4 ms·

>By the time Darren was assigned to drug court, his addiction story carried almost every possible red flag for high-mortality risk: prior overdose, prior treatm

>By the time Darren was assigned to drug court, his addiction story carried almost every possible red flag for high-mortality risk: prior overdose, prior treatment failure, a childhood ADHD diagnosis, and a family history of mental illness. Any addiction doctor—or anybody who simply follows evidence-based treatment guidelines—would know exactly what to prescribe for him: opioid maintenance, by far the most effective treatment, known to lower the death rate of opioid addiction by between 66 and 75 percent. I am a psychiatrist, and I treat many people with addiction problems. This formulation is a gross oversimplification. Opioid agonist therapy (methadone or bupronorhpine) is not trivial or one-size-fits-all. There are many other factors to consider, not the least of which is the person's interest in getting clean.

nashequilibrium 11y ago
Why is a psychiatrist on hackernews, just curious?
- phren0logy 11y ago
  During my residency, I did some fMRI research and learned a little bit of programming. The structured thinking involved in programming has been a useful skill that I try to maintain. Plus there's lots of interesting discourse with smart people, which is a rare thing to find on the internet these days.
stronglikedan 11y ago
How right you are. I have a friend whose been on Suboxone for years. First thing she does when she gets her prescription is sell it or shoot it. I have no idea how to help her anymore (as if I ever did). Her ex was the same way.
worik 11y ago
It is a generalisation but a good one. "Getting clean" is a loaded term. Most (not all) people who have "drug" problems actually have police problems. The drugs do them very little harm (impurities are a different story, but not as common as people think) but the police and legal systems do them untold damage. Making the drugs available is by far the best treatment for most forms of drug addiction in the vast majority of cases. The simplest way to do that is to remove criminal sanctions from drugs and make prescription for addiction legal. Addiction is a complex beast and demanding that people deal with the chemical dependence before dealing with the other problems in an addicts life is usually a cruel approach and ineffective. This is something a psychiatrist should know.
- phren0logy 11y ago
  I can't really agree with your premise. Our current situation is pretty broken, and our drug laws and enforcement have not achieved their stated aims. That said, the legality of alcohol hardly keeps it from causing lots of people very serious problems. "Drugs do them very little harm" is fantasy, though you are quite right that a felony history and time behind bars only makes things worse.
  - worik 11y ago
    What harm does heroin do a person? Pharmacologically it does very little. Addiction is the main harm. The vast majority of drug users do not have problems (almost every adult uses drugs) except problems with the legal systems. This is well known and extensively documented. I would encourage you to study what has happened in Portugal over the last decade. Different drugs have different effects. Alcohol is one of the more dangerous yet is legal and a huge business. More dangerous than cocaine, heroin, ecstasy. See David Nutt's research from the UK. http://www.businessinsider.com.au/alcohol-more-harmful-heroin-2012-7 http://www.businessinsider.com.au/alcohol-more-harmful-heroi... http://www.sciencemediacentre.co.nz/2010/08/06/professor-david-nutt-the-inconvenient-truth-about-drugs/ http://www.sciencemediacentre.co.nz/2010/08/06/professor-dav...
    - phren0logy 11y ago
      You are kidding, right? Do you know how many people die of opioid overdose every year? I'm not arguing that criminalization has helped, so let's keep these two lines of thought separate. Is alcohol more dangerous than heroin? Perhaps, and David Nutt's research is very interesting on relative harms, but it doesn't magically make either one totally safe.
      - worik 11y ago
        "You are kidding, right? Do you know how many people die of opioid overdose every year?" Not of heroin overdose. Often "heroin overdose" is reported in the MSM but it is inaccurate

nashequilibrium 11y ago

Why is a psychiatrist on hackernews, just curious?

phren0logy 11y ago
During my residency, I did some fMRI research and learned a little bit of programming. The structured thinking involved in programming has been a useful skill that I try to maintain. Plus there's lots of interesting discourse with smart people, which is a rare thing to find on the internet these days.

stronglikedan 11y ago

How right you are. I have a friend whose been on Suboxone for years. First thing she does when she gets her prescription is sell it or shoot it. I have no idea how to help her anymore (as if I ever did). Her ex was the same way.

worik 11y ago

It is a generalisation but a good one. "Getting clean" is a loaded term. Most (not all) people who have "drug" problems actually have police problems. The drugs do them very little harm (impurities are a different story, but not as common as people think) but the police and legal systems do them untold damage. Making the drugs available is by far the best treatment for most forms of drug addiction in the vast majority of cases. The simplest way to do that is to remove criminal sanctions from drugs and make prescription for addiction legal. Addiction is a complex beast and demanding that people deal with the chemical dependence before dealing with the other problems in an addicts life is usually a cruel approach and ineffective. This is something a psychiatrist should know.

phren0logy 11y ago
I can't really agree with your premise. Our current situation is pretty broken, and our drug laws and enforcement have not achieved their stated aims. That said, the legality of alcohol hardly keeps it from causing lots of people very serious problems. "Drugs do them very little harm" is fantasy, though you are quite right that a felony history and time behind bars only makes things worse.
- worik 11y ago
  What harm does heroin do a person? Pharmacologically it does very little. Addiction is the main harm. The vast majority of drug users do not have problems (almost every adult uses drugs) except problems with the legal systems. This is well known and extensively documented. I would encourage you to study what has happened in Portugal over the last decade. Different drugs have different effects. Alcohol is one of the more dangerous yet is legal and a huge business. More dangerous than cocaine, heroin, ecstasy. See David Nutt's research from the UK. http://www.businessinsider.com.au/alcohol-more-harmful-heroin-2012-7 http://www.businessinsider.com.au/alcohol-more-harmful-heroi... http://www.sciencemediacentre.co.nz/2010/08/06/professor-david-nutt-the-inconvenient-truth-about-drugs/ http://www.sciencemediacentre.co.nz/2010/08/06/professor-dav...
  - phren0logy 11y ago
    You are kidding, right? Do you know how many people die of opioid overdose every year? I'm not arguing that criminalization has helped, so let's keep these two lines of thought separate. Is alcohol more dangerous than heroin? Perhaps, and David Nutt's research is very interesting on relative harms, but it doesn't magically make either one totally safe.
    - worik 11y ago
      "You are kidding, right? Do you know how many people die of opioid overdose every year?" Not of heroin overdose. Often "heroin overdose" is reported in the MSM but it is inaccurate