Did you see the movie "Traffic?" Did you think it was an accurate representation of the American drug problem? Should the "War on Drugs" continue? If not, what alternative would you propose for dealing with the problem of drug abuse?

-- Anonymous, January 17, 2001

Answers

legalize them all.

drastic, I know. but it's how I feel. addiction should be a problem for rehab, not jail.

-- Anonymous, January 17, 2001

While I wholeheartedly agree that most drugs should be legalized, the truth is it will never, ever happen unless the ENTIRE world legalizes it. Think of the consequences to other nations were we to legalize drugs. The smuggling that would occur would tax the abilities of most other nations to police their borders for drugs and deal with the obvious social impact. The U.S. legalizing drugs would seriously damage our standing in the global economy.

-- Anonymous, January 17, 2001

So, do you guys who support legalization support age restrictions for drug use? Because most addicts start using drugs as teenagers, and I would argue that many teens and pre-teens aren't mature enough to make informed decisions about drug use.

Another reality to contend with is that drug rehab does not work for most people. This is a very active field of public health research, but little progress has been made. Only about 15% of people who go through U.S. drug treatment centers are still off drugs one year later. Some centers have higher success rates than others, but even the best centers only seem to have about 50% success after one year-- and who knows what will happen after that one year? At this time, the technology simply does not exist for reliably curing drug addiction.

In light of this, it seems that legalizing drugs and making them more widely available would worsen the drug problem.

I honestly don't know what the solution is, since restricting the flow of drugs into the country is clearly not working out, nor is anti- drug education.

-- Anonymous, January 17, 2001

Good point, Jen. I realize that the laws governing the age of cigarettes aren't working that well, because we've all seen the fifteen year olds smoking behind convienance stores.

But I would definately go for no drugs before the age of 18. But once you hit 18, you should be allowed to do whatever you want. (Within reason - no driving while under the influence, etc.)

At the very least it would (theoretically) lower crime rates (no junkies robbing places to get their next fix), make the glam life of the drug dealer non-existant (you can get your drugs at the local seven eleven), make money for the gov't (mad taxes), and make the drugs themselves more pure and less likely to kill you from something you didn't expect (gov't regulations).

Just my ideas, though.

I liked Todd's point that it would be tough for the whole world.. but what other country has the same (or similar) drug laws as here? (I'm honestly curious. I don't know.)

-- Anonymous, January 17, 2001

Emily wrote:

But once you hit 18, you should be allowed to do whatever you want.

See, this is what I have a problem with. By making drugs legal, the government would be legitimizing them. The government is seen as having some responsibility for maintaining public safety. We have laws against putting known human carcinogenic agents in foods, against dangerous workplace conditions, and in some states, laws requiring the wearing of seatbelts. If I tried to sell a food product containing low levels of carcinogenic material, even if the people who bought it had full knowledge of the danger, I would be breaking the law. I've heard dozens of people justify their tobacco smoking habits by saying "if it was really so bad for you, it would be illegal." If drugs are legalized, will people rationalize their drug use by saying "if heroin is really so bad for you, why did they legalize it?"

Making drugs easier to get and more cheaply available seems likely to lead to more widespread drug use, which would lead to more widespread drug addiction. Drug addiction is a serious public health problem, and it affects not just users, but everyone who comes in contact with them.

One might say that our society functions reasonably well despite the hefty number of alcoholics in our midst, but I wonder how different things would be if we lived in an alcohol-free society. Alcoholics are more likely to abuse their children, to lose their jobs, to wind up in prison, and to get divorced than non-alcoholics. It's obviously too late for us to turn back the tide and prohibit alcohol--alcohol use is too deeply engrained in our society. I'm not sure if this is also true of cocaine, heroin, et al., but if these drugs were ever legalized, there would definitely be no turning back.

-- Anonymous, January 17, 2001

Cory asked:

1) Would the population of abusers become substantially larger, or would the current population of substance abusers simply increase with a small subset? This I don't know.

2) And, so what of it? Would the population of new legal drug users be worse to manage than a population of alcoholics, and furthermore would it really be worse than the drug problems we have now?

I do think that legalizing access to drugs such as heroin and cocaine would lead to a more widespread addiction problem in our society, for a few different reasons. For one thing, heroin and cocaine are more addictive than alcohol, so people who are not at risk for addiction to alcohol would be at greater risk with these other drugs. Also, addiction to cocaine and heroin tends to set in more quickly than with alcohol (with alcohol abuse, there is typically a period of months or years during which drinking becomes a problem, whereas heroin and cocaine addicts can develop their addictions within days or weeks). Greater exposure to more addictive drugs would most likely lead to a greater number of addicts.

I can't answer your question about whether cocaine/heroin addiction is "worse" than alcoholism. Alcoholics do tend to be more successful at maintaining a high level of functionality despite their addiction, but I guess you can't really say how much of that is due to the fact that alcohol is easily and legally available, and because alcohol addiction is more socially acceptable than illegal drug addiction. But my overall point is that more drugs will lead to more opportunities for addiction. We have legitimized alcohol in our society, and we have a major alcohol-addiction problem.

According to admittedly-somewhat-fuzzy government statistics there are currently about 500,000 heroin "addicts" in the U.S., 600,000 cocaine addicts, and about 10.5 million alcoholics. Heroin and cocaine are both more addictive than alcohol, but there are 20 times as many alcohol addicts in this country as there are heroin or cocaine addicts! As far as I can see, the only reason for this is the fact that heroin and cocaine are illegal and somewhat difficult for many people to acquire and alcohol is legal and easy for most people to acquire.

4) We can't save individuals from their own willful acts. Let's admit it. But there's a lot we can do to cut the legs and arms of our current drug problems and put all our efforts into treatment, and treatment centers.

Well, as I said before, treatment simply doesn't work for most people. It's not a matter of throwing more money at the problem, either. Look at a millionaire like Robert Downey, Jr., who has access to the best possible treatment, yet still can't kick his addiction. I do think that some individuals can be saved from "their own willful acts" with education, and I don't think that addiction should be shrugged off as the prerogative of the addict.

The government being responsible for public safety is an interesting question. I think it might be possible for the government to control the market of illegal substances (if in this case, there are no distribution centers) by careful application of the law.

Well, the more the government regulates the drug trade, the greater the aura of legitimacy it creates, and I do believe that that legitimacy would affect the attitude people have towards drugs.

Anyway, I think that it's pretty crazy to think that if you can't stop drugs from getting past our guarded national borders, you're going to be able to do anything about enforcing pricing and distribution laws.

-- Anonymous, January 17, 2001

Cory wrote:

Treatment centers are for those wanting treatment. If treatment fails (as you suggest), controlled distribution is their other option. What is the option right now? Pretty dire isn't it?

Well, how would their options be any better in a society where drugs were legal? Most addicts are not able to hold down jobs, because they have a physiological need to have drugs in their system at all times. Addiction also has a devastating effect on relationships with family and friends. It's likely that many of these addicts will end up homeless, friendless, and without any means to buy drugs unless they turn to crime (with drugs like heroin, tolerance develops very quickly, so addicts need to take more and more drug all the time just to feel "normal." I don't see how an unemployed person could financially maintain a heroin habit unless the drugs were free).

What you are proposing sounds a lot like current methadone programs, in which heroin addicts are given free doses of a less potent opiate, methadone, in order to abate their heroin cravings. People on methadone treatment typically remain unemployable (67% are unemployed, according to a federal study), and thus rely on public assistance, handouts, or crime for their livelihood.

Granted, not all addicts will face a total life collapse, but it does happen now with many alcoholics, and as I said before, I think that legalization would probably lead to a dramatic increase in the number of people with addiction problems. I don't see how you can dismiss outright the idea that addiction will increase when people have greater exposure to drugs that are thousands of times more addictive than alcohol. What is your basis for making this judgement, other than your own gut feeling?

As to the question of government legitimacy -- we also should consider the equally possible lure of having created the desirous 'forbidden fruit' among the same naive and unthinking masses that, by your statement, must think in aphorisms.

Well, I don't think the government is in the business of using psychology to try and manipulate people with the laws they pass. the point I was making has to do with ethics, not with manipulation. I don't see how the government can morally oversee the distribution of drugs which are known to be deadly and highly addictive. Doing so would destroy the government's credibility on public health issues.

-- Anonymous, January 18, 2001

Cory wrote:

Granted, if going to prison for drug use is better than staying in society.

Well, I'm not so sure that many of these people would stay out of prison even if drugs were legalized. As I pointed out earlier, as long as drugs cost money, addicts, who are largely unemployable, will have to somehow scrounge up money to buy them. Also, many drugs can affect judgement and cause a sense of invincibility (cocaine, heroin) or can cause normally calm people to engage in violent or aggressive behavior (amphetamines, PCP). These behavioral changes are the root cause of much drug-related crime, and would not disappear if drugs were legalized.

There's all sorts of questions I could ask here, such as how employable was this population before drug use? Is this mostly a group of highly employable doctors and lawyers, who've gotten the monkey on their back recently, or a collection of high school drop-outs, felons (for other crimes), runaways, minorities, and maybe a few wayward college kids 2 years short of degree?

Addicts come from all walks of life, and even if the majority were dropouts, felons, etc., such people are not unemployable. In contrast, most hard-core drug addicts are inherently unemployable, because they are under the influence of drugs which affect their personality, judgement, and cognitive processes.

Third, assuming you're aptly demonstrating the failure of some legalized treatment, you're failing to suggest what option is left when recidivism is as high as 85% after one year, and there is no where left to turn -- no controlled legal drug use, so it must be prison or the streets as the best option?

The point I'm trying to make is that once someone is addicted to drugs, there is little hope of rehabilitating them and ever making them a productive member of society. However, if people never try drugs in the first place, they have a 100% chance of avoiding addiction! It seems to me that the most effective course to pursue is to try and keep as many people in the "never tried drugs" bracket as possible. I agree that prison and the street are not good options, but controlled legal drug use has been tried (in Britain), and doesn't seem to work particularly well, either.

Do methadone clinics really create a climate for new addicts? Because (as you suggest) what I'm proposing is very similar. Does a methadone clinic have the appeal of an all night rave with glitter balls? Have you felt the lure walking past one?

Well, there is a substantive difference in the way methadone is given in treatment clinics--it is given in low doses that stay in the body for long periods of time, whereas recreational heroin users typically inject a large bolus of drug at a time to achieve a transient "high." So, there is no reason for recreational drug users to get methadone from a clinic (plus, you need a prescription to get it).

In contrast, if recreational drug users could go to a government-run center and buy as much drug as they want (by claiming to be addicts), I'm sure some would go, get their drugs, and then go do whatever they wanted wherever they wanted. You also mention restricting this drug sale to "addicts," but what would you propose for dealing with non- addictive illegal drugs such as marijuana, ecstasy, LSD, PCP, etc. Would these drugs remain illegal?

Well heart medications, for one, are dangerous. The VA gives my 84 y/o dad a medication capable of stroke, arthymias, or even death.

Yes, all drugs can be dangerous, which is why we have the FDA to regulate their use. The primary consideration in FDA drug approval is whether a drug's side effects are tolerable given the overall health benefit of the drug. If a drug is found to have significant risk, it is issued to patients only with the permission of a physician. Cocaine and many opiates actually are used in hospitals as analgesic and therapeutic agents, but in people who do not suffer from chronic pain these drugs have no health benefit, and many risks.

-- Anonymous, January 18, 2001

Yes, but can we assume everyone is not employable?

Well, we don't need to "assume" that ALL drug addicts are unemployable in order to see the burden they place on society. My statements about the unemployability of drug addicts are not based on assumptions--the statistics are very clear that the majority of addicts are not able to hold down jobs. Drug addiction turns people who might otherwise be productive members of society into burdens on society.

As does alcohol [affect judgement and mood]. These people can even work non-critical jobs while under milder doses.

Well, experience shows that most people are not able to do their jobs competently while under the influence of high doses of alcohol or other mind-altering drugs.

Furthermore, I'm not sure some of the more severe effects of Heroin and Amphetamines, couldn't be treated with some other combination of legal and currently illegal drugs, that would both satisfy the user and subdue the worst of typical ill effects if authorities were allowed to legally use them.

Well, as I said in my previous post, heroin addiction has been treated widely in this country with methadone and with prescription heroin in Britain for more than thirty years. The British policy has had little effect on changing the number of heroin addicts, and on increasing employment or decreasing criminal behavior among addicts (many references on this topic can be found here. In addition, a black market for heroin still exists in Britain, and street prices for heroin there are the same as those in the U.S. There is no pharmacologic treatment for amphetamine addiction currently available that I know of.

Well, I ask you as a trained scientist (or as an objective individual)? Do you really think all the data is in on any variation of legalization as a solution?

No, which is exactly why I would advocate extreme caution in making changes to our drug policy. Any policy that runs the risk of creating more addicts should be carefully investigated before being implemented.

What if the director of your lab wants you to pursue a solution to a problem in the tradition of true scientific methodology, and indicates, in effect, that he will afford you massive resources to reach that solution -- but regardless of the slightest potential for success -- you are not to pursue certain paths to a solution? Not because, the variables of a complex social phenomena have been explored with a scientific method ruling out the potential usefulness of such an approach, but because preliminary results, with these studies with narrow goals have been tried -- and she's just fairly certain -- you will fail.

I think you are misunderstanding me badly. I think that experimental legalization of drugs is a bad idea because there are strong indicators that it would many people at risk of addiction who would otherwise not be. Furthermore, it has been shown in many countries in results that are far from preliminary that legalization does little to improve the quality of life of addicts.

So, even if my lab director wanted to do such an experiment, it would be illegal (as well as unconscionable) to put so many people at risk.

I doubt we'll ever stop recreational users of any drug. Clinics and distribution centers don't service recreational users. But they do serve to cut the income of the dealer, and the cycle of the whole organized drug distribution system undercutting the prices drug distributors want.

The British system would dispute this prediction.

I don't really see how your proposal would constitute a substantial improvement in the drug problem in any way. The British heroin clinics have shown that legalization doesn't solve the problem of illegal activity or unemployment among addicts, nor does it eliminate the black market for drugs. Casual drug users would have easier access to pure drugs, leading to a higher rate of addiction (it has been shown repeatedly in every organism from fruitflies on up that the more times you use an addictive drug, the more likely you are to get addicted). And I suspect that non-users would also be tempted to try out drugs in this sort of safe, legal setting, as well (your suggestion about giving users drug tests is not only impractically expensive and time- consuming, but it would also not be a good indicator of addiction. You can take cocaine every day and not be an addict, and you can be an addict and go for years without taking it).

But in general, drug use shouldn't put you in jail, though crimes you commit while on drugs or for that matter while not on drugs, should.

This type of policy recently went into effect here in CA. It will be interesting to see how it turns out. I actually voted for this proposition, because I strongly support decriminalization of addiction. However, I don't think that making drugs more widely available through government distribution is necessarily the right way to deal with the current addict population.

-- Anonymous, January 19, 2001

I also found evidence that heroin addicts of a certain classes did indeed function in society in Britain through 1920's to 1960's while being given "regular and stable" doses.

Yes, this is what the Hartnoll article states, although it is not backed up by any evidence, nor even a definition of what constitutes "functioning in society." I wasn't able to find any data on heroin maintenance outcomes pre-1970, but currently, unemployment among those in the maintenance program is about 50% (it was about 5% for the general British population).

Furthermore, while heroin maintenance does seem to cause a small decrease in criminal behavior, it is hardly anything to cheer about. In this article, the authors state that 50% of heroin maintenance patients in a study conducted between 1972 and 1976 were convicted of a crime during a single year of the study, as opposed to 70% of patients being treated with methadone.

This article states that only one random design outcome study has actually been done on the British system, "Hartnoll et al. (1980) randomly assigned 96 treatment-seeking heroin abusers to treatment with injectable heroin or oral metha-done...follow-up revealed that the minimal improve-ments in employment status, health, and consumption of nonopiate drugs were comparable between the two groups."

Also evidence that heroin administration is safe in clinical settings (so where's the ethical problem, and they are volunteers as well)

Heroin is inherently not a safe drug, even when taken in controlled doses. This article details just a few of the health risks from taking chronic doses of opiates. Heroin causes damage to the immune system, the nervous system, the digestive system, thereproductive system, and other aspects of human physiology. In addition, as I stated before heroin has effects on personality and behavior that detract from the user's quality of life. Furthermore, the fact that the patients would be volunteers does not lessen the ethical burden on those handing out the heroin. The fact that someone will voluntarily engage in dangerous behavior does not give anyone license to disregard that person's best interests.

Furthermore as to current heroin prices and the black market, I found that physicians in the 1990's in Britain treat less that 2% of heroin addicts in this way. This would hardly be incentive to any kind of market reaction.

This has not always been the case. In the 1970s, the percentage of addicts receiving prescription heroin was estimated to be about 20% ( source) and the black market still persisted. What leads you to believe that a higher percentage of addicts would enroll in such a program in this country? The gradual dropoff from 20% to 2% enrollment in maintenance programs is attributed to a combination of preference of addicts to buy their drugs on the street and physicians deciding that heroin maintenance is not in their patients' best interest.

In addition, there is ample evidence that heroin clinics have, over the years, contributed to the supply of black market heroin (see here , here, here, and here ).

A prime objection of yours never showed up at all. That is, drug maintenance in this form has any potential to increase the number of addicts.

Just because new addictions have not been explicitly demonstrated to exist doesn't mean you can dismiss the possibility. There is abundant evidence that government heroin distribution contributes to the amount of heroin available to the general public. There are several papers indicating that heroin use in Britain has increased at a faster rate than heroin use in the U.S. over the last 20 years. In addition, the British system differs substantially from what you are proposing in several ways. You have not proposed that heroin be prescribed by a physician, nor limited in quantity by a physician, as it is in Britain. In addition, Britain benefits from a socialized medicine infrastructure that we don't have in this country.

"Explicitly, the report compares a society in which a group of people use drugs at great cost to themselves, and significant cost to society, to a society in which (possibly) more people use drugs at less cost to themselves, and less cost to society. Ironically, the first society is the one which is deemed desirable."

I agree that this does sum up our differences. I simply don't think that a program which leaves 50% of heroin addicts unemployed and in trouble with the law is a good enough payoff to risk increasing the rate of addiction. The authors you cite all set low standards and then claim that any improvement in the health or well-being of addicts is a great triumph. But look objectively at the outcome for these addicts. All are still addicted to heroin. Half are unable to work. Half are involved with the criminal justice system. Most are still using street drugs (and at a higher rate than regular heroin users according to one paper you cited). What has really been gained?

-- Anonymous, January 19, 2001

As I've suggested before, unemployability may be due to several factors: class, education, economic background...What is one to make from heroin maintenance program that has enrolled half of its participants as prior criminals, as to their employability?

Again, former criminals and people with little education, etc. are not inherently unemployable. In fact, unskilled workers are a vital segment of our economy! Being on heroin, in contrast, affects your ability to function on a day-to-day basis. As to your other argument, even if many drug addicts were criminals beforehand, I don't see how this weakens the argument that maintenance does not significantly decrease criminality.

The inference should be made though, that they did not need to commit crimes to feed their drug habit.

Whoa! That's a huge assumption, and it's one that flies in the face of some established facts about those on maintenance. One is the fact that a majority of those on maintenance still use street drugs. Also, half are not employed. The facts stand that crime rate of those on maintenance is not significantly decreased.

I really couldn't find the explicit dangers of administering pharmacological heroin in that article...The side effects mentioned aren't peculiar to heroin and exist as well in the legitimate narcotic drugs. Remember it's pharmaceutical heroin, and I don't know what damage you are referring to.

The dangers of pharmacologic heroin are quite real, although I wasn't able to find much literature on it online. Here is a brief list of opiate use guidelines, which includes a list of side effects, which include constipation, respiratory depression, cognitive effects, sexual dysfunction, and amenorrhea in women, and urinary problems, among others. I agree with you completely that heroin is not any more dangerous than other narcotics, but I doubt you would be able to find any physician in the world who thinks it would be a good idea to give an otherwise healthy person chronic doses of morphine or methadone.

There may be ethical issues -- but if heroin is a manageable drug (as you have failed to dissuade me from that notion) it is possibly no more unethical than other drug studies.

Well, I have a hard time believing that you are truly convinced that controlled heroin addiction does not contribute negatively to a person's quality of life. If nothing else, consider the fact that it makes you constipated all the time! I don't know how much experience you have in talking to addicts, but I got a chance to interact with many of them when I took a course on addiction last year, and many described their lives while on methadone, and it sounded pretty awful. Basically, you feel like crap all the time, because you're getting enough opiate to maintain your physical addiction, but not enough to get you high. People on maintenance-level doses of heroin probably feel similarly.

I can see many physicians having a problem with maintenance therapy of drug addiction. It just doesn't seem within the normal criteria for their profession, and they would also have conflicted opinions. That said, I still believe destitution, if nothing else would lead addicts to enroll. Or their attempt to change -- all that goes with the lifestyle and street purchases.

Well, the British addicts were presumably destitute, yet there was a lot of resistance to enrollment. I still don't understand why you think American addicts would react differently.

I don't dismiss [the possibility of new addicts] -- but if it's not mentioned as a factor in these repeated controlled experiments, of all the concerns I have (so far) zero evidence of producing new addicts. What more can I ask?

I don't think such a thing could be studied in controlled experiments. There is no direct evidence of new addicts, but that doesn't mean there is no evidence that such a thing would happen. Similarly, there is no direct evidence that Neptune isn't made of rubber, but that doesn't mean we should be satisfied with the assumption that it is.

Finally, my question to you about what has been gained was not a theoretical one, I was asking you specifically about the British system. Britain has a bigger illegal heroin problem and more addicts now than it ever has. Addicts in the maintenance program show little progress in terms of re-integration into society. I simply don't see the incentive for emulating such a program.

-- Anonymous, January 19, 2001

No they're not. But you were comparing an employment rate (was it 5%) of the entire range of of the population of the country against a 50% unemployment rate of 1/2 prior criminals (education and training levels actually unknown) as heroin addicts. A fair comparison would be a random and similarly educated sample with 50% of them having prior criminal records.

But as I've been saying, this is exactly the sort of experiment which was done in the 1980 Hartnoll study! Heroin addicts were randomly placed in either heroin maintenance, methadone maintenance or no maintenance groups with controls for socioeconomic factors. The net result was that all three groups showed no significant difference in criminality or employability.

Well, they've apparently ["put apparently healthy people on opiates"] in Britain and other countries.

No, healthy people have not been treated with opiates by physicians in Britain! Opiates are only given to people with diseases which cause physical pain, including opiate addiction, or people suffering from pain due to trauma, such as surgery. Physicians do not prescribe opiates to people who are not ill, because they are debilitating drugs with many harmful side effects.

If you read the warnings and indications on drugs in the Physicians Desk Reference, you may wonder if anything is safe. Do you want me to quote all the crap on the OTC drugs in my medicine cabinet for you?

Yes, as I mentioned in a previous post, all drugs have side effects and potential dangers. That's why the more dangerous ones, such as opiates, are only available with a physician's prescription. However, the fundamental difference between using opiates to treat opiate addiction and using, say, Sudafed, to treat the symptoms of a cold is that Sudafed will not worsen your disease, whereas taking opiates is exactly what causes continued opiate addiction (and also, Sudafed's side effects are far less pronounced).

However bad, controlled heroin addiction is, I'm sure uncontrolled is even worse.

That's not what I've been told by the addicts I've spoken to. None of the ones I spoke to thought that methadone maintenance was satisfactory, and all went back to uncontrolled use after a short time on methadone, and were subsequently able to get clean by quitting heroin cold turkey. If controlled addiction is so great, why did 90% of the addicts in the British program drop out?

And addicts out of a program show what?

The same thing as addicts in the program, which is my point exactly! The British program costs the government money, brings additional heroin into the black market, and has absolutely no effect in terms of improving the lives of addicts.

Actually, Britain may actually have switched to a failed model in the last half decade.

Yes, but the explosive rate of increase in heroin use began before the 1997 policy switch. By all accounts, the current British heroin epidemic began in 1995, two years before Blair took office.

-- Anonymous, January 20, 2001

Well, I note your general rating of success of maintenance programs now ranges from "no significant difference" to where you say programs have "absolutely no effect."

In scientific jargon, saying that there is "no significant difference" means that no effect is seen. This was the result of the Hartnoll study, which showed no change at all among people in maintenance programs with respect to employment, criminality and health. Other studies did show modest improvements in these things, but those studies did not control for the socioeconomic factors you mentioned--subjects were allowed to self-segregate into maintenance, methadone, or uncontrolled groups. One might say that those who opted for heroin maintenance might have had fewer criminal/antisocial tendencies to begin with. In fact, it seems highly likely that this is the case, given that they have chosen to adopt a law-abiding path of drug procurement.

Furthermore, if I recall correctly, the death rates among participants of various studies were extremely low. I am curious what the average death rate of the heroin addict that "prefers" to go off one these programs and doesn't successfully go cold turkey?

I haven't seen any data on this--probably because the sample size of heroin addicts on maintenance is too small to study such a rare event as death. However, as I mentioned before, the Hartnoll study reported no improvement in overall health.

Btw, if chronic pain is your definition of unhealthy (with otherwise functioning systems) I'll buy that. Though a deference for administration of highly dangerous opiates to people which might be medically okay, versus other people minus the pain, seems unethical for such "dangerous" medications -- if that they really be

Chronic pain isn't in and of itself considered to be a disease, but it is considered to be a component of a disease. Addiction is considered to be a disease.

The dangers of opiate use absolutely do determine their clinical use. Typically, physicians give opiates to two classes of patients: those suffering from terminal illnesses that cause them pain (such as cancer) and those suffering from acute pain (such as people recovering from surgery). A physician would typically not prescribe opiates, however, to an otherwise healthy person who has chronic back pain. While opiates would help that person deal with his or her pain, the tradeoff of the side effects (as well as the risk of addiction) is not considered to be worth the benefits.

Another fact to consider is that heroin withdrawal symptoms typically only last about a week, so it would be hard to argue that heroin addicts "need" heroin to manage the pain of withdrawal.

-- Anonymous, January 20, 2001

Well, I don't know if you agree or not, but I think there's enough conflicting data, to declare questions of legalization still not definitively answered.

At the very least, I would like to see several more studies achieving similar results before I would conclude anything approaching finality.

As well, nothing rules out other innovative approaches, that might yield better outcomes.

-- Anonymous, January 20, 2001

Well, I don't know if you agree or not, but I think there's enough conflicting data, to declare questions of legalization still not definitively answered.

Well, I'd say the data are quite clear on the British system, and it's a pretty definitive failure. There have been dozens of studies done now over the course of more than thirty years, and none shows any impact whatsoever on the illegal drug trade, and none shows anything more than a modest improvement in quality of life for addicts (and even that improvement is suspect at best)!

However, I agree that legalization might warrant further study in terms of looking at how that system might be improved. For example, it might be useful to interview addicts to find out why there is such a low rate of participation in the program, and find out what could be done to make it more appealing (of course, in doing so, you would run the risk of making it more appealing to recreational users, as well). Or, they could try combining the treatment program with job training and counseling (although as I said before, addicts are hard to employ for a number of reasons.

I know that Switzerland and Australia have been looking at establishing maintenance programs, so perhaps we will soon have that data to draw on as well. I, personally, am not very optimistic.

-- Anonymous, January 21, 2001

certainly a system that was created in the 1920's may very well fail if it is not routinely reviewed, adapted for a more modern society and -- well properly supported.

The current British heroin maintenance program was conceived in 1970, and has undergone significant adaptation since that time in response to subsequent heroin abuse epidemics. Further, similar results (low participation rates, and little to no effect on quality of life for addicts) have been seen in heroin maintenance trials in the U.S., Switzerland, and in Eastern Europe over both short and long intervals.

Unless the factors which lead to the failure of such programs can be identified and changed, I don't see the point in repeating an experiment which has failed time after time.

I suspect that these factors include the following immutable problems:

-casual heroin users (who outnumber addicts in both the U.S. and Britain) are not affected, thus limiting the impact of maintenance on the black market, as well as creating a black market for legally- obtained heroin. This is even more true of cocaine.

-heroin addicts typically use many other illegal drugs

-addicts apparently prefer to buy drugs on the street rather than jumping through the hoops of maintenance programs where they are subjected to encouragement to quit

-many heroin users on maintenance are sufficiently affected by the drug that it inhibits their ability to work

-heroin maintenance, by definition, sustains heroin addiction

-- Anonymous, January 22, 2001

Dare I put in my 2-cents? (my wallet's bare)...You two have covered it pretty well...

Insanity is defined as doing the same thing over and over, when it is proven to have no positive effect on the outcome.... for example, banging one's head against the wall in an attempt to get rid of headaches. Our national drug policy has proven to me to be INSANE! Man has a yearning for altered states of consciousness... you will never change that (until we start snipping DNA strands). Maybe you'd prefer the government to channel that inate urge by making every US citizen become an ultra-religious zealot, starting at birth. Jen, you state that legalization would make a worse addiction problem. I guess you think that YOU would immediately go out and take the most addictive drugs you could buy, if legalized. I wouldn't... why do people assume most others would? You said: I've heard dozens of people justify their tobacco smoking habits by saying "if it was really so bad for you, it would be illegal." If drugs are legalized, will people rationalize their drug use by saying "if heroin is really so bad for you, why did they legalize it?"

You know full well that everyone knows tabacco is unhealthy. People knew that 30 years ago. They're just giving a whining excuse. The reason Heroin is dangerous IS BECAUSE IT IS ILLEGAL! By being illegal, it will: get you arrested, put you in prison, kill you from overdoses, kill you from poisoned cutting materials, kill you from infected /dirty needles, get you beat-up/killed from low life crimminals. If you're really concerned about govermnent being serious about PUBLIC SAFETY, then you should be leading the parade for a mandatory 30mph speed limit. Where else but the highways are YOU so likely to be randomly killed, with no blame from your own actions.

Drug rehab -- Jen, I don't know how accurate your stats are... Cory's UK data must be taken with the grain of salt that it's a government run program, and so, not the best designed or run. There may be better run programs that have better results in private institutions in this country. But... even if the success-#'s were less than you think, should we not keep running them for the benifit of: 1) those that seek it, and 2) the benefit of society as a whole. We don't stop cancer protocols on especially hopeless cancer types because they have poor results... or do you think we should shut down all cancer programs that have less than a 95% success rate? The other benefit of rehab programs is that it cuts down on crime to innocent surrounding people. Of course, legal drugs would (should) lessen the price, so crime would more naturally abate.

Functioning Addicts -- The thinking that Heroin addicts are all non'functioning is mostly a hollywood illusion. There are many doctors, lawyers, and professional people who've taken controlled amounts of narcotics for decades, with very little negative effects. You don't know of many because.... well, they don't want you to. They fly under the rader screen because: as people with good incomes, they can afford it. They don't have to commit crimes, and get arrested. William S Burroughs was on junk for 20+ years... it didn't handicap him (professionally). The WORST thing about illegal drugs is the consequenses that arrise from their being illegal. Narcotics and most amphetamines are less destructive to the body (if not abused) than just about any drug or substance (over the counter herbs and minerals) I can think of. Ask a knowlegable MD... don't rely on government propaganda... the same one that said LSD damaged your chromosomes; that was based on a single study where lymph-tissue was exposed (in vitro) to 1000's of time any normal amounts of LSD, and put in newspapers as "proof". Under much less restrictive guidelines, you can simply drink too much water, changing you electrolyte balance, and die. Should we ban water too?

Interdiction -- this has a proven track record of failure. I know friends who were doing military work in Columbia 20 years ago... all very hush-hush at the time. Last year, we discover we're going down a Vietnam-like path, with billions of dollars spent with no public knowledge. We crack down here, the traffic goes there. Unless you want to live in a nightmare totalitarian world like cold-war E Germany, or Gulag style Russia, there's no solution by interdiction. It's a stupid waste of time and money. When will these bozo's in Washington wake up?

-- Anonymous, January 25, 2001

Jen, you state that legalization would make a worse addiction problem. I guess you think that YOU would immediately go out and take the most addictive drugs you could buy, if legalized. I wouldn't... why do people assume most others would?

I'm not in any way "assuming most others would," but I'm saying there is a risk that some others would. All indications are that marijuana use in the Netherlands has gone up sharply since it was partially legalized there in 1976 (for one of the very few scientific studies on the subject see MacCoun, R; Reuter, P. Interpreting Dutch cannabis policy: reasoning by analogy in the legalization debate. Science, 1997 Oct 3, 278(5335):47-52). Given this data, I think it's foolish to assume that increased usage and thus increased addiction would not be a possible outcome of legalization.

You know full well that everyone knows tabacco is unhealthy. People knew that 30 years ago. They're just giving a whining excuse. The reason Heroin is dangerous IS BECAUSE IT IS ILLEGAL!

Everyone ought to know that tobacco is unhealthy, but there are clearly people who are in denial about it. The fact that tobacco is legal and a part of everyday life undoubtedly contributes to these individuals' capacity for denial. I've had several conversations in which people told me that they absolutely don't believe (contrary to multitudes of scientific evidence) that smoking marijuana can cause lung cancer. Your analogy about highway speed limits is absolutely the same thing--if high-speed cars were not a part of our everyday life, would we accept their danger into our society? People tend to be more afraid than they ought to be of things that are unfamiliar, and less afraid than they ought to be of things that are familiar. Making drugs legal makes them a more accepted part of our society, and thus breaks down one of the barriers to drug use.

We don't stop cancer protocols on especially hopeless cancer types because they have poor results... or do you think we should shut down all cancer programs that have less than a 95% success rate?

Actually, if someone were trying an experimental cancer treatment and it had a low success rate and contributed to disease in the remaining patients, then federal research guidelines would demand that it be stopped. The problem with heroin maintenance is that taking heroin perpetuates heroin addiction, making the disease worse.

The other benefit of rehab programs is that it cuts down on crime to innocent surrounding people. Of course, legal drugs would (should) lessen the price, so crime would more naturally abate.

Are you talking about rehab or maintenance? If you're talking about maintenance, then what you say is simply not true. Heroin maintenance has been tried in Britain for thirty years, and there has been no effect on drug-related crime or the price of heroin.

Functioning Addicts -- The thinking that Heroin addicts are all non'functioning is mostly a hollywood illusion.

Nobody here has said that heroin addicts are all non-functioning, nor has anyone quoted Hollywood as a source. My contention that most heroin addicts are involved with crime and unable to hold down a job are based on scientific studies. The British system has shown that even among patients on heroin maintenance, few are employed, and many engage in criminal behavior. Heroin acts on opiate receptors in the brain, and has direct effects on behavior. This affects the way heroin users think, act and interact with others.

Narcotics and most amphetamines are less destructive to the body (if not abused) than just about any drug or substance (over the counter herbs and minerals) I can think of. Ask a knowlegable MD... don't rely on government propaganda...

As someone who works daily with M.D.s who treat drug addiction and as someone who has spent three months actually doing addiction research (in another lab with many M.D.s), I can assure you that my knowledge of the subject is not based on "government propaganda." To say that narcotics and amphetamines are safe is simply not true. Even in controlled doses, narcotics and amphetamines can cause death and a multitude of health problems. Heroin causes malnutrition and health neglect (due to its analgesic effects), respiratory depression (which can result in death), suppression of the immune system, digestive problems, miscarriage and amenorhhea in women and loss of sexual function in men, as well as the well-known behavioral effects and the risk of addiction/dependence. In addition, heroin users are more likely than non-users to use other psychoactiver drugs, and both cocaine and alcohol have been shown to increase the dangers associated with heroin use.

Amphetamines cause increased heart rate and blood pressure which can cause heart attacks and other cardiovascular problems as well as panic attacks. They can also cause liver damage. And, like heroin, they also cause behavioral and mood changes (including aggression and depression, which can lead to suicide) and are highly addictive.

While some over-the-counter drugs have serious side effects, reams of scientific literature demonstrate that none are as severe as those of heroin or amphetamines. I can't speak for the safety of "herbs and minerals" which are not regulated by the FDA and thus not routinely tested for safety in a manner which is open to the public. However, to my knowledge, there are no herbs or minerals being sold over the counter today in the U.S. which routinely cause chemical dependence and addiction.

Furthermore, if you really believe that these drugs are no more harmful than an aspirin, why did you say earlier on in your post that you wouldn't use heroin if it were legalized? I hear it gives you a great high...at least for the first few times.

he same one that said LSD damaged your chromosomes; that was based on a single study where lymph-tissue was exposed (in vitro) to 1000's of time any normal amounts of LSD, and put in newspapers as "proof"

I agree that the newspapers are not necessarily a reliable source of scientific information, as they tend to write stories based on single studies and not on bodies of work. But it seems to me that whatever source you are getting your information from is also not in line with what the vast majority of scientists and physicians believe. I actually don't know much about LSD (it's not considered to be an addictive drug, so it's not so widely studied by addiction researchers), but I just did a quick medline search and pulled up about 150 papers showing accounts of chromosomal abnormalities and birth defects in infants whose parents used LSD recreationally. I honestly don't know how strong the story is since most of the papers are from the 1970s and I'd have to go over to the library to get them, but it sounds like there is more to this story than "a single study" using megadoses of LSD.

Under much less restrictive guidelines, you can simply drink too much water, changing you electrolyte balance, and die. Should we ban water too?

Actually, I think this is just an urban legend--I've never heard a verified account of this actually happening to anyone. If you have normally functioning kidneys, they should be able to process as much water as you can drink without vomiting. But anyway, it's a totally ludicrous comparison. We all need water to survive, so we live with the risks associated with it. Nobody needs LSD to survive. With water, the benefits clearly outweigh the risks. With LSD, the risks clearly win out.

-- Anonymous, January 25, 2001

"water intoxication"

I remember reading about it, since it happened in my local city (at the time)

http://www.cleveland.com/news/pdnews/metro/o17recu.ssf

The above news story, doesn't delve into the circumstances much, but basically what I remember, is the guy had symptoms of illness, which due to the heavy emphasis to the Training Instructors on hydration, they mistakenly assumed it was from dehydration, when in fact he had already consumed two full canteens -- and they ordered him to drink more. Then when he really got sick, they called the local base hospital and (and I think, but not sure that) he ended up getting two large bore IV's on site by the paramedics who went unfortunately with the same dehydration diagnosis as they were told by the excited instructors -- just one big fuck up, you might say.

-- Anonymous, January 25, 2001

Well, it's definitely possible to die within a matter of minutes from electrolyte imbalance if someone gives you IV water or something. But I've never heard of a healthy person just sitting down and then drinking water until it kills them.

-- Anonymous, January 25, 2001

It's my understanding that the studies that purported to show chromosomal damage from LSD have been discounted. Also, I think you need to take something like 10,000 times the usual dose before you run the risk of death by overdose. And there's no accepted medical evidence that hallucinogens cause brain damage, although a small percentage of users report perceptual or mental changes which last for months after they take the drugs--it's not clear if this is a psychological effect or if it's due to some unknown changes in the brain (likewise with 'flashbacks').

-- Anonymous, January 26, 2001

I just had to laugh when I read Jen's post:

"I've never heard of a healthy person just sitting down and then drinking water until it kills them."

Ain't that the truth! How long would that even take? It seems that comparing water intake to heroin intake is a little too simplistic. I guess you could eat yourself to death too, or even sleep too much until your muscles atrophy and you waste away, but that's a little different from injecting a substance into your bloodstream.

I think that there are benefits to legalizing marijuana, but I couldn't advocate legalizing other drugs such as heroin or other types. I think it's sending the message that it's OK to be so destructive to your body and to be so dependent on another substance that you will do anything to get it.

I'm not as well informed as others who have posted, but it seems to me that even if drugs are legalized, the amount of crime will actually go up. I mean, if you need drugs, you need them. Just because they are readily available doesn't mean you have the money to buy them! I remember scraping the bottom of the change jar just to buy cigarettes (I know, it's hypocritical - but I've since quit) - and that's just cigarette addiction! I would imagine, anyway, that other drug addictions are more powerful.

Maybe the fact that drugs are illegal now is clouding my judgement. But I just can't help but think that people die from drug overdose all the time. Yes, you die from cancer too, but with drugs you could just take too much one night and die.

With the way people are suing bars now when the bars let drunk people leave intoxicated, what will happen when someone dies from using drugs purchased from the local 7-11? I don't think the argument "They should have known better" will work in that case.

Sorry to ramble on! DL

-- Anonymous, February 02, 2001