6 ms·

Trapped by the ‘Walmart of Heroin’

88 points by pmcpinto 8y ago

rwmj 8y ago
A problem that could easily be solved by simply prescribing them all heroin. This was successful when it was done in the UK (https://health.spectator.co.uk/the-case-for-prescription-heroin/ https://health.spectator.co.uk/the-case-for-prescription-her...) although of course the government eventually shut it down.
- benbreen 8y ago
  Well, maybe not "easily," but I agree. Worth noting that heroin prescriptions have been happening in Switzerland for going on 20 years now, with excellent results.[1] The article was fantastic reporting by the way. Hard to read, but difficult to put down once you start. [1] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)72875-0/fulltext?code=lancet-site https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
  - yayana 8y ago
    It's becoming a logistical problem in Switzerland to have so little replacement as they've aged. There aren't enough to warrant many centers anymore, but each closing means some would have travel further, possibly dropping out. The US doesn't have to worry about these kinds of problems.. or about who will buy it's newly acquired crop domestically with veterans such as the one in the article coming home with trauma and addictions. Still, a little sad for the US if Portugal and Switzerland are the first signs of European dominos -- Russian and domestic customers can't make strong demand for agriculture at US scale.. Asia is too brutal about drugs and Africa too poor.. Continued financial support for Afghanistan and less black money for operations. Is this an example of nothing is ever easy or of nothing ever goes to plan..
    - leetcrew 8y ago
      > It's becoming a logistical problem in Switzerland to have so little replacement as they've aged. this sounds like a pretty good problem to have.
      - tomcam 8y ago
        > this sounds like a pretty good problem to have. Think that one through. Who pays for the disabled, unemployed, and elderly?
        leetcrew 8y ago
        unless I misread the post, the logistical problem is that there aren't enough new heroin addicts to justify keeping so many centers open. not sure what that has to do with paying for the unemployed and elderly.
    - stephengillie 8y ago
      20 years is enough to quit anything. Something here doesn't add up. Have there been a lot of new heroin users entering this system over the past 20 years? Or have these governments been supporting the drug addiction of a small handful of people who refuse to kick the habit, despite 20 years of therapy? Also, who fills the prescriptions? Or do the doctors just prescribe whatever the patient can get from a dealer? How does free healthcare the dealer? GP's great article is paywalled.
      - cm2012 8y ago
        It's not necessarily bad to support the drug addictions of a small handful of people for 20 years. Some people just suck at life, due to mental illness. They're going to be addicts regardless. It is insanely cheaper to just give them drugs than to close your eyes and let the other costs of them being unpredictable, homeless and sick add up.
        stephengillie 8y ago
- breakingcups 8y ago
  Not just the UK. Switzerland, Belgium, Germany, Denmark and The Netherlands too. The Netherlands had a very bad heroin epidemic in the 90's which has virtually disappeared thanks to this approach. The two main takeaways in my opinion are: Treat heroin addiction as a health issue instead of a criminal issue and don't just give out heroin, always couple it with social services, treatment, etc. Note that this approach mostly solves the visible issues. Encampments with heroin users are gone, along with all the trash, safety issues and health issues. The addicts are still addicts but the enormous cost to the community and the health of the users is enormously lessened. Also, because there's nearly no business for drug dealers anymore, there are virtually no new users. Nearly all heroin users in The Netherlands are over 40 years of age. There are clearly huge benefits to this approach. However, according to some addicts there is also a downside. Now that there's a great way to solve all the visible issues, there is less of a focus on getting the addicts clean they say. See: 1. https://www.cleveland.com/metro/index.ssf/2018/07/in_amsterdam_the_government_pr.html https://www.cleveland.com/metro/index.ssf/2018/07/in_amsterd... 2. https://www.tdpf.org.uk/blog/heroin-assisted-treatment-switzerland-successfully-regulating-supply-and-use-high-risk-0 https://www.tdpf.org.uk/blog/heroin-assisted-treatment-switz... 3. https://news.vice.com/en_us/article/xwp74q/only-in-the-netherlands-do-addicts-complain-about-free-government-heroin https://news.vice.com/en_us/article/xwp74q/only-in-the-nethe... 4. https://www.rollingstone.com/culture/culture-news/treating-heroin-addiction-with-heroin-what-you-need-to-know-196882/ https://www.rollingstone.com/culture/culture-news/treating-h...
  - Itaxpica 8y ago
    Of course, the one thing that all of those countries have in common is universal healthcare. "Treat addiction as a disease and prescribe heroin for it" doesn't really work so well when the overwhelming majority of addicts most likely don't have insurance or the means to pay for medical treatment out-of-pocket.
    - intuitionist 8y ago
      This is surely true, but the US can and does cover certain medical expenses as part of Medicare/Medicaid. The political obstacles are much harder to overcome than the logistical ones.
- alecco 8y ago
  It's good results for society but bad for the addict and their families. They are the ones pushing back. And they have a point.
  - jpatokal 8y ago
    Worse than overdosing in the streets? This seems like a classic case of the perfect (being off drugs completely) being an enemy of the good (off the streets but on prescribed heroin).
  - yayana 8y ago
    IMO the family is actually much better off, especially children. A big part of the problem is over valuing the addicted parent and the shadow life they should have been. Not fixing the problem let's them keep a lot of blame for reality being far from expectations on the new environment, and probably that is pretty healthy. But it doesn't mean this solution is actually wrong.
    - Latteland 8y ago
      Being able to not be a criminal, to not be arrested, to not die on the street, this is dramatically better than the alternative. No one can be prevented from buying street drugs in western countries, where there is demand someone will meet it. But this is far better for society too.
- cgb223 8y ago
  How do you think people would react to a major corporation selling heroin? Is that going well for the existing companies selling OxyContin? Is it going well for the people prescribed it, or are they abusing/ODing on that as well?
  - pharrington 8y ago
    Purdue Pharma is still doing pretty damn well. The problem isn't in using opiates to treat pain - it is Purdue's marketing actively lying about the addiction potential of OxyContin.
  - User23 8y ago
    You mean for example Bayer? They lost the Heroin trademark the same time they lost the Aspirin trademark, due to the war. Both were a product of the acetylate all the things school of medicinal chemistry.
    - nyolfen 8y ago
      yes, for instance bayer, a company that still regularly gets trotted out to highlight the evils of pharma companies for among other things selling heroin one hundred years ago
  - jowsie 8y ago
    You do realise that heroin is still used in hospitals all across the world on a daily basis for routine surgeries. A company is making and selling that heroin.
- dzmien 8y ago
  The closest we have here is methadone. I am proud to say that I have managed to stay the fuck out of Kensington for almost three years. I could not have done it without methadone.
clydesdale 8y ago
Addendum to The Great Universal Basic Income Debate: A large portion of UBI funds will get dumped into places like this.
- nickthemagicman 8y ago
  Or maybe free from the stressess of poverty they will finally have the stability to get clean. I hope UBI goes into these places. It will end a lot of misery and give people an escape ladder out of that world.
- EdwardDiego 8y ago
  ...and? If UBI replaces money obtained from crime, then does the overall social cost rise or diminish? We have a decent social security system in my country, and as I often like to tell well-off people whinging about their taxes being given to the "spongers" - social security keeps society secure against poor people.
- dang 8y ago
  Please don't take HN on offtopic tangents unless it's in a little-discussed and curious direction. The last thing we need is for threads to get sucked into the black holes of classic flamewar topics.
bluetwo 8y ago
Philly Proud
- TomK32 8y ago
  if this was reddit we'd recite the lyrics of a certain song...
- danmg 8y ago
  The last time was in Kensignton was to buy a, probably hot, used bicycle when I was in grad school out of a weird artist space.
alphabettsy 8y ago
Seems like it would be cheaper and safer to continue giving them the opioid derivitive medications they were already using until they are willing to go through treatment.
TomK32 8y ago
The weirdest X of Y I've ever heard of...
michaelmrose 8y ago
I understand why they are killing their dealers in the Philippines. How can you watch these people poisoning your city and suffer them to live.
bravetraveller 8y ago
Holy shit. The town I'm in is becoming like this too... To think I was just about to head that way to escape this place...

88 points by pmcpinto 8y ago

rwmj 8y ago

A problem that could easily be solved by simply prescribing them all heroin. This was successful when it was done in the UK (https://health.spectator.co.uk/the-case-for-prescription-heroin/ https://health.spectator.co.uk/the-case-for-prescription-her...) although of course the government eventually shut it down.

benbreen 8y ago
Well, maybe not "easily," but I agree. Worth noting that heroin prescriptions have been happening in Switzerland for going on 20 years now, with excellent results.[1] The article was fantastic reporting by the way. Hard to read, but difficult to put down once you start. [1] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)72875-0/fulltext?code=lancet-site https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
- yayana 8y ago
  It's becoming a logistical problem in Switzerland to have so little replacement as they've aged. There aren't enough to warrant many centers anymore, but each closing means some would have travel further, possibly dropping out. The US doesn't have to worry about these kinds of problems.. or about who will buy it's newly acquired crop domestically with veterans such as the one in the article coming home with trauma and addictions. Still, a little sad for the US if Portugal and Switzerland are the first signs of European dominos -- Russian and domestic customers can't make strong demand for agriculture at US scale.. Asia is too brutal about drugs and Africa too poor.. Continued financial support for Afghanistan and less black money for operations. Is this an example of nothing is ever easy or of nothing ever goes to plan..
  - leetcrew 8y ago
    > It's becoming a logistical problem in Switzerland to have so little replacement as they've aged. this sounds like a pretty good problem to have.
    - tomcam 8y ago
      > this sounds like a pretty good problem to have. Think that one through. Who pays for the disabled, unemployed, and elderly?
      - leetcrew 8y ago
        unless I misread the post, the logistical problem is that there aren't enough new heroin addicts to justify keeping so many centers open. not sure what that has to do with paying for the unemployed and elderly.
  - stephengillie 8y ago
    20 years is enough to quit anything. Something here doesn't add up. Have there been a lot of new heroin users entering this system over the past 20 years? Or have these governments been supporting the drug addiction of a small handful of people who refuse to kick the habit, despite 20 years of therapy? Also, who fills the prescriptions? Or do the doctors just prescribe whatever the patient can get from a dealer? How does free healthcare the dealer? GP's great article is paywalled.
    - cm2012 8y ago
      It's not necessarily bad to support the drug addictions of a small handful of people for 20 years. Some people just suck at life, due to mental illness. They're going to be addicts regardless. It is insanely cheaper to just give them drugs than to close your eyes and let the other costs of them being unpredictable, homeless and sick add up.
      - stephengillie 8y ago
breakingcups 8y ago
Not just the UK. Switzerland, Belgium, Germany, Denmark and The Netherlands too. The Netherlands had a very bad heroin epidemic in the 90's which has virtually disappeared thanks to this approach. The two main takeaways in my opinion are: Treat heroin addiction as a health issue instead of a criminal issue and don't just give out heroin, always couple it with social services, treatment, etc. Note that this approach mostly solves the visible issues. Encampments with heroin users are gone, along with all the trash, safety issues and health issues. The addicts are still addicts but the enormous cost to the community and the health of the users is enormously lessened. Also, because there's nearly no business for drug dealers anymore, there are virtually no new users. Nearly all heroin users in The Netherlands are over 40 years of age. There are clearly huge benefits to this approach. However, according to some addicts there is also a downside. Now that there's a great way to solve all the visible issues, there is less of a focus on getting the addicts clean they say. See: 1. https://www.cleveland.com/metro/index.ssf/2018/07/in_amsterdam_the_government_pr.html https://www.cleveland.com/metro/index.ssf/2018/07/in_amsterd... 2. https://www.tdpf.org.uk/blog/heroin-assisted-treatment-switzerland-successfully-regulating-supply-and-use-high-risk-0 https://www.tdpf.org.uk/blog/heroin-assisted-treatment-switz... 3. https://news.vice.com/en_us/article/xwp74q/only-in-the-netherlands-do-addicts-complain-about-free-government-heroin https://news.vice.com/en_us/article/xwp74q/only-in-the-nethe... 4. https://www.rollingstone.com/culture/culture-news/treating-heroin-addiction-with-heroin-what-you-need-to-know-196882/ https://www.rollingstone.com/culture/culture-news/treating-h...
- Itaxpica 8y ago
  Of course, the one thing that all of those countries have in common is universal healthcare. "Treat addiction as a disease and prescribe heroin for it" doesn't really work so well when the overwhelming majority of addicts most likely don't have insurance or the means to pay for medical treatment out-of-pocket.
  - intuitionist 8y ago
    This is surely true, but the US can and does cover certain medical expenses as part of Medicare/Medicaid. The political obstacles are much harder to overcome than the logistical ones.
alecco 8y ago
It's good results for society but bad for the addict and their families. They are the ones pushing back. And they have a point.
- jpatokal 8y ago
  Worse than overdosing in the streets? This seems like a classic case of the perfect (being off drugs completely) being an enemy of the good (off the streets but on prescribed heroin).
- yayana 8y ago
  IMO the family is actually much better off, especially children. A big part of the problem is over valuing the addicted parent and the shadow life they should have been. Not fixing the problem let's them keep a lot of blame for reality being far from expectations on the new environment, and probably that is pretty healthy. But it doesn't mean this solution is actually wrong.
  - Latteland 8y ago
    Being able to not be a criminal, to not be arrested, to not die on the street, this is dramatically better than the alternative. No one can be prevented from buying street drugs in western countries, where there is demand someone will meet it. But this is far better for society too.
cgb223 8y ago
How do you think people would react to a major corporation selling heroin? Is that going well for the existing companies selling OxyContin? Is it going well for the people prescribed it, or are they abusing/ODing on that as well?
- pharrington 8y ago
  Purdue Pharma is still doing pretty damn well. The problem isn't in using opiates to treat pain - it is Purdue's marketing actively lying about the addiction potential of OxyContin.
- User23 8y ago
  You mean for example Bayer? They lost the Heroin trademark the same time they lost the Aspirin trademark, due to the war. Both were a product of the acetylate all the things school of medicinal chemistry.
  - nyolfen 8y ago
    yes, for instance bayer, a company that still regularly gets trotted out to highlight the evils of pharma companies for among other things selling heroin one hundred years ago
- jowsie 8y ago
  You do realise that heroin is still used in hospitals all across the world on a daily basis for routine surgeries. A company is making and selling that heroin.
dzmien 8y ago
The closest we have here is methadone. I am proud to say that I have managed to stay the fuck out of Kensington for almost three years. I could not have done it without methadone.

clydesdale 8y ago

Addendum to The Great Universal Basic Income Debate: A large portion of UBI funds will get dumped into places like this.

nickthemagicman 8y ago
Or maybe free from the stressess of poverty they will finally have the stability to get clean. I hope UBI goes into these places. It will end a lot of misery and give people an escape ladder out of that world.
EdwardDiego 8y ago
...and? If UBI replaces money obtained from crime, then does the overall social cost rise or diminish? We have a decent social security system in my country, and as I often like to tell well-off people whinging about their taxes being given to the "spongers" - social security keeps society secure against poor people.
dang 8y ago
Please don't take HN on offtopic tangents unless it's in a little-discussed and curious direction. The last thing we need is for threads to get sucked into the black holes of classic flamewar topics.

bluetwo 8y ago

Philly Proud

TomK32 8y ago
if this was reddit we'd recite the lyrics of a certain song...
danmg 8y ago
The last time was in Kensignton was to buy a, probably hot, used bicycle when I was in grad school out of a weird artist space.

alphabettsy 8y ago

Seems like it would be cheaper and safer to continue giving them the opioid derivitive medications they were already using until they are willing to go through treatment.

TomK32 8y ago

The weirdest X of Y I've ever heard of...

michaelmrose 8y ago

I understand why they are killing their dealers in the Philippines. How can you watch these people poisoning your city and suffer them to live.

bravetraveller 8y ago

Holy shit. The town I'm in is becoming like this too... To think I was just about to head that way to escape this place...