BBC: Why is heroin killing so many people?

[Boz33]

They should.

That wouldn't impact on today's addicts though.

Lots of actions taken today would have no effect on current users of anything, be it heroin, other drugs, pain killers, anti depressants, fags, booze, surely it's a long term game. For example it seems to me anti depressants and pain killers seem to be the norm in a lot of cases today where years gone by they wouldn't have been. Every man and his dog seems to be on them for one reason or another and to me it just seems like a quick fix in a lot of cases so the quacks can get you in and out of the surgery. Maybe better coping strategies given out by the docs would be a better starting place.

 

[Deleted member 22590]

How do you think detox works?

You go into clinic and are honest with them and say how much you use. Do you think they just pluck a methadone or buprenorphine dose out of the air and see how it goes?

If this were to happen then patients are monitored in a clinical setting, if they have a hit and are suffering the doctor/nurse would give them Narcan to reverse the opioid effect, you know the same way that happens know with NEAS turning up.

I think you are naive to think that there is no alternative

I've not said there isn't an alternative. My question, as yet unanswered by anyone is do you give someone as much heroin as they want? You are indeed being naïve if you think that currently, people on methadone don't also take heroin. Many if not most, do. Any pretty much anything else they can get their hands on to boot. Rarely is their a drugs death these days where the toxicology reports don't show a mixture of prescription and controlled drugs.
So, once again, if someone says they're doing 6-7 bags a day and so you replicate that with prescription heroin, apart from anything else, you've an institution that's open 24/7 with people lying around intoxicated who come round and demand their next hit.
As soon as you say they've had their allowance and have to leave, they're off to buy some elsewhere or get some subbies , gabapentin , spice, vallium etc etc etc. to take the edge off until they can start again the next day.
I happen to think that's not a viable alternative.

 

[Some Random Guy]

Lots of actions taken today would have no effect on current users of anything, be it heroin, other drugs, pain killers, anti depressants, fags, booze, surely it's a long term game. For example it seems to me anti depressants and pain killers seem to be the norm in a lot of cases today where years gone by they wouldn't have been. Every man and his dog seems to be on them for one reason or another and to me it just seems like a quick fix in a lot of cases so the quacks can get you in and out of the surgery. Maybe better coping strategies given out by the docs would be a better starting place.

Most public health interventions are playing the long game marra.

We touched on the this last night when we talked about how difficult it is to get changes to policy in place.

It's hard to say "if you spend money on X now Y will happen in 20 years" and get traction, it's nigh on impossible if it's not a popular policy with the government of the day as I'm 20 years they aren't going to be running for office.

 

[Keawyeds]

This is one of them posts where the poster gives it away that they too ignorant for the discussion. Smackheads off their tits on weed. Running the gauntlet? All scratters. I took heroin for about 14 years so got a canny good idea about the people who take it. But you have no f***ing clue about it. You carry on condemning those worse off than yourself, hope it makes you feel better.

There are lot of people who clearly need help. What needs to happen primarily is take out the suppliers.
If you've been to Manchester and seen the people in Piccadilly Gardens, some may want help, some don't.
Some probably don't care because they're getting what they want and feel they have no other option.

Well done for getting off the heroin.
What needs to be addressed is:
How people end up on it in the first place
How they get it or keep getting hold of it and
Why they keep using it.

It's about breaking the cycle I suppose.

There was a Spice Zombie in Wigan this Saturday. Comatose on a bench. Ambulance had to come and get them.
It's a shame that anyone would get themselves into that situation in this day and age.

 

[Nicky Winterwasp]

Heroin doesn't make you "spaz out".

As for functionality it can vary massively.

If I could maintain my job I could spend £20 a day on heroin without issues, I'm sure many people do just that.

Think about the wider population, there are plenty of functional alcoholics.

I know nothing about it. I suppose I always assumed heroin addicts were in a perpetual cycle of constantly wanting to shoot up and being useless in between other than to do what is required to get their next dose by any means. Reading this thread has exposed my ignorance though, which is good.

 

[Keawyeds]

I know nothing about it. I suppose I always assumed heroin addicts were in a perpetual cycle of constantly wanting to shoot up and being useless in between other than to do what is required to get their next dose by any means. Reading this thread has exposed my ignorance though, which is good.

Unfortunately that was the attraction to some to Spice as it basically knocked you out for 12 hours or so, so you didn't have to do anything, think about anything etc.
It's a shame that people get into a situation that that seems like a better option than being awake

 

[Some Random Guy]

You are indeed being naïve if you think that currently, people on methadone don't also take heroin. Many if not most, do. Any pretty much anything else they can get their hands on to boot. Rarely is their a drugs death these days where the toxicology reports don't show a mixture of prescription and controlled drugs.
So, once again, if someone says they're doing 6-7 bags a day and so you replicate that with prescription heroin, apart from anything else, you've an institution that's open 24/7 with people lying around intoxicated who come round and demand their next hit.
As soon as you say they've had their allowance and have to leave, they're off to buy some elsewhere or get some subbies , gabapentin , spice, vallium etc etc etc. to take the edge off until they can start again the next day.
I happen to think that's not a viable alternative.

Sauce for the bolded please.

 

[Boz33]

Most public health interventions are playing the long game marra.

We touched on the this last night when we talked about how difficult it is to get changes to policy in place.

It's hard to say "if you spend money on X now Y will happen in 20 years" and get traction, it's nigh on impossible if it's not a popular policy with the government of the day as I'm 20 years they aren't going to be running for office.

But this is the thing, giving them immediate access to gear, say in the morning isn't going to address many of the problems unless the addict is thieving and causing crime and the like to get just one hit a day......I assume many addicts take multiple hits a day and then use other substances to excess inbetween, whether this be alcohol, prescribed drugs, hash whatever. So unless we give them hits on demand they are still going to cause crime to fund the other things they do
I could possibly get on board with funding centres where addicts reside for an amount of time say 6 month and are administered gear but are then are kept in the centre so other substances don't come into play and slowly ween them off that way along with counselling so hopefully they don't just get back into the cycle upon release.
My suggestion would probably cost more ( but I could live with that)
however in the longer term they may have a better recovery rate. It gets them out of the everyday circle of friends doing the same stuff, stops all the crime that they personally would commit not just possibly lower it like one hit a day would do and also get them away from all the other shit they are pumping into their body in addition to the heroin
Security wise it would have to be run like a prison on the perimeter but inside wouldn't have to be anywhere near as regimented or strict and run courses and the like during the day so those with little to no skills have have half a chance of finding a job afterwards rather that falling straight back in with previous associates and the possibility of the cycle repeating

 

[pavarotti1980]

I've not said there isn't an alternative. My question, as yet unanswered by anyone is do you give someone as much heroin as they want? You are indeed being naïve if you think that currently, people on methadone don't also take heroin. Many if not most, do. Any pretty much anything else they can get their hands on to boot. Rarely is their a drugs death these days where the toxicology reports don't show a mixture of prescription and controlled drugs.
So, once again, if someone says they're doing 6-7 bags a day and so you replicate that with prescription heroin, apart from anything else, you've an institution that's open 24/7 with people lying around intoxicated who come round and demand their next hit.
As soon as you say they've had their allowance and have to leave, they're off to buy some elsewhere or get some subbies , gabapentin , spice, vallium etc etc etc. to take the edge off until they can start again the next day.
I happen to think that's not a viable alternative.

I think you should have a read of my previous comments which clearly state that addicts who are on methadone also take heroin as to top up due to their tolerance levels or need to constant hits (delete as appropriate). ps for @Some Random Guy i have seen and heard patients talking about it whilst collecting methadone, psychiatric meds (i was on the professional side of the counter )

For some results have a look at the brief summary which was handily linked by @Lankester Merrin which details the trial which had one study location in Darlington to counteract that planned care can work. Results indicated that whilst receiving their prescribed diamorphine or IV/oral methadone a lot werent getting additional hits on the street.

https://www.kcl.ac.uk/ioppn/depts/addictions/research/drugs/riott.aspx

To replicate their heroin street use they would ascertain the amount they take a day, and give them an approximate dose which can be easily titrated up or down depending on response, this is already done with methadone and replicated across almost every speciality of healthcare. Its just basic medicine and conversion charts between opiates is already available. Add into that the use of clean aseptic technique when adminsitering, different site and method of administration to include fluids such as sodium chloride or glucose etc etc and it becomes more of a clinical procedure.

It is a clinically proven alternative, im not sure why you think you would know better than the clinicians involved in the study with demonstrable evidence apart from the fact it may see reductions in crime.

 

[the boot]

They're not successful anymore, that's the point. There are countless people who have stable lives with good jobs and family who end up getting hooked on painkillers after a surgery or an accident, for example.

Not heroin though.

Again, you haven't read the article in the op. Other countries that have a model like this have see. reductions in the number of addicts.

It's supply and demand.

Why as a dealer would you prioritise heroin if your traditional customer base is f***ing off to a clinic every day?

There would be less demand and therefore supply would decline, meaning there's less opportunity for new addicts.

Again I did read it. So what your saying is no one will ever want to buy heroin again from the black market as they are given it free once these new ideas are put in place? Already the op and other posters have said a lot of people die from cross contamination of needles. Even though they are given out free?
Pain killers are given free Plenty of addicts buy them
Viagra is free but people buy them
Sleepers is one of the biggest sellers free on NHS.

Like many things in life it's a problem we just gotta put up with. Let them take there chances in the open market.
Why should I fund free smack.
Before ya say anything I know in a way I find them anyway, recovery, crime, treatment etc. But let's not make it easy.

 

[Sir Lancelot]

I’m not sure that residential centres would work in the long term. Look at prisons where inmates are weaned off drugs and then put back onto them before they are released, as they will go back into the same circumstances from which they were imprisoned. If they try taking the same level of drugs as they did on admission they would overdose, so they have to build up their tolerance again before leaving prison.

I’m not sure there is a simple solution, you could legalise all drugs to reduce the illicit thrill side of it, and hope that might bring some reduction in use. You could make them freely available like alcohol and tobacco, to try to drive out the dealers and criminal aspects, but people still smuggle alcohol and tobacco.

Or we, as a society could just stand back, legalise drugs and treat only those who actively seek help to reduce their dependence, in the same way that we help people to stop smoking.

 

[pavarotti1980]

I’m not sure that residential centres would work in the long term. Look at prisons where inmates are weaned off drugs and then put back onto them before they are released, as they will go back into the same circumstances from which they were imprisoned. If they try taking the same level of drugs as they did on admission they would overdose, so they have to build up their tolerance again before leaving prison.

Are we talking about ordinary prescription drugs here or drugs for dependance i.e. methadone/buprenorphine?

 

[Lonz]

Not heroin though.


Again I did read it. So what your saying is no one will ever want to buy heroin again from the black market as they are given it free once these new ideas are put in place? Already the op and other posters have said a lot of people die from cross contamination of needles. Even though they are given out free?
Pain killers are given free Plenty of addicts buy them
Viagra is free but people buy them
Sleepers is one of the biggest sellers free on NHS.

Like many things in life it's a problem we just gotta put up with. Let them take there chances in the open market.
Why should I fund free smack.
Before ya say anything I know in a way I find them anyway, recovery, crime, treatment etc. But let's not make it easy.

if you're ultimately of the view point of "fuck em" if someone falls into that vicious cycle then there's likely nothing anyone can say to change their mind. Even you spell out that it's actually going to save money (as the evidence abroad suggests)

In which case you have to look at how doctors prescribe painkillers and all the miriad of other numbing drugs for both mind and body they seem to hand out like confetti and for how long.

Absolutely, I 100% agree. But that doesn't solve the heroin problem. Or are you just suggesting we let them all die because it's their own fault?

 

[the boot]

Not wanting to get in a long winded argument (I'm going to ) but the evidence suggests that when heroin is made safer to access (e.g. Safe injecting sites, needle exchanges) then deaths fall and there is no increase in injection rates.

I wouldn't inject heroin, nor would 99% of people and that's because they don't want to inject a drug into their body which harms them and sends them out their mind. Some people do want to do that and unfortunately some will do it no matter what we try to do.

You raise a good point regarding alcohol and smoking. However there's very good reason to think that the reason the consumption of these is so high is because of their availability, their cost and the fact they're normalised in society. Before the New Psychoactive Substances Act 1p-LSD was legal and cheap- how many people took it? Barely any, because most people have no interest in taking LSD or an analogue of it.

So returning to the issue of heroin - if what someone suggested was "legalisation" whereby heroin could be advertised and sold in shops etc. Then they're bonkers imo.

What you need is a system of regulation suitable for the drug. In the case of heroin there's good clinical evidence to suggest prescribing heroin to addicts is the best policy (which we did in the 1920's, it's not a new idea). Methadone can be helpful but unfortunately for many heroin users it just isn't enough - and as a result they supplement it with benzodiazepines; usually temazepam which is more likely to create an overdose than heroin itself.

Case study would be Portugal. Portugal didn't prescribe heroin but what they did do in circa 2001 was decriminalise all possession offences for drugs and treat it as a health issue. They also invested more in needle exchanges and educating heroin users about safer practice. The result was a 50% reduction in new HIV rates amongst injecting drug users and a 50% (I think!) reduction in rates of heroin injection. There was an increase in the consumption of cannabis, however.

In the last year in the U.K. we had the highest rate of drug deaths since records began. The majority of those (circa 80%) were from problematic drug users (eg crack cocaine/ heroin addicts). This year already there have been twice as many fentanyl deaths as there was the year prior. Fentanyl has absolutely devastated parts of the US and Canada and regrettably the evidence suggests synthetic fentanyls are making their way over here. We need to start thinking radically about how we can save people's lives or thousands of people will die.

The evidence from around the world suggests that simple abstentionist policies do little to save lives and what is needed is a pragmatic harm reduction approach. This needs to be multifaceted and would include: greater access to needle exchanges, not just exchanging needles but giving them out more easily, safe injection sites, giving heroin users naloxone and training them how to use it, providing up to date information on dangerous batches of heroin found (eg ones with fentanyls), and ultimately, imo, prescribing heroin. But the current system is not working.

For anyone interested in a really good paper on why in practice a lot of the policies which are advocated don't help heroin users the righteous dopefiend by Phillipe bourgeois is really good. It's both a book and also a shorter version in a paper but it is seriously worth reading.

Ok as you rightly say about smoking and drinking been normalised and legal. Which is my argument against normalising smack and making it legal possession wise, although no need to possess as why would someone posses it if they are getting it free.

The needle exchanges throughout the country also offer a safe space to take heroine but have simple rules. The one in Sunderland as these facilities but people break these simple rules. I.e. Clean up, be sick in provided containers, don't be horrible to staff. Just a few simple rules. 90% of their customers fail.

That's why the government won't take it further. Watch Stacey Dooley on drugs, whatcha cape cods heroin programme. They can't turn up for the methadone course which is always backed up with a suspended sentence or probation.

 

[Sir Lancelot]

Are we talking about ordinary prescription drugs here or drugs for dependance i.e. methadone/buprenorphine?

Why would you need methadone if people can buy the real thing on the high street? Methadone is a substitute for the real thing. It’s like buying Asda coke instead of Pepsi.

 

[the boot]

I’m not sure that residential centres would work in the long term. Look at prisons where inmates are weaned off drugs and then put back onto them before they are released, as they will go back into the same circumstances from which they were imprisoned. If they try taking the same level of drugs as they did on admission they would overdose, so they have to build up their tolerance again before leaving prison.

I’m not sure there is a simple solution, you could legalise all drugs to reduce the illicit thrill side of it, and hope that might bring some reduction in use. You could make them freely available like alcohol and tobacco, to try to drive out the dealers and criminal aspects, but people still smuggle alcohol and tobacco.

Or we, as a society could just stand back, legalise drugs and treat only those who actively seek help to reduce their dependence, in the same way that we help people to stop smoking.

Fantastic post. Tip of the hat to you sir.

 

[pavarotti1980]

Why would you need methadone if people can buy the real thing on the high street? Methadone is a substitute for the real thing. It’s like buying Asda coke instead of Pepsi.

because in prison they have a methadone programme and they definitely do not bump up there dose prior to release.

Heroin and methadone are different in terms of half life, duration of action and methadone has less withdrawl problems

 

[Some Random Guy]

Again I did read it. So what your saying is no one will ever want to buy heroin again from the black market as they are given it free once these new ideas are put in place?

No, not at all. Why you would think that after reading the thread is a mystery to me given that it's been said more than once it's reducing take up (and the relating costs).

It's not a magic wand, it's harm reduction.

Already the op and other posters have said a lot of people die from cross contamination of needles. Even thoughthey are given out free?

I am the op.

A lot do catch infections through cross contamination. It's massively lower than when we didn't. It's not a silver bullet though.

Pain killers are given free Plenty of addicts buy them
Viagra is free but people buy them
Sleepers is one of the biggest sellers free on NHS.

I'm not sure what your point is here, nobody is claiming the market will disappear completely.

Many start by becoming addicted to prescribed medication. Opioid addiction in the states is massive because of the way things like Oxycotin was prescribed.

Viagra is a whole other kettle of fish things like embarrassment, a condition that would make it too risky to prescribe play their part.

Why should I fund free smack.
Before ya say anything I know in a way I find them anyway, recovery, crime, treatment etc. But let's not make it easy.

You accept we already pay for it. Great.

I would argue we would be making it easier for us by funding it. Through not getting burgled, or mugged, by not clogging up a disproportionate amount of emergency services, we could actually put public service money to better use.

 

[Some Random Guy]

@Some Random Guy i have seen and heard patients talking about it whilst collecting methadone, psychiatric meds (i was on the professional side of the counter )

I'm not claiming it doesn't happen, I think our current system is shit. I've got a similar position to @Frijj on the commissioning.

I'm after a source that shows many, "if not most people" in the service are still using the real stuff.

No offense to yourself intended when I say anecdotal information from yourself doesn't cut it. That's barely a case study.

Frankly if they are isn't it showing that what were doing now isn't working and a radical shift is needed?

 

[pavarotti1980]

I'm not claiming it doesn't happen, I think our current system is shit. I've got a similar position to @Frijj on the commissioning.

I'm after a source that shows many, "if not most people" in the service are still using the real stuff.

No offense to yourself intended when I say anecdotal information from yourself doesn't cut it. That's barely a case study.

Frankly if they are isn't it showing that what were doing now isn't working and a radical shift is needed?

Well its not anecdotal per se, but professional experience. although i certainly wont say "if not most" though