Wednesday, December 19, 2012

Conflating the Harms of Heroin with the Harms of Prohibition



I have a problem with this graph, from a 2007 Lancet article by David Nutt. I actually like David Nutt, he was fired from his position in the UK government for criticizing the decision to reclassify cannabis to Class B from C. That's right, a scientist who was working for the UK equivalent of the NIDA actually bucked the orthodoxy of "drugs are bad, mmkay," of course he was sacked for it. You will notice that heroin scores the highest on both dependence and physical harm. This the criteria used to evaluate physical harms in the lancet article:
Assessment of the propensity of a drug to cause physical harm—ie, damage to organs or systems—involves a systematic consideration of the safety margin of the drug in terms of its acute toxicity, as well as its likelihood to produce health problems in the long term. The effect of a drug on physiological functions—eg, respiratory and cardiac—is a major determinant of physical harm. The route of administration is also relevant to the assessment of harm. Drugs that can be taken intravenously—eg, heroin—carry a high risk of causing sudden death from respiratory depression, and therefore score highly on any metric of acute harm. Tobacco and alcohol have a high propensity to cause illness and death as a result of chronic use. Recently published evidence shows that long-term cigarette smoking reduces life expectancy, on average, by 10 years.9 Tobacco and alcohol together account for about 90% of all drug-related deaths in the UK.
     My main problem with the lancet article is they compare legal drugs, alcohol and tobacco, with illegal ones like heroin. Black market heroin is a dangerous drug because of its unknown purity and possibility of being adulterated with any number of substances, assuming you're even getting heroin and some some obscure fentanyl analog. Some basic information would go a long way to making heroin a less dangerous drug. For one combining opiates with CNS depressants dramatically increases the chance of overdose. Easy access to naloxone (narcan) nasal sprays could save countless lives, without having to call 911 and risk arrest in states without "good samaritan" laws. Disseminating information on safe injecting practices would go a long way to improving users health. Instead we get PSAs with a teenage girl destroying her kitchen in an apparently heroin-fueled rage. Furthermore due to the social stigma of using heroin, most users hide their drug use making it more likely no one will be around to save their life should they OD.
     This is comparing apples to oranges. To compare apples to apples one would have to look at a quasi-legal system. One option would be to compare the physical harms of individuals on heroin prescriptions or physician opiate users. Both use pharmaceutically pure opiates and sterile injecting equipment. In the heroin assisted therapy trials in Vancouver there were ODs, but medical staff quickly revived them. Most importantly there were no opiate-related fatalities. Putting aside the potential for an opiate overdose, just how bad for the body is heroin? Dr. Arnold Trebach, writing in "The Heroin Solution," informs us that "putting aside the problem of addiction, the chemical heroin seems almost a neutral or benign substance. Taken in stable, moderate doses, it does not seem to cause organic injury, as does alcoholism over time." Interesting, so if heroin were administered in an environment where the chance of ODs were minimized, and with a readily available narcotic antagonist (antidote), heroin would score below alcohol and tobacco, probably just above cannabis. Heroin is the poster child for prohibition making drug use far more dangerous than it would be in a legal, regulated market.

Rob Arthur writing in his article, "Heroin Is Harmless?" breaks it down the harms further:
Three aspects of an ingestible substance that can be considered harmful are (1) its potential to debilitate, (2) its effects on one’s health, and (3) its potential to kill via an overdose.
(1) Like the stimulants, caffeine and cocaine, heroin is not a debilitating drug. That is, moderate usage does not interfere with one’s functioning, e.g. driving ability. This is in contrast to alcohol, in which one’s performance is directly hampered. Extreme usage can interfere just like with caffeine and cocaine, e.g. too much of a stimulant can make it difficult to focus and even cause hallucinations. However, even heroin addicts can moderate their usage so that they can work unimpaired and avoid withdrawal symptoms. For this reason, heroin addicts can and do have successful professional lives in such diverse fields as surgery and law enforcement.
(2) Long-term heroin addiction is relatively harmless to one’s health. Like caffeine addicts who “need” their coffee in the morning, the side-effects are minimal. Heroin’s long-term side-effects can include constipation and impotency. This is in contrast to alcohol and tobacco which destroy the liver and the lungs respectively.
(3) Like caffeine, it is difficult to fatally overdose on heroin by itself. (It is easy to overdose when using heroin and alcohol in combination.) The popular image of a dead heroin user with the needle still in his or her arm is misleading. A fatal heroin overdose is usually a long process that takes over an hour and it can be countered within minutes by an antidote.

25 comments:

  1. You hit the proverbial "nail on the head" with this post; I always shuddered at the inaccuracies/ ignorance depicted in that graph when I first saw it on Wikipedia. The
    x-axis or "physical harm" aspect of this quasi-scientific graph with regards to heroin is completely a function of the drug's legality/ overall societal opinion. Bravo.

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  2. you mean naloxone nasal spray, NOT naltrexone.

    silly morphy.

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    1. You're right I meant naloxone, fixed now.

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  3. I'd give anything for some black tar right now... I hate my life so Damn much.....and I hate Indiana!!!!! Help me....

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    1. Where at in indiana I'm sick as fuck right now blah fucking sucks

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  4. Its dry in Amarillo the sickness sets in....

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  5. Well, Alabama is kickin'! That boy is here, there, and everywhere you turn. Damn...up, down, and ALL AROUND...it can be found. I hate it for the peeps who are sick. I would help them all if I could. Nobody wants to be sick from withdrawing on this shit. It is the WORST feeling BY FAR.

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    1. Does it matter? Dope sickness is horrible whether you rely on doctors or street pharmacists.

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  7. It is a genetic condition that humans have evolved over much time and the end result is or children carry genes that have enzymes that just like reverse engineering that phar.company s have made such semi synthetic opiods from are the very drugs are child create in there livers. Now who to blame! Big pharma or the generations of us kids growing up in a science first kids later future.

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    1. I have no idea what you're talking about. Stringing together biochemical terms in semi-sentences does not make for coherent thought.

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    2. That was total gibberish. None of that made any sense whatsoever. Were you high on heroin when you wrote that? Lol

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  8. I wish the hospital emergency rooms would stop injecting this into patients that they ha e stereotyped to be there specifically for that drug. Anxiety problems and real medical issues not diagnosed seem to be secondary. ��

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  9. I attended a 1hr instructional class @ the dwntwn LA needle exchange in Skidrow on the proper use of narcan. Upon completion I received an ODB (overdose bag) kit with 2 of everything needed to save 2 lives. Now back in NC and I'm disgusted with the reluctance of lawmakers making narcan available w/o prescription to anyone who's at least willing to pay for it @ a pharmacy. The attitude amongst these idiots is that it will encourage more heroin/opiate/opioid use if there's no dangerous consequences. I've used for 33yrs and don't see myself abstaining anytime in the future. If a relationship with God was like the spiritual experience felt after injecting I would've become a Bible Thumping Hard-core Christian a long time ago. However, smack is and always will be my God!
    Op8 Sed8ed 4ever...

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    1. Good thought, i wish more peeps would speak up I'm there's plenty of users hiding amongst us if only we could show some unity against these assholes dictating stupid ignorant laws upon us ! I am so pissed off at the thought that someone without any experience apart from reading a book written by another ignoramus is making law by which I have to abide! WTF is going on here ? I watch every single fucking day these pissheads frown at me feeling superior calling ME junkie when after 20 odd years of pretty hardcore use I'm in much better shape than any of them ! Aaagh I'm so angry everyone should be grateful I don't have acces to weapons or else.... ;) Anyway, good luck everyone

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  10. I myself have used for years have had a couple point habbit to a gram a day habit, really depending on availability and my income. Never have I been sick before though I can't stand it when people cry about being sick. They over act just to try and get u to fill bad and share now I'll share all the time prob to much most of the time. But not to people crying about being sick. It's all in your head. You tell urself that ur sick so u get sick. It's like when u say I'm getting sick, next thing u know ur sick. Your brain is very powerful and can do basically anything I believe and getting urself sick is one of them that's a fact. Just try it tell ur self I'm not going to get sick because I don't have any medicine I don't need it to fill good and I won't allow myself to let something take controls of me. I will use when I want and quit when I want with no bad experience. I bet over 75% of u won't fill sick from not using. I have proved this time and time again. And if u can't convince urself try not being around others who say they are sick it's a direct link to ur brain saying maybe I'm getting sick to. Use the medicine don't let it use you

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    1. You are full of shit. How u didnt get sick is beyond me. You got lucky. The sickness is real n the worst feeling ever. So fuck off

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    2. If you aren't getting sickness from withdrawal, then you are simply not a heroin addict. The withdrawals are very real. Would you tell a person detoxing from alcohol that the agony they are feeling is in their head? No. So, either you are not really addicted to heroin and you are just on here to insult real addicts or you are sick and just lying about it to make others feel bad, in an attempt to make yourself feel better. Stop being a bully.

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  12. Whoever comments on this subject are and really need mental and yes u r a addict sorry just being real

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    1. Well, you just commented on this subject. So I guess you "are and really need mental" (whatever that's supposed to mean) and "u r a addict" too. (Should be "an" addict). It's folks like you that ruin intelligent, legitimate responses and make struggling addicts with real issues look so damn bad. Learn to spell and create complete sentences before trying to insult people. You only make yourself appear "mental" with that gibberish.

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  13. Is there a site for responsible people who use opiates as medicine. I think it's time for opiate users to step up and show people what a great tool they can be. I hope people will get off the streets get jobs and forge ahead to protect this valuable resource. Is their a website for responsible people who medicate with opioids?

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