7 ms·

Reading this leaves me so confused: why have we as a society (roughly - I know there are exceptions) decided that things like heroin and cocaine are illegal an

by nlh 7y ago

Reading this leaves me so confused: why have we as a society (roughly - I know there are exceptions) decided that things like heroin and cocaine are illegal and worthy of criminal punishment (jail, etc) and things like opioids are ‘prescription painkillers’ and fully within the bounds of our laws. It’s absurd.

maxerickson 7y ago
Heroin is an opioid. In the US, it isn't used medically, apparently the reasoning is that there are less additive opioids that are similarly effective for managing pain.
- solotronics 7y ago
  It's still used in a hospital setting.
  - maxerickson 7y ago
    I don't think heroin is used medically in the US. It's schedule I. It might be used in extremely limited circumstances, but it isn't in use at most hospitals. Like others are saying, other powerful opioids are used instead.
    - martinald 7y ago
      Very common in the UK in hospital settings. Probably the one of the most used strong painkillers - most people I know who have had painful surgery got it post operation. A GP could also prescribe it no problems. Indeed there are a small number of people that get it prescribed if other drug treatments have failed.
  - bookofjoe 7y ago
    Yes, in the U.K. Brompton cocktail: https://en.wikipedia.org/wiki/Brompton_cocktail#Variants https://en.wikipedia.org/wiki/Brompton_cocktail#Variants >Some specifications for variants of Brompton cocktail call for methadone, hydromorphone, diamorphine (heroin), or other strong opioids in the place of morphine.
- klyrs 7y ago
  I'm not sure that I buy that. Fentanyl is prescribed in the US; it's 100x stronger than heroin
- tyingq 7y ago
  Hospitals use Dilaudid, Fentanyl, and other stuff that's worse than heroin in that regard.
  - refurb 7y ago
    How so?
    - tyingq 7y ago
      More powerful, more addictive.
      - refurb 7y ago
        Not necessarily. Addictiveness is not directly related to potency. From what I’ve heard, most addicts prefer heroin to fentanyl, even though it’s less potent on a weight basis.
        tyingq 7y ago
        They prefer heroin likely due to the fear of overdose. I pushed the button as often as the Dilaudid dispenser would let me after surgery. It's a pretty magical warm blanket. I understood the appeal immediately. All your worries melt away, and you're floating in a cloud.
        magila 7y ago
        Heroin produces a stronger euphoric effect than synthetic and semi-synthetic opioids like Dilaudid and fentanyl relative to its less desirable effects like respiratory suppression. Studies have shown that recreational opioid users prefer heroin to other opioids for this reason.
- AstralStorm 7y ago
  It is used for patients in palliative care, including US. With special prescriptions. It's less risky then fentanyl most of the time.
journalctl 7y ago
Because making “street” drugs illegal allows you to jail any race you don’t like. And making the same drugs available as a prescription allows drug companies to make billions, negative externalities be damned. Always follow the money.
- monieseee 7y ago
  Selling cocaine/heroin at the corner grocery shop would bring in billions of dollars of sales. Just imagine tens of millions of people buying their daily does. So if following the money is the answer, why doesn't this happen?
  - AstralStorm 7y ago
    Because it's really deadly and addictive. Legalising it would bring untold number of deaths. We've been there before, opium, laudanum and heroin were available without prescription one time...
  - lstodd 7y ago
    Because not selling them at the corner grocery shop brings in hundreds of billions in sales.
  - i_am_nomad 7y ago
    The grocery stores already sell highly addictive and thus highly profitable substances.
  - ufmace 7y ago
    IMO, it's not follow the money, it's follow the power. The power to lock up anybody doing a common thing because you don't like them for some reason is intoxicating. Maybe power is the most dangerous drug of them all.
DanBC 7y ago
The history of medical opioids is weird. Pain is a complex phenomena. This has caused a lot of problems with pain treatment. We used to think heroin was okay, then we realised it was addictive. So we moved to other opioids thinking they weren't as addictive, but they are all about as addictive as morphine and diamorphine. We started reducing the quantities of the opioids and adding other meds like paracetamol / acetaminophen. This led to fucking stupid meds like coproxamol -- a mix of dextropropoxyphene (an opioid) and paracetamol. This opioid is very toxic, and it was killing many people in the UK until the licencing changed. And then we tried other meds like NSAIDs and etc. Some of them sort of work for some pain, some are very good for a specific type of pain. But they all have side effects. We split pain up in different ways. We talk about chronic (long term) pain or acute pain. We talk about medically unexplained pain, and the implication is that the other pain has a medical explanation. The public have three incorrect beliefs about pain treatment. 1) Opioids are effective 2) Pain is either real or imagined, and imagined pain isn't real pain. 3) The aim of pain treatment is always to eliminate all pain and anything less is a failure. Turns out none of these are true. Opioids are a good choice for a limited number of patients. It's really important that people get all the opioids they need at end of life, for example. Or that people going through surgery have them available if needed. But for long term pain they're a bad choice. The person in pain ends up taking very high doses of opioids, with all the side-effects that causes, and they're still in pain. We can see their function - the stuff they do every day - is much reduced. We also see some conspiracy-theory style thinking here - "morphine is dirt cheap and this non-opioid you've got me on is really expensive, because you're in the pocket of big pharma". We know that patients reject psychological treatment for their pain. They'll say "but my pain is real, it's not all in my head". But many pain patients experience benefit from psychological treatment. (Imagine a purely physical disease like t1 diabetes. Even these patients will get benefit from a psychological treatment. Clearly I don't mean that mindfullness will control blood sugars, but the 3 questions "can you do your bloods every day?", "can you take your insulin at the right dose and right time every day?" and "can you adjust your diet and lifestyle?" -- these are all firmly psychology). Sadly, lots of people in pain will not experience relief from that pain even if we give them high dose opioids. So pain treatment should be looking at function. The aim should be to allow someone to live their life even if they still have pain. For one example of this see "Sean's Story" https://www.england.nhs.uk/south/2019/06/25/seans-story/ https://www.england.nhs.uk/south/2019/06/25/seans-story/ There's also a visit to a pain-management clinic in a section of this radio programme: https://www.bbc.co.uk/programmes/b04wv052 https://www.bbc.co.uk/programmes/b04wv052
throwaway5752 7y ago
Because heroin is so addictive and powerful that it changes the structure and function of your brain. It will destroy and kill a person in the blink of an eye. People will steal from the parents and kids, prostitute themselves, or just about anything to satisfy their addiction. You lump in cocaine as though all schedule 1 drugs are equal. You are having two different conversations. One of them is complicated (why are LSD, peyote, and marijuana classified with opioids? why are they enforced and punished so unevenly along race and class lines?) Opioids are critical medical tools for pain management. The solution is to have doctors decide when it is necessary and to have pharmacists manage its distribution. Why this works is that doctors and pharmacists will be delicensed and possibly go to jail for this, and they generally have a highly asymmetric amount to lose from doing so. Opioids are unlike any other drug. Look at national death statistics. Read this article. If they weren't so necessary for critical pain management and hospice care they'd be completely illegal.
- kirstenbirgit 7y ago
  It's possible to overdose on anything. Heroin is dangerous because of cuts like fentanyl and various contaminants, not because you just inherently die randomly after using it. One could use heroin your whole life with no ill effects. In that way, it's comparable to coffee. Addicts simply need cheap access to legal heroin to stop using. Only after that's taken care of can they start getting their life back on track and to be about something other than drugs.
  - qz_ 7y ago
    Not sure why you're being downvoted, you're completely correct. The only significant negative effect heroin use has on you besides addiction is constipation. For a heroin addict, the problem isn't the heroin, it's the absence of heroin.
    - throwaway5752 7y ago
      To anyone who reads the above comments minimizing opioid addiction: heroin will eat you from the inside and kill you eventually. It is the most evil drug that has ever existed. Before it kills you it will ruin your mind irreversibly. Constipation is the least of the problems. Never use it, ever.

by nlh 7y ago

maxerickson 7y ago

Heroin is an opioid. In the US, it isn't used medically, apparently the reasoning is that there are less additive opioids that are similarly effective for managing pain.

solotronics 7y ago
It's still used in a hospital setting.
- maxerickson 7y ago
  I don't think heroin is used medically in the US. It's schedule I. It might be used in extremely limited circumstances, but it isn't in use at most hospitals. Like others are saying, other powerful opioids are used instead.
  - martinald 7y ago
    Very common in the UK in hospital settings. Probably the one of the most used strong painkillers - most people I know who have had painful surgery got it post operation. A GP could also prescribe it no problems. Indeed there are a small number of people that get it prescribed if other drug treatments have failed.
- bookofjoe 7y ago
  Yes, in the U.K. Brompton cocktail: https://en.wikipedia.org/wiki/Brompton_cocktail#Variants https://en.wikipedia.org/wiki/Brompton_cocktail#Variants >Some specifications for variants of Brompton cocktail call for methadone, hydromorphone, diamorphine (heroin), or other strong opioids in the place of morphine.
klyrs 7y ago
I'm not sure that I buy that. Fentanyl is prescribed in the US; it's 100x stronger than heroin
tyingq 7y ago
Hospitals use Dilaudid, Fentanyl, and other stuff that's worse than heroin in that regard.
- refurb 7y ago
  How so?
  - tyingq 7y ago
    More powerful, more addictive.
    - refurb 7y ago
      Not necessarily. Addictiveness is not directly related to potency. From what I’ve heard, most addicts prefer heroin to fentanyl, even though it’s less potent on a weight basis.
      - tyingq 7y ago
        They prefer heroin likely due to the fear of overdose. I pushed the button as often as the Dilaudid dispenser would let me after surgery. It's a pretty magical warm blanket. I understood the appeal immediately. All your worries melt away, and you're floating in a cloud.
        magila 7y ago
        Heroin produces a stronger euphoric effect than synthetic and semi-synthetic opioids like Dilaudid and fentanyl relative to its less desirable effects like respiratory suppression. Studies have shown that recreational opioid users prefer heroin to other opioids for this reason.
AstralStorm 7y ago
It is used for patients in palliative care, including US. With special prescriptions. It's less risky then fentanyl most of the time.

journalctl 7y ago

Because making “street” drugs illegal allows you to jail any race you don’t like. And making the same drugs available as a prescription allows drug companies to make billions, negative externalities be damned. Always follow the money.

monieseee 7y ago
Selling cocaine/heroin at the corner grocery shop would bring in billions of dollars of sales. Just imagine tens of millions of people buying their daily does. So if following the money is the answer, why doesn't this happen?
- AstralStorm 7y ago
  Because it's really deadly and addictive. Legalising it would bring untold number of deaths. We've been there before, opium, laudanum and heroin were available without prescription one time...
- lstodd 7y ago
  Because not selling them at the corner grocery shop brings in hundreds of billions in sales.
- i_am_nomad 7y ago
  The grocery stores already sell highly addictive and thus highly profitable substances.
- ufmace 7y ago
  IMO, it's not follow the money, it's follow the power. The power to lock up anybody doing a common thing because you don't like them for some reason is intoxicating. Maybe power is the most dangerous drug of them all.

DanBC 7y ago

The history of medical opioids is weird. Pain is a complex phenomena. This has caused a lot of problems with pain treatment. We used to think heroin was okay, then we realised it was addictive. So we moved to other opioids thinking they weren't as addictive, but they are all about as addictive as morphine and diamorphine. We started reducing the quantities of the opioids and adding other meds like paracetamol / acetaminophen. This led to fucking stupid meds like coproxamol -- a mix of dextropropoxyphene (an opioid) and paracetamol. This opioid is very toxic, and it was killing many people in the UK until the licencing changed. And then we tried other meds like NSAIDs and etc. Some of them sort of work for some pain, some are very good for a specific type of pain. But they all have side effects. We split pain up in different ways. We talk about chronic (long term) pain or acute pain. We talk about medically unexplained pain, and the implication is that the other pain has a medical explanation. The public have three incorrect beliefs about pain treatment. 1) Opioids are effective 2) Pain is either real or imagined, and imagined pain isn't real pain. 3) The aim of pain treatment is always to eliminate all pain and anything less is a failure. Turns out none of these are true. Opioids are a good choice for a limited number of patients. It's really important that people get all the opioids they need at end of life, for example. Or that people going through surgery have them available if needed. But for long term pain they're a bad choice. The person in pain ends up taking very high doses of opioids, with all the side-effects that causes, and they're still in pain. We can see their function - the stuff they do every day - is much reduced. We also see some conspiracy-theory style thinking here - "morphine is dirt cheap and this non-opioid you've got me on is really expensive, because you're in the pocket of big pharma". We know that patients reject psychological treatment for their pain. They'll say "but my pain is real, it's not all in my head". But many pain patients experience benefit from psychological treatment. (Imagine a purely physical disease like t1 diabetes. Even these patients will get benefit from a psychological treatment. Clearly I don't mean that mindfullness will control blood sugars, but the 3 questions "can you do your bloods every day?", "can you take your insulin at the right dose and right time every day?" and "can you adjust your diet and lifestyle?" -- these are all firmly psychology). Sadly, lots of people in pain will not experience relief from that pain even if we give them high dose opioids. So pain treatment should be looking at function. The aim should be to allow someone to live their life even if they still have pain. For one example of this see "Sean's Story" https://www.england.nhs.uk/south/2019/06/25/seans-story/ https://www.england.nhs.uk/south/2019/06/25/seans-story/ There's also a visit to a pain-management clinic in a section of this radio programme: https://www.bbc.co.uk/programmes/b04wv052 https://www.bbc.co.uk/programmes/b04wv052

throwaway5752 7y ago

Because heroin is so addictive and powerful that it changes the structure and function of your brain. It will destroy and kill a person in the blink of an eye. People will steal from the parents and kids, prostitute themselves, or just about anything to satisfy their addiction. You lump in cocaine as though all schedule 1 drugs are equal. You are having two different conversations. One of them is complicated (why are LSD, peyote, and marijuana classified with opioids? why are they enforced and punished so unevenly along race and class lines?) Opioids are critical medical tools for pain management. The solution is to have doctors decide when it is necessary and to have pharmacists manage its distribution. Why this works is that doctors and pharmacists will be delicensed and possibly go to jail for this, and they generally have a highly asymmetric amount to lose from doing so. Opioids are unlike any other drug. Look at national death statistics. Read this article. If they weren't so necessary for critical pain management and hospice care they'd be completely illegal.

kirstenbirgit 7y ago
It's possible to overdose on anything. Heroin is dangerous because of cuts like fentanyl and various contaminants, not because you just inherently die randomly after using it. One could use heroin your whole life with no ill effects. In that way, it's comparable to coffee. Addicts simply need cheap access to legal heroin to stop using. Only after that's taken care of can they start getting their life back on track and to be about something other than drugs.
- qz_ 7y ago
  Not sure why you're being downvoted, you're completely correct. The only significant negative effect heroin use has on you besides addiction is constipation. For a heroin addict, the problem isn't the heroin, it's the absence of heroin.
  - throwaway5752 7y ago
    To anyone who reads the above comments minimizing opioid addiction: heroin will eat you from the inside and kill you eventually. It is the most evil drug that has ever existed. Before it kills you it will ruin your mind irreversibly. Constipation is the least of the problems. Never use it, ever.