This Just In: Heroin Addicts Like Heroin

Jacob Sullum | August 21, 2009

A Canadian study reported in the New England Journal of Medicine this week found that "injectable diacetylmorphine was more effective than oral methadone" as "a treatment for chronic, relapsing opioid dependence." Specifically, "the rate of retention in addiction treatment in the diacetylmorphine group was 87.8%, as compared with 54.1% in the methadone group," while "the reduction in rates of illicit-drug use or other illegal activity was 67.0% in the diacetylmorphine group and 47.7% in the methadone group."

Stripped of the medicalese, what the researchers found is that if you give heroin addicts heroin, they will keep coming back for more. They will also be less likely to buy heroin on the street or commit crimes to support their habit. These findings, similar to the results of European studies, are not exactly surprising. The puzzling thing is that we're asked to pretend that heroin is a "treatment" for heroin addiction. "Study Backs Heroin to Treat Addiction," says the headline over a New York Times story that begins, "The safest and most effective treatment for hard-core heroin addicts who fail to control their habit using methadone or other treatments may be their drug of choice, in prescription form."

What the study actually shows is that the problems associated with heroin addiction are largely caused by prohibition, which creates a black market in which prices are artificially high, quality is unreliable, and obtaining the drug means risking arrest and associating with possibly violent criminals. The drug laws also encourage injection by making heroin much more expensive that it would otherwise be and foster unsanitary, disease-spreading injection practices by treating syringes and needles as illegal drug paraphernalia. When you take these dangers out of the equation, regular use of heroin is safe enough that it can qualify as a "treatment" dispensed by men in white coats. That rather startling fact should cause people to question not just current addiction treatment practices but the morality of trying to save people from themselves by making their lives miserable.

For more on "the surprising truth about heroin and addiction," see my June 2003 Reason article.

Comments

|8.21.09 @ 11:35AM|#

It would be nice to have a real factual debate about what the effects of heroin use are. So these junkies are getting their fix. Are they still able to work? Do they still function in society? Does it radically reduce their lifespan? If not and they can pay their own freight, why should I or anyone else care what they are doing?

|8.21.09 @ 11:35AM|#

Think I'll stick with my vicodin thanks. Opioids are too scary.

|8.21.09 @ 11:40AM|#

...Vicodin is an opioid.

Rick H.|8.21.09 @ 11:49AM|#

John: many, many junkies have an insane work ethic, and are able to hold down one or more steady jobs while simultaneously managing the fulltime 24-7 career of constantly trying to score on the black market. In my, er, observation, your average dope fiend puts in far more focused, dedicated labor per week than a comparable "civilian."

|8.21.09 @ 11:54AM|#

Nice visual shout-out to The Man With The Golden Arm. Some of Johnny Fontane's best work.

TallDave|8.21.09 @ 11:59AM|#

In other shocking news, scientists have discovered hunger can be treated with food.

|8.21.09 @ 12:00PM|#

I have learned to control my addiction to tobacco by smoking.

|8.21.09 @ 12:07PM|#

SugarFree,

You're not suggesting that Sinatra was the inspiration for Johnny Fontane, are you? Why, why, that would mean that Ol' Blue Eyes had serious mob connections!

|8.21.09 @ 12:15PM|#

"With his olive oil voice and guinea charm..."

Tricky Prickears|8.21.09 @ 12:21PM|#

My understanding is that heroin addicts actually prefer oxy Contin. Consistent purity. The brand name is water soluble, but the generic contains gelatin fillers which requires a filtration process.

But they've been prescribing Heroin in Switzerland for years now. There should be no doubt. Besides, there actually is a cure for opiate addiction.

http://www.lancegooberman.com/

Good guy. I met him once.

|8.21.09 @ 12:23PM|#

Rumor was Frank about had a hit put out on Copola over that movie. He was not amused.

|8.21.09 @ 12:29PM|#

John,

That's a myth. What really did happen was that Coppola was given an offer that he couldn't refuse and was later forced to stop making good movies. It's a sad story, really. Sinatra's revenge also has something to do with why Nick Coppola keeps making bad movies.

|8.21.09 @ 12:29PM|#

My pain management doc has given me Oxy twice after having discograms. I was in agonizing pain that vicodin wouldn't even dent. The oxy made me as pain free as I have been for years.
Interestingly, I notice no "high" from vicodin or Oxy. Demerol, on the other hand, makes me fucked upper than cooter brown but doesn't do shit for my back pain.

qwerty|8.21.09 @ 12:35PM|#

"This Just In: Heroin Addicts Like Heroin"

Hahaha! Awesome title for a story.

Tomcat1066|8.21.09 @ 12:56PM|#

Demerol, on the other hand, makes me fucked upper than cooter brown but doesn't do shit for my back pain.

Maybe if you get high enough, you just won't give a shit that you're hurting ;)

Robert|8.21.09 @ 12:56PM|#

It would be nice to have a real factual debate about what the effects of heroin use are. So these junkies are getting their fix. Are they still able to work? Do they still function in society? Does it radically reduce their lifespan?

There's no basis for such a debate. These things are well established. What you want is publicity, not debate, because the only "factual debate" you could have would be a worthless one between somebody telling the truth and somebody lying. (Or maybe an even more worthless one between 2 people telling different lies.)

If not and they can pay their own freight, why should I or anyone else care what they are doing?
Well now, see that's the actual possible debating ground, but not a very factual one.

Robert|8.21.09 @ 1:00PM|#

Seems I put tags in the wrong places, so I'm trying to close it before it hurts somebody.

Robert|8.21.09 @ 1:02PM|#

So close already!

Ben|8.21.09 @ 1:10PM|#

Do the docs give you enough to nod off? If not, they may not exactly be on the same page with the addicts here.

Tim|8.21.09 @ 1:19PM|#

...Vicodin is an opioid.

Not only that, it contains acetaminophen, which is rally scary.

Tim|8.21.09 @ 1:22PM|#

It would be nice to have a real factual debate about what the effects of heroin use are.

It is just an acetylated form of morphine, which is somewhat more fat soluble, which enables it to pass through the blood brain barrier faster, causing a quicker onset, more potent but shorter acting effect.

|8.21.09 @ 2:21PM|#

So...if your a sex addict...and they give you free poontang - wouldn't that reduce prostitution, venereal disease, pimping, and boneritis?
just trying to protect the pubic health...

LarryA|8.21.09 @ 3:13PM|#

It would be nice to have a real factual debate about what the effects of heroin use are.

Offhand I can think of at least a dozen such debates we need. Unfortunately that would require a two-party political system, with two parties that were actually different.

Robert|8.21.09 @ 3:52PM|#

Political parties are not for debating.

jasno|8.21.09 @ 5:21PM|#

I don't speak from experience, but I've spoken to a friend about his experiences with opiods. This is all based on that conversation so take it with a grain of salt.

Most heroin users are in the maintenance phase - they're using enough to keep the shakes away. Opiate withdrawl is like getting the flu, and a hangover, multiplied by some large number. You gain tolerance fairly quickly, so you either keep increasing your dose until you're dead, or you go into maintenance. When you're in maintenance, you do get high, but only briefly. After that, you can resume your life as normal for a while.

I think what this study is getting at is - when you're a heroin addict in treatment, and they're giving you something to stop the withdrawl(the dose is gradually brought down), you might as well do heroin, because, hey, maybe you'll enjoy it enough to stick around treatment.

Incidentally, one of the places to find heroin dealers is at a methadone clinic. They like to prey on people going through treatment.

Also, methadone is still an opiate, and you still can't get off it cold turkey, and you can become addicted to it as well.

Opiates are fucked up drugs. They all start out feeling like heaven, but then that feeling fades and you're trapped.

Urkobold™|8.21.09 @ 5:25PM|#

"Political parties are not for debating."

RIGHT YOU ARE, BOB. THEY'RE FOR DELIBERBATING.

EscapedWestOfTheBigMuddy|8.21.09 @ 6:37PM|#

Opioids are effective, enormously safe to use, easy to develop a tolerance to, and highly dependency forming.

But their addictive potential varies considerably from person to person and depends on how you're using them. Folks who use them for genuine pain control rarely become addicted. Though they can expect to become tolerant and dependent. Getting off, or even switching from one opioid to another means either a slow titration or suffering chills, sweats, digestive upset, etc...

When used at a regular just-enough-to-control-the-pain level (for even fairly serious levels of pain), they leave the patient lucid and able be fully functional in real life.

But the really important thing to note here is that dependency is a biochemical effect (as are the consequent withdraw symptoms), but addiction is psychological. There are often correlated, but they are not the same thing. Dependence ends when detox is over. Addiction continues because it lives in the mid of the addict.

Pain patients who need opioids should have them, and need not be frightened of them.

The drug warriors constantly (and so far as I can tell intentionally) conflate the dependency and addiction, so a steady education campaign is needed.

For the Love of IVey...|8.21.09 @ 7:40PM|#

Opiates are fucked up drugs.

No.They're very useful and, for quite a few people, lots of fun.
Personally,I find the actual flu to be worse than stopping regular narcotic analgesic use.
Might be my metabolism though.

|8.21.09 @ 10:58PM|#

...but the morality of trying to save people from themselves by making their lives miserable.

Of course it is moral, people must suffer so they will be GOOD. The LORD says they will suffer for eternity if they aren't GOOD, so what is a little suffering now?

|8.21.09 @ 11:45PM|#

"No.They're very useful..."

When I had meningitis I experienced head and neck pain like I have never experienced pain. I couldn't keep any pain killers in the form of pills down, so I was given morphine. It worked like a charm! I can also say, that I understand completely how someone could get used to that. For me, I just felt a bit of a burning sensation in my arm and then BAM, it hit my head and I disappeared along with the pain. It was very useful pour moi!

B|8.22.09 @ 2:16AM|#

And naturally, the taxpayer would be called upon to subsidize a fuckups drug habit, albeit in prescription form.

EscapedWestOfTheBigMuddy|8.22.09 @ 1:39PM|#

B,

Have you any idea how cheap most opioids are?

Were talking about medium sized methadone running less than most name-brand OTC analgesics.

Seriously. Even in the current, highly regulated schedule II market, it is barely worth charging for the stuff.

Of course, the FDA and the DEA are actively encouraging the use of less safe, more expensive alternatives like Oxycotin. Thanks, guys. Thanks a lot.

EscapedWestOfTheBigMuddy|8.22.09 @ 1:41PM|#

Er...which does not detract from the principle of your point, of course.

But if we have to subsidize something, it might as well be something easy to pay for.

|8.25.09 @ 2:02AM|#

"Opiates are fucked up drugs."

I have a multitude of post-op patients that would strongly diasgree with you.

If I performed a surgical procedure on you, even laparoscopic, such as a cholecytectomy (excision of the gall bladder) which is roughly the equivalent of playing ping pong and cut and paste with your viscerae, I'm pretty damn sure you would want something to relieve that pain.

EWOTBM

Excellent post, could'nt have said it better myself.

Vicodin Rehab|11.4.09 @ 2:02AM|#

It's good to see someone who doesn't underestimate the power of Vicodin. Just because it comes in pill form, and is prescribed by a doctor doesn't make it any less dangerous that street drugs. Vicodin addiction treatment shares a lot in common with heroin rehab for a reason!

chris s|11.22.09 @ 7:33PM|#

why not just stop using all together? sobriety is the answer. http://www.soberliving.com