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Further <https://www.spectator.co.uk/2015/05/the-case-for-prescription-heroin/> https://www.spectator.co.uk/2015/05/the-case-for-prescriptio... A short read, a

Further <https://www.spectator.co.uk/2015/05/the-case-for-prescription-heroin/> https://www.spectator.co.uk/2015/05/the-case-for-prescriptio... A short read, a couple of pages. Extract: " The [heroin] addicts on prescriptions, by contrast, looked like the nurses or receptionists or Dr Marks himself. As a group, you couldn’t tell. Faced with this evidence, Marks was beginning to believe that many ‘of the harms of drugs are to do with the laws around them, not the drugs themselves’. In the clinic, as Russell Newcombe tells me, they started to call the infections and abscesses and amputations ‘drug war wounds’. So Dr Marks began to wonder: if prescription is so effective, why don’t we do it more? He expanded his heroin prescription programme from a dozen people to more than 400. The first people to notice an effect were the local police. Inspector Michael Lofts studied 142 heroin and cocaine addicts in the area, and he found there was a 93 per cent drop in theft and burglary. ‘You could see them transform in front of your own eyes,’ Lofts told a newspaper, amazed. ‘They came in in outrageous condition, stealing daily to pay for illegal drugs; and became, most of them, very amiable, reasonable law-abiding people.’ He said elsewhere: ‘Since the clinics opened, the street heroin dealer has slowly but surely abandoned the streets of Warrington and Widnes.’ One day a young mother called Julia Scott came into Dr Marks’s surgery and explained she had been working as a prostitute to support her habit. He wrote her a prescription, and she stopped sex work that day. " Just a perspective, not saying right or wrong. Edit: added this: " And something nobody predicted took place. The number of heroin addicts in the area actually fell. Research published by Dr Marks in the Proceedings of the Royal College of Physicians of Edinburgh compared Widnes, which had a heroin clinic, to the very similar Liverpool borough of Bootle, which didn’t — and found Widnes had 12 times fewer addicts. "

wang_li 7y ago
> ... looked like the nurses or receptionists or Dr Marks himself. That would be because Dr Marks can't see himself. The difference between a high functioning, long term heroin addict and everyone else is that the heroin addicts require large support staffs that keep them high functioning.
- leetcrew 7y ago
  what do you mean by this? it sounds like Dr marks's approach is quite resource efficient. many people are served by each clinician.
- derefr 7y ago
  You mean all the people who make and prescribe and administer the heroin? If that’s your meaning, then “everyone else” has much the same problem: it’s a rare person in our society who isn’t dependent on some part of the pharmaceuticals / medical equipment / biochemical industry to keep their life together. You can’t just stop taking SSRIs if you’re on them, insulin if you’re diabetic, antibiotics in the middle of a regimen, immunosuppressants if you’ve had an organ transplant... and you could never be a doctor (without immediately causing a life-threatening incident) without a constant supply of scrub and pre-sterilized instruments.
  - wang_li 7y ago
    >You can’t just stop taking SSRIs if you’re on them, insulin if you’re diabetic, antibiotics in the middle of a regimen, immunosuppressants if you’ve had an organ transplant... These do not constitute such a large portion of the population that you can say that folks who do not require them are rare. If anything it's the opposite. The point I make is that heroin addicts require everything that everyone else requires, plus medical support staff that provide them with cheap and safe sources to feed their addiction. Equating this with the tools of the trade of medical professionals is absurd.
    - CaptainZapp 7y ago
      The point I make is that heroin addicts require everything that everyone else requires, plus medical support staff that provide them with cheap and safe sources to feed their addiction. Pharmacies serve quite well and rather cost efficient for this purpose. It's not really that far away of their core business of dispensing prescrition drugs. The substance is different, but the logistics are exactly the same. You may think that pharmacy robberies are a concern, but it's not really an issue. I accept that this may not universally be the case.
kradroy 7y ago
It is a perspective, but I think the culture in most places in the US would render this option unviable. I can guarantee you that if this were to be attempted in SF, they would have to have the drugs administered by medical staff. They couldn't just hand heroin and crack to the patients. Pimps and dealers would send in mules to get drugs that could be resold for cash. That would also probably cause human trafficking to surge. Portugal's efforts to reduce addiction and homelessness sound great too, but those won't work here either. We need to find solutions that are workable for our culture... or wait for our culture to change.
- tempguy9999 7y ago
  > ...they would have to have the drugs administered by medical staff As they do in the UK I believe. I was once in a branch of boots IIRC (boots is a UK pharmacist) in a midlands city where there was plenty of drugs problem. A rattily-dressed guy came in and they gave him half a measuring cup of some thick green liquid which he drank in half a minute, while he chatted with them. They were watching him carefully, 2 of the pharmacists. I dunno but I guess that was methadone. There's no reason to assume that they'd simply hand out the stuff, and if it was by medical staff who expected to be taken as they watched, that's ok I think.
  - Scoundreller 7y ago
    Dunno about the UK, but usually for the more trust-earned patients, they get to take most of their doses home and consume them there.
- futureastronaut 7y ago
  A less pessimistic take is that it would be unprecedented, and we have no idea what would happen.
- CaptainZapp 7y ago
  I believe you're spot-on that culturally that would not be acceptable in the US. I can guarantee you that if this were to be attempted in SF, they would have to have the drugs administered by medical staff. They couldn't just hand heroin and crack to the patients. I'm not sure about the logistics, but don't think they're that complicated. Getting into those programs is tied to quite stringent conditions. Like a certain age barrier and a number of attempts to go clean. I'd wager that there's more prescribed Ritalin resold on the black market than heroin obtained through those programs. In one sense I believe it was fundamentally successul: It turned the drug from having a "hero image" in the 70s and 80s into a complete loser drug. Harm reduction is one of the pillars in treatment of addiction, which now is widely and generally accepted. Proven by two referendums in which the public had a say on the issue. And harm reduction is unarguably a good thing, when it comes to addiction.
CaptainZapp 7y ago
Faced with this evidence, Marks was beginning to believe that many ‘of the harms of drugs are to do with the laws around them, not the drugs themselves’. I believe this to be quite self-evident. A heroin addict can be quite a succesful and functioning member in society, provided that she can maintain her habit, without the hassle that comes with bad quality drugs and the stress (and invariably crime), which is required to maintain the addiction. That all falls away when the drug is made available cheaply, regularely and even paid for by health insurance.
- dymk 7y ago
  But you need some strong incentive structure to not start doing heroin in the first place. For most, that's the knowledge that heroin is going to invariably screw you over in the long term. Not to mention the long-term medical side effects of heroin usage...
  - Scoundreller 7y ago
    > Not to mention the long-term medical side effects of heroin usage... The constipation?
  - Broken_Hippo 7y ago
    Is there a young to middle aged person alive in the Western world that doesn't know that long-term drug use is bad for your health? This doesn't deter. Besides, most folks don't intend to get addicted and only a portion do. Many more can use opiates medicinally or recreationally without addiction. It seems decriminalisation works. Safety nets help. Offering free, medical-based addiction help would help. Prudent disussions with doctors when using opiate main meds would help - you know, what to watch out for with addiction, help if it happens, and not treating folks like criminals the rest of their lives if it happens. I'd personally advocate legalisation of most drugs, even if I wouldn't do them, just to keep folks safe.
    - algaeontoast 7y ago
      The painful truth to this problem seems to be that people who actively use drugs and decimate their bodies when provided a steady supply of drugs will simply die sooner? It seems hard to argue that supporting someone's heroin habit wouldn't incur a higher than normal cost for healthcare?
deleted 7y ago
[deleted]
jMyles 7y ago
> ‘Since the clinics opened, the street heroin dealer has slowly but surely abandoned the streets of Warrington and Widnes.’ Is there any doubt, then, about who is bankrolling support for prohibition and why?

wang_li 7y ago

> ... looked like the nurses or receptionists or Dr Marks himself. That would be because Dr Marks can't see himself. The difference between a high functioning, long term heroin addict and everyone else is that the heroin addicts require large support staffs that keep them high functioning.

leetcrew 7y ago
what do you mean by this? it sounds like Dr marks's approach is quite resource efficient. many people are served by each clinician.
derefr 7y ago
You mean all the people who make and prescribe and administer the heroin? If that’s your meaning, then “everyone else” has much the same problem: it’s a rare person in our society who isn’t dependent on some part of the pharmaceuticals / medical equipment / biochemical industry to keep their life together. You can’t just stop taking SSRIs if you’re on them, insulin if you’re diabetic, antibiotics in the middle of a regimen, immunosuppressants if you’ve had an organ transplant... and you could never be a doctor (without immediately causing a life-threatening incident) without a constant supply of scrub and pre-sterilized instruments.
- wang_li 7y ago
  >You can’t just stop taking SSRIs if you’re on them, insulin if you’re diabetic, antibiotics in the middle of a regimen, immunosuppressants if you’ve had an organ transplant... These do not constitute such a large portion of the population that you can say that folks who do not require them are rare. If anything it's the opposite. The point I make is that heroin addicts require everything that everyone else requires, plus medical support staff that provide them with cheap and safe sources to feed their addiction. Equating this with the tools of the trade of medical professionals is absurd.
  - CaptainZapp 7y ago
    The point I make is that heroin addicts require everything that everyone else requires, plus medical support staff that provide them with cheap and safe sources to feed their addiction. Pharmacies serve quite well and rather cost efficient for this purpose. It's not really that far away of their core business of dispensing prescrition drugs. The substance is different, but the logistics are exactly the same. You may think that pharmacy robberies are a concern, but it's not really an issue. I accept that this may not universally be the case.

kradroy 7y ago

It is a perspective, but I think the culture in most places in the US would render this option unviable. I can guarantee you that if this were to be attempted in SF, they would have to have the drugs administered by medical staff. They couldn't just hand heroin and crack to the patients. Pimps and dealers would send in mules to get drugs that could be resold for cash. That would also probably cause human trafficking to surge. Portugal's efforts to reduce addiction and homelessness sound great too, but those won't work here either. We need to find solutions that are workable for our culture... or wait for our culture to change.

tempguy9999 7y ago
> ...they would have to have the drugs administered by medical staff As they do in the UK I believe. I was once in a branch of boots IIRC (boots is a UK pharmacist) in a midlands city where there was plenty of drugs problem. A rattily-dressed guy came in and they gave him half a measuring cup of some thick green liquid which he drank in half a minute, while he chatted with them. They were watching him carefully, 2 of the pharmacists. I dunno but I guess that was methadone. There's no reason to assume that they'd simply hand out the stuff, and if it was by medical staff who expected to be taken as they watched, that's ok I think.
- Scoundreller 7y ago
  Dunno about the UK, but usually for the more trust-earned patients, they get to take most of their doses home and consume them there.
futureastronaut 7y ago
A less pessimistic take is that it would be unprecedented, and we have no idea what would happen.
CaptainZapp 7y ago
I believe you're spot-on that culturally that would not be acceptable in the US. I can guarantee you that if this were to be attempted in SF, they would have to have the drugs administered by medical staff. They couldn't just hand heroin and crack to the patients. I'm not sure about the logistics, but don't think they're that complicated. Getting into those programs is tied to quite stringent conditions. Like a certain age barrier and a number of attempts to go clean. I'd wager that there's more prescribed Ritalin resold on the black market than heroin obtained through those programs. In one sense I believe it was fundamentally successul: It turned the drug from having a "hero image" in the 70s and 80s into a complete loser drug. Harm reduction is one of the pillars in treatment of addiction, which now is widely and generally accepted. Proven by two referendums in which the public had a say on the issue. And harm reduction is unarguably a good thing, when it comes to addiction.

CaptainZapp 7y ago

Faced with this evidence, Marks was beginning to believe that many ‘of the harms of drugs are to do with the laws around them, not the drugs themselves’. I believe this to be quite self-evident. A heroin addict can be quite a succesful and functioning member in society, provided that she can maintain her habit, without the hassle that comes with bad quality drugs and the stress (and invariably crime), which is required to maintain the addiction. That all falls away when the drug is made available cheaply, regularely and even paid for by health insurance.

dymk 7y ago
But you need some strong incentive structure to not start doing heroin in the first place. For most, that's the knowledge that heroin is going to invariably screw you over in the long term. Not to mention the long-term medical side effects of heroin usage...
- Scoundreller 7y ago
  > Not to mention the long-term medical side effects of heroin usage... The constipation?
- Broken_Hippo 7y ago
  Is there a young to middle aged person alive in the Western world that doesn't know that long-term drug use is bad for your health? This doesn't deter. Besides, most folks don't intend to get addicted and only a portion do. Many more can use opiates medicinally or recreationally without addiction. It seems decriminalisation works. Safety nets help. Offering free, medical-based addiction help would help. Prudent disussions with doctors when using opiate main meds would help - you know, what to watch out for with addiction, help if it happens, and not treating folks like criminals the rest of their lives if it happens. I'd personally advocate legalisation of most drugs, even if I wouldn't do them, just to keep folks safe.
  - algaeontoast 7y ago
    The painful truth to this problem seems to be that people who actively use drugs and decimate their bodies when provided a steady supply of drugs will simply die sooner? It seems hard to argue that supporting someone's heroin habit wouldn't incur a higher than normal cost for healthcare?

deleted 7y ago

[deleted]

jMyles 7y ago

> ‘Since the clinics opened, the street heroin dealer has slowly but surely abandoned the streets of Warrington and Widnes.’ Is there any doubt, then, about who is bankrolling support for prohibition and why?