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Interesting question: The replacing opioid addiction with maintenance drugs... I could understand that drug being an okay interim solution, but in the end the p

Interesting question: The replacing opioid addiction with maintenance drugs... I could understand that drug being an okay interim solution, but in the end the person still needs to go through withdrawal, the drug just replaces withdrawal with another drug. Withdrawal is hard. Yes. But at least the person is in the right mindset to go through it once they are off the compulsory addiction, even if it takes a year to get to that point. As kchoudhu points out and many have pointed out to me before this article, certainly once a bunch of white kids have this problem, suddenly they are "victims" not "criminals". Yet we have destroyed so many lives between the 80s and now, especially with the mandatory minimums and such.

jtmcmc 9y ago
Why? The problems with addiction - specifically opioid addiction - is that it causes negative, destructive behavior. This isn't a consequence of having a physical dependence we are all physically dependent on things after all.
- otakucode 9y ago
  No, it does not cause negative, destructive behavior. It causes you to lie down and feel good. And it also causes constipation. And, if your supply is interrupted, withdrawal symptoms. The rest is caused primarily by the laws and social environment. Having to interact with criminals? Getting uncertain doses? Overdosing? Those things are because it is illegal, not because it's an opiate.
  - graphememes 9y ago
    The withdrawals do lead to destructive behavior.
  - jtmcmc 9y ago
    Addiction by definition does cause negative destructive behavior. That's part of the definition. What you're describing is a combination of the psychoactive effects of it and its withdrawal symptoms. I do agree with you, however. People become addicts due to how our society has criminalized and deregulated drug manufacture and sale and made it extremely hard to teach people how to do properly.
  - astura 9y ago
    "Negative distractive behavior" can also include things like "spending so much money on drugs you can't afford basic living expenses," "destroying relationships with your friends/family," "being unable to take care of your children," "getting fired from your job," "not being able to take care of your basic commitment," "'lying down' while driving," etc., etc.
0x27081990 9y ago
I'm not sure it is a race issue. Times were different. People are now accepting that drug consumption doesn't make you a criminal. At some point Britain thought that wealthy highly-educated people were incapable of being criminals, until time proved them wrong. Science is always evolving.
- refurb 9y ago
  I would agree with this perspective. Over the last few decades there has definitely been a change in how people view addiction and more importantly how to address it. Harm reduction has much more traction then 20 years ago.
- grasshopperpurp 9y ago
  In a fair system, black and white defendants who score the same number of points under this formula would spend the same time beyond bars. But The Herald-Tribune found that judges disregard the guidelines, sentencing black defendants to longer prison terms in 60 percent of felony cases, 68 percent of serious, first-degree crimes and 45 percent of burglaries. In third-degree felony cases — the least serious and broadest class of felonies — white Florida judges sentenced black defendants to 20 percent more prison time than white defendants. The war on drugs weighs particularly heavily on black defendants. The police target their neighborhoods, herding people into a court system where judges are demonstrably harder on black offenders. The report found that nearly half of the counties in Florida sentenced African-Americans convicted of felony drug possession to more than double the jail time of whites — even when their backgrounds were the same. This may just be a Florida problem, but I doubt it. https://www.nytimes.com/2016/12/17/opinion/sunday/unequal-sentences-for-blacks-and-whites.html https://www.nytimes.com/2016/12/17/opinion/sunday/unequal-se...
  - graphememes 9y ago
    Male vs Women rape statistics seem to denote the same thing, 10% difference, 18% difference, -5% difference. How many cases did the study cover? Looks to be about 300 given the dataset from the website. 300 is a small statistic. 10% of 300 is even smaller. Science is hard.
wbl 9y ago
I'm physically dependent on caffeine. Why bother fixing that when it is cheap legal and available?
- spraak 9y ago
  In case you're looking for a sincere answer: being physically dependent on any otherwise unnecessary drug is a drag. You constantly have to seek it out to feel better. Even though caffeine is easily obtainable, I still have found it to be inconvenient when I've been at high levels of consumption. Plus, it does have health effects. It may not be so, but you'll likely feel a lot better without it.
  - pbhjpbhj 9y ago
    I've gone cold turkey on caffeine a couple of times (takes me about a week of headaches, I'm not an especially heavy user), mainly because I was making hot drinks to avoid work out of boredom, so switched to ginger teas and such like. Anyway, there doesn't appear to be consensus on whether coffee/tea drinking in moderate amounts is good or bad, but I've seen more suggestions that it's beneficial than otherwise. Any input to that?
- tree_of_item 9y ago
  No you aren't. Caffeine "withdrawals" are trivial and not life threatening at all.
  - wu_tang_chris 9y ago
    Opiate withdrawal is generally not life threatening either.
sndean 9y ago
> Withdrawal is hard. Just to emphasize that: Before my SO started working in a hospital, I had no idea that people going through alcohol withdrawal can end up in the ICU. They're ending up in an ICU because of the withdrawal, not the alcohol... That was really surprising to me.
- otakucode 9y ago
  Alcohol is one of the only substances on the planet that can cause you to straight up die from withdrawal alone. Deaths from opiate withdrawal are secondary, usually from falling during a seizure. But with alcohol, your heart can simply stop or your brain have a massive stroke from the withdrawal. We think it harmless because its legal, but alcohol is radically dangerous from an addiction standpoint.
  - sndean 9y ago
    That's interesting and makes alcohol sound pretty menacing. I should read more about it. It definitely sounds like seizures and heart issues come up the most. Plus their livers are shot, so toxicity of normally benign treatments is a concern. Also interesting that, in the very wealthy area we're in, outside of infants and the elderly, middle-aged white men going through alcohol withdrawal are the most common ICU patients. (sorry for derailing discussion away from opioid addiction)
    - wu_tang_chris 9y ago
      FWIW, you can die from alcohol withdrawal well before your liver is shot. Also, you don't need to have been drinking for decades; you can get yourself in that pickle in months, not years.
  - wu_tang_chris 9y ago
    Alcohol and benzodiazepines are the only ones, IIRC. In 2014, Xanax killed more people than fentanyl, morphine, and meth (https://www.usnews.com/news/articles/2016-12-20/heroin-cocaine-among-top-drug-killers-in-us https://www.usnews.com/news/articles/2016-12-20/heroin-cocai...)
Xylakant 9y ago
Maintenance drugs are usually legal and tend to have less side-effects. This allows the addicted to focus on the underlying issue and then, once that is solved go through withdrawal. There has been a fairly interesting experiment in northern Germany a few years ago that handed out medical grade heroin to heavily addicted people. The results were pretty good, people were highly functional. Often the side effects of the addiction- having to organize drugs (and money for drugs), infections from used needles, additives in the drugs, breakdown of the social support network etc. are much worse than the actual drug. Giving substitutes, even allowing legal access to drugs helps removing those hindrances. Drug policy is just weird.
peteretep 9y ago
> but in the end the person still > needs to go through withdrawal Why?
otakucode 9y ago
Withdrawal is stupid and unnecessary. You don't go through withdrawal if your doctor were to say 'ok, you are no longer injured, but your medication is one which has dependence as a side effect. Here is your 12 month schedule for reducing your dosage very gradually.'
icantdrive55 9y ago
1. I haven't read the article. Why--because for myself, all the talk makes the problem worse. 2. For myself, going on generic bupenorpine, and tapering off was not that bad. I took a year to taper off. I probally could have tapeed off the opioids if I was given a chance. The problem is most Doctors just cut you off. Completely ridiculous, especially if the patient is a serious individual. (I got lucky to find a doctor to prescribe bupenorpine without driving me crazy with endless office visits. I also just happened to be given the drug for another disorder.) 3. The generic bupenopine is still pricey. I don't quite get it, other than most Dr's don't trust their patients to not abuse opioids, so there isn't a huge demand for generic Subutex? There are still some sensible people who just want to stop the original addiction. On the other hand, I wouldn't be schocked if the price of generic Subutex is the result of some shenanigans. 4. Most people will be given Suboxone, that has Naloxone in it. It makes doctors feel safe, and that's what was taught in the course they had to take in order to prescribe/treat. Crazy again. (I felt Nalaxone just raised the price of the drug, but some of you will need an opoid antagonist in your treatment, especially if street drugs are easily available, or you don't have not much self control.) 4. My point is if you Taper off, all the drama is spared. My story will never be on Lifetime. 5. It's still a pain in the ass with the Dr. visits, and getting scripts though. 6. I can offer this, if you want to stop, Taper off. Yes--I know it's just not that easy. The system we currently have makes getting off difficult. Again crazy? 7. Stay away from all the support group sites. They just scared the hell out of me, especially the ones on the internet. 8. If you are addicted to anything, most of you can successfully taper off yourself. Very few of you need the drama, and expense of a rehab. Again--the system is so rediculious, we are forced into going to the rehabs, just to get the opportunity to taper off. Again crazy. 9. We have a crisis. It's not giving addicted people the easy/cheap way to Taper off the most controlled substances. It's no wonder people turn to the streets to feed their cravings.

jtmcmc 9y ago

Why? The problems with addiction - specifically opioid addiction - is that it causes negative, destructive behavior. This isn't a consequence of having a physical dependence we are all physically dependent on things after all.

otakucode 9y ago
No, it does not cause negative, destructive behavior. It causes you to lie down and feel good. And it also causes constipation. And, if your supply is interrupted, withdrawal symptoms. The rest is caused primarily by the laws and social environment. Having to interact with criminals? Getting uncertain doses? Overdosing? Those things are because it is illegal, not because it's an opiate.
- graphememes 9y ago
  The withdrawals do lead to destructive behavior.
- jtmcmc 9y ago
  Addiction by definition does cause negative destructive behavior. That's part of the definition. What you're describing is a combination of the psychoactive effects of it and its withdrawal symptoms. I do agree with you, however. People become addicts due to how our society has criminalized and deregulated drug manufacture and sale and made it extremely hard to teach people how to do properly.
- astura 9y ago
  "Negative distractive behavior" can also include things like "spending so much money on drugs you can't afford basic living expenses," "destroying relationships with your friends/family," "being unable to take care of your children," "getting fired from your job," "not being able to take care of your basic commitment," "'lying down' while driving," etc., etc.

0x27081990 9y ago

I'm not sure it is a race issue. Times were different. People are now accepting that drug consumption doesn't make you a criminal. At some point Britain thought that wealthy highly-educated people were incapable of being criminals, until time proved them wrong. Science is always evolving.

refurb 9y ago
I would agree with this perspective. Over the last few decades there has definitely been a change in how people view addiction and more importantly how to address it. Harm reduction has much more traction then 20 years ago.
grasshopperpurp 9y ago
In a fair system, black and white defendants who score the same number of points under this formula would spend the same time beyond bars. But The Herald-Tribune found that judges disregard the guidelines, sentencing black defendants to longer prison terms in 60 percent of felony cases, 68 percent of serious, first-degree crimes and 45 percent of burglaries. In third-degree felony cases — the least serious and broadest class of felonies — white Florida judges sentenced black defendants to 20 percent more prison time than white defendants. The war on drugs weighs particularly heavily on black defendants. The police target their neighborhoods, herding people into a court system where judges are demonstrably harder on black offenders. The report found that nearly half of the counties in Florida sentenced African-Americans convicted of felony drug possession to more than double the jail time of whites — even when their backgrounds were the same. This may just be a Florida problem, but I doubt it. https://www.nytimes.com/2016/12/17/opinion/sunday/unequal-sentences-for-blacks-and-whites.html https://www.nytimes.com/2016/12/17/opinion/sunday/unequal-se...
- graphememes 9y ago
  Male vs Women rape statistics seem to denote the same thing, 10% difference, 18% difference, -5% difference. How many cases did the study cover? Looks to be about 300 given the dataset from the website. 300 is a small statistic. 10% of 300 is even smaller. Science is hard.

wbl 9y ago

I'm physically dependent on caffeine. Why bother fixing that when it is cheap legal and available?

spraak 9y ago
In case you're looking for a sincere answer: being physically dependent on any otherwise unnecessary drug is a drag. You constantly have to seek it out to feel better. Even though caffeine is easily obtainable, I still have found it to be inconvenient when I've been at high levels of consumption. Plus, it does have health effects. It may not be so, but you'll likely feel a lot better without it.
- pbhjpbhj 9y ago
  I've gone cold turkey on caffeine a couple of times (takes me about a week of headaches, I'm not an especially heavy user), mainly because I was making hot drinks to avoid work out of boredom, so switched to ginger teas and such like. Anyway, there doesn't appear to be consensus on whether coffee/tea drinking in moderate amounts is good or bad, but I've seen more suggestions that it's beneficial than otherwise. Any input to that?
tree_of_item 9y ago
No you aren't. Caffeine "withdrawals" are trivial and not life threatening at all.
- wu_tang_chris 9y ago
  Opiate withdrawal is generally not life threatening either.

sndean 9y ago

> Withdrawal is hard. Just to emphasize that: Before my SO started working in a hospital, I had no idea that people going through alcohol withdrawal can end up in the ICU. They're ending up in an ICU because of the withdrawal, not the alcohol... That was really surprising to me.

otakucode 9y ago
Alcohol is one of the only substances on the planet that can cause you to straight up die from withdrawal alone. Deaths from opiate withdrawal are secondary, usually from falling during a seizure. But with alcohol, your heart can simply stop or your brain have a massive stroke from the withdrawal. We think it harmless because its legal, but alcohol is radically dangerous from an addiction standpoint.
- sndean 9y ago
  That's interesting and makes alcohol sound pretty menacing. I should read more about it. It definitely sounds like seizures and heart issues come up the most. Plus their livers are shot, so toxicity of normally benign treatments is a concern. Also interesting that, in the very wealthy area we're in, outside of infants and the elderly, middle-aged white men going through alcohol withdrawal are the most common ICU patients. (sorry for derailing discussion away from opioid addiction)
  - wu_tang_chris 9y ago
    FWIW, you can die from alcohol withdrawal well before your liver is shot. Also, you don't need to have been drinking for decades; you can get yourself in that pickle in months, not years.
- wu_tang_chris 9y ago
  Alcohol and benzodiazepines are the only ones, IIRC. In 2014, Xanax killed more people than fentanyl, morphine, and meth (https://www.usnews.com/news/articles/2016-12-20/heroin-cocaine-among-top-drug-killers-in-us https://www.usnews.com/news/articles/2016-12-20/heroin-cocai...)

Xylakant 9y ago

Maintenance drugs are usually legal and tend to have less side-effects. This allows the addicted to focus on the underlying issue and then, once that is solved go through withdrawal. There has been a fairly interesting experiment in northern Germany a few years ago that handed out medical grade heroin to heavily addicted people. The results were pretty good, people were highly functional. Often the side effects of the addiction- having to organize drugs (and money for drugs), infections from used needles, additives in the drugs, breakdown of the social support network etc. are much worse than the actual drug. Giving substitutes, even allowing legal access to drugs helps removing those hindrances. Drug policy is just weird.

peteretep 9y ago

> but in the end the person still > needs to go through withdrawal Why?

otakucode 9y ago

Withdrawal is stupid and unnecessary. You don't go through withdrawal if your doctor were to say 'ok, you are no longer injured, but your medication is one which has dependence as a side effect. Here is your 12 month schedule for reducing your dosage very gradually.'

icantdrive55 9y ago

1. I haven't read the article. Why--because for myself, all the talk makes the problem worse. 2. For myself, going on generic bupenorpine, and tapering off was not that bad. I took a year to taper off. I probally could have tapeed off the opioids if I was given a chance. The problem is most Doctors just cut you off. Completely ridiculous, especially if the patient is a serious individual. (I got lucky to find a doctor to prescribe bupenorpine without driving me crazy with endless office visits. I also just happened to be given the drug for another disorder.) 3. The generic bupenopine is still pricey. I don't quite get it, other than most Dr's don't trust their patients to not abuse opioids, so there isn't a huge demand for generic Subutex? There are still some sensible people who just want to stop the original addiction. On the other hand, I wouldn't be schocked if the price of generic Subutex is the result of some shenanigans. 4. Most people will be given Suboxone, that has Naloxone in it. It makes doctors feel safe, and that's what was taught in the course they had to take in order to prescribe/treat. Crazy again. (I felt Nalaxone just raised the price of the drug, but some of you will need an opoid antagonist in your treatment, especially if street drugs are easily available, or you don't have not much self control.) 4. My point is if you Taper off, all the drama is spared. My story will never be on Lifetime. 5. It's still a pain in the ass with the Dr. visits, and getting scripts though. 6. I can offer this, if you want to stop, Taper off. Yes--I know it's just not that easy. The system we currently have makes getting off difficult. Again crazy? 7. Stay away from all the support group sites. They just scared the hell out of me, especially the ones on the internet. 8. If you are addicted to anything, most of you can successfully taper off yourself. Very few of you need the drama, and expense of a rehab. Again--the system is so rediculious, we are forced into going to the rehabs, just to get the opportunity to taper off. Again crazy. 9. We have a crisis. It's not giving addicted people the easy/cheap way to Taper off the most controlled substances. It's no wonder people turn to the streets to feed their cravings.