relaxed in 2001 together with increased support and therapy. Statistics suggest that drug use and related problems have reduced since then: https://en.wikipedia.org/wiki/Drug_policy_of_Portugal https://en.wikipedia.org/wiki/Drug_policy_of_Portugal