3 ms·

> but no claims anywhere that prescribing heroin has eliminated all opiate fatalities. Can you cite a more rigorous source? I have edited the comment above to

> but no claims anywhere that prescribing heroin has eliminated all opiate fatalities. Can you cite a more rigorous source? I have edited the comment above to add a word. The friend who taught me about her opiate addiction knew how to manage her dose pretty well. Then the mental health industry got her addicted to benzodiazepines, which changed her tolerance. She overdosed on me when trying to get off the benzos. The fire department revived her, then disappeared into the night. Those two doses of Naloxone stabilized her for about 2 weeks... A lot of the deaths in the United States' present opiate overdose epidemic has to do with contamination of the heroin supply with more powerful synthetic opiates. When the supply includes elephant opiates, addicts don't know how much to use.

tptacek 9y ago
I see credible claims that Switzerland has reduced overdose deaths from opiates with this strategy, but none saying they've "effectively eliminated" them. I didn't look very hard, and you see familiar with the subject. Can you point me to a resource establishing this? The thing I see reports saying Switzerland has effectively eliminated is deaths due to needle contamination. That's not hard to believe (but then, you could get that effect by giving addicts clean needles). In the article you posted, I see Hari saying that Switzerland's practices have eliminated wounds and abscesses he attributes to drug contamination. That, too, is very plausible. But most opiate fatalities are not caused by injection site wounds; they're caused by overdose. I think there might be some confusion. Switzerland itself claims that nobody has died from overdose of officially prescribed heroin. That, too, is totally plausible. But Switzerland still has a street opiate drug market problem!
- tcj_phx 9y ago
  > But Switzerland still has a street opiate drug market problem! The planet's various governments created the street drug marketplace by making desired substances illegal. The United States government created the country's drug culture by lying to people about the actual hazards of these desired substances. Perhaps Switzerland has not eliminated opiate deaths, as my comment originally indicated, but the Swiss are doing better than everyone else in making progress at helping people with opiate addictions. Results from the Swiss studies, however, show that mortality among patients in heroin assisted maintenance programmes is low, and lower than for patients in other maintenance programmes.14 In addition, the wider safety concerns could not be empirically confirmed in Switzerland or the Netherlands.15 Finally, the incidence of heroin dependence has decreased greatly in Switzerland since the start of the trials, and currently heroin has a more negative image than it did 15 years ago.16 - http://www.bmj.com/content/336/7635/70?variant=full http://www.bmj.com/content/336/7635/70?variant=full ref #14 (above) says: CONCLUSION: Mortality in heroin-assisted treatment was low compared to the mortality rate of Swiss opioid users 1990s (estimated to be between 2.5 and 3%). It was also low compared to mortality rates of opioid users in other maintenance treatments in other countries as reported in the literature. The SMR was also lower than that reported in the only meta-analysis in the literature: 13.2 (95% C.I. 12.3-14.1). The low mortality rate is all the more noteworthy as heroin-assisted treatment in Switzerland included only refractory opioid addicts with existing severe somatic and/or mental problems. - https://www.ncbi.nlm.nih.gov/pubmed/16002023?access_num=16002023&link_type=MED&dopt=Abstract https://www.ncbi.nlm.nih.gov/pubmed/16002023?access_num=1600...

tptacek 9y ago

I see credible claims that Switzerland has reduced overdose deaths from opiates with this strategy, but none saying they've "effectively eliminated" them. I didn't look very hard, and you see familiar with the subject. Can you point me to a resource establishing this? The thing I see reports saying Switzerland has effectively eliminated is deaths due to needle contamination. That's not hard to believe (but then, you could get that effect by giving addicts clean needles). In the article you posted, I see Hari saying that Switzerland's practices have eliminated wounds and abscesses he attributes to drug contamination. That, too, is very plausible. But most opiate fatalities are not caused by injection site wounds; they're caused by overdose. I think there might be some confusion. Switzerland itself claims that nobody has died from overdose of officially prescribed heroin. That, too, is totally plausible. But Switzerland still has a street opiate drug market problem!

tcj_phx 9y ago
> But Switzerland still has a street opiate drug market problem! The planet's various governments created the street drug marketplace by making desired substances illegal. The United States government created the country's drug culture by lying to people about the actual hazards of these desired substances. Perhaps Switzerland has not eliminated opiate deaths, as my comment originally indicated, but the Swiss are doing better than everyone else in making progress at helping people with opiate addictions. Results from the Swiss studies, however, show that mortality among patients in heroin assisted maintenance programmes is low, and lower than for patients in other maintenance programmes.14 In addition, the wider safety concerns could not be empirically confirmed in Switzerland or the Netherlands.15 Finally, the incidence of heroin dependence has decreased greatly in Switzerland since the start of the trials, and currently heroin has a more negative image than it did 15 years ago.16 - http://www.bmj.com/content/336/7635/70?variant=full http://www.bmj.com/content/336/7635/70?variant=full ref #14 (above) says: CONCLUSION: Mortality in heroin-assisted treatment was low compared to the mortality rate of Swiss opioid users 1990s (estimated to be between 2.5 and 3%). It was also low compared to mortality rates of opioid users in other maintenance treatments in other countries as reported in the literature. The SMR was also lower than that reported in the only meta-analysis in the literature: 13.2 (95% C.I. 12.3-14.1). The low mortality rate is all the more noteworthy as heroin-assisted treatment in Switzerland included only refractory opioid addicts with existing severe somatic and/or mental problems. - https://www.ncbi.nlm.nih.gov/pubmed/16002023?access_num=16002023&link_type=MED&dopt=Abstract https://www.ncbi.nlm.nih.gov/pubmed/16002023?access_num=1600...