New Report on Rising Heroin Use and Deaths

The Centers for Disease Control released a report today, "Vital Signs: Demographic and Substance Use Trends Among Heroin Users — United States, 2002–2013." The press release is here.

It finds increased heroin use, particularly among users of pain pills and cocaine, and increased heroin-related deaths.

Predictably, the report calls for more restrictions on pain pills. The U.S. always gets it backwards when it comes to drugs.


As I wrote in a very long post here on the futility of using our criminal laws as a response to drug use and addiction, if heroin use is indeed rising due to it being a cheaper and readily available substitute for pain pills, the answer seems clear: End the war on pain pills. Let people use them. At least they won't turn to heroin, and die shooting up in a bathroom because the drug they obtained through the black market contained a lethal combination of substances.

Oxycontin and pain meds aren't causing heroin deaths. It is the criminalization of pain meds and prosecution of the doctors who prescribe them, putting them in short supply compared to demand, that is leading users to seek alternatives, which often can be deadly.

The restrictions on pain pills and resulting increased demand for heroin has also led to increased production of heroin, especially in Mexico.

The U.S. has fewer meth labs since the restrictions on pseudoephedrine were ushered in. But people didn't stop using meth, the production just shifted to Mexico, and the finished product is now shipped here in larger quantities to accommodate demand.

Prohibition perpetuates the black market. It increases profits for foreign producers and suppliers of illegal substances. By contrast, legalization of marijuana in Colorado and other states has put a big crimp in profits of Mexican marijuana growers and suppliers, resulting in less production and less pot being shipped to the U.S. The War on Drugs gets everything backwards. There's a lesson here, if any lawmakers care to examine it.

As for the numbers in the report, take them with a grain of salt. For one thing, they are based on self-reported data.

This study is subject to several limitations. First, NSDUH data are self-reported, and their value depends on the truthfulness and accuracy of individual respondents; under- or over-reporting might occur. Second, because the survey is cross-sectional and different individuals were sampled each year, it is not possible to infer causality from the observed associations. Third, because NSDUH only captures noninstitutionalized civilians, it excludes active duty military personnel, homeless and incarcerated populations, and persons in residential substance abuse treatment programs. Therefore, the drug use estimates in this study might not be generalizable to the total U.S. population, particularly for estimates of uncommonly used drugs like heroin.....

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    Looks like ingesting prescription opiates (5.00 / 1) (#1)
    by oculus on Wed Jul 08, 2015 at 12:46:38 AM EST
    frequently becomes addictive.  And those addicts try heroin and quickly become addicted to it.  

    And all the while... (5.00 / 3) (#2)
    by MileHi Hawkeye on Wed Jul 08, 2015 at 07:55:15 AM EST
    those of us with a legitimate use get screwed over - from Dr.'s running scared of the DEA to the pharmacist making you feel like a criminal when you go to fill your Rx.

    Like its my fault I have to live every hour of every day with chronic, debilitating pain.

    F*cking f*ckers.  

    It's a sin... (5.00 / 3) (#3)
    by kdog on Wed Jul 08, 2015 at 08:10:28 AM EST
    you and many others who suffer chronic pain have to suffer more because, god forbid, someone somewhere an addict is getting high.  Senseless cruelty.  

    Not to mention totally f*ckin' stupid, as Jeralyn illustrates in her post.

    We have gotten addiction all wrong...the trick to beating the scourge of addiction isn't hiding the drugs (which is a fools errand anyway) or dropping the hammer on the addict, it's illuminating the things to live for and be present for.  Physical dependency is not the problem, that can be beat in a matter of days or weeks...it's the demons and sadness in the addicts mind and soul. Not easy, not easy at all...which is why we take the easy wrong road time and time and time again.  

    Addicts ain't the only ones deluding themselves.


    Same Experience Here (5.00 / 1) (#98)
    by Aspidistra on Thu Jul 09, 2015 at 06:52:17 PM EST
    Needed narcotic painkillers last year after a nasty bicycle crash and I simply could. not. believe how incredibly prejudiced and ignorant medical personnel were about these drugs.  Basically they are just trying to get their prescribing numbers down for the DEA at all costs, so they focus on denying painkillers to people who need them.  Sigh.

    Sarc , don't worry about taking Oxys (5.00 / 1) (#18)
    by fishcamp on Wed Jul 08, 2015 at 02:24:29 PM EST
    Don't take one every four hours, like they usually say.  When I'm in pain I take one half of a pill.  If that doesn't help, then boost your dosage.  You're not going to get strung out when you're in pain.  You just have to know when to taper down and quit.  Knee surgery and the rehabilitation takes a long time, and lots of half pills.  I have one artificial hip and many ski injuries, that I'm now remembering in the gym.  On rainy days I take half a pill before going to the torture room.  Don't forget aspirin or any of the NSAID's that actually reduce swelling and therefore  pain.

    couple of thoughts (none / 0) (#22)
    by Reconstructionist on Wed Jul 08, 2015 at 02:55:59 PM EST
      First, the failure to synthesize a compound that provides safe, effective pain relief without the flaws of tolerance/dependence is not for lack of trying. Someone  cracking that nut would become fabulously wealthy (as would a person  developing  a safe and effective medication to treat opiate addiction). It's not as simple as waving a wand.

      Second, it is unwise to dispense (pun intended) medical advice to others based on one's own experience. Every person's "body chemistry" (and psyche) is unique. Just because one person can use something without a problem doesn't mean everyone can.

      Opiates, natural or synthetic, are dangerous drugs and heavily regulated with good reason. Just because every regulation is not perfect and some regulations intended to address one problem exacerbate others does not mean the free market and unfettered individual choice should be the goal. (Many people here recognize that in other contexts.)


    Every recent previous attempt... (5.00 / 1) (#26)
    by kdog on Wed Jul 08, 2015 at 03:37:13 PM EST
    to regulate the pills has only been a boon to the heroin trade...and a detriment to legit patients, doctors, pharmacists, government resources, and of course pain pill addicts who switched to the cheap dirty version.

    Part of the discussion should be reducing regulations to 21 and over from a licensed pharmacist, no script required.  Done.  Worth a shot anyway, I don't see what we stand to lose.  I'd rather my friend who I had to cut outta my life be strung out on the pills than the needle.  Last I heard she was in the ER for infections from shooting up.  

    And good luck finding a bed at a no cost/low cost detox/rehab...not that they work to well either, but it's a chance.


    The thing that scares me the most (none / 0) (#28)
    by NYShooter on Wed Jul 08, 2015 at 04:18:13 PM EST
    is the politicization of the doctor/patient relationship.

    Down here in Tennessee the ultimate arbiter of who gets, or doesn't get, legally prescribed medications, is not the attending physician, nor even the insurance company. It is the dispenser of the meds, and, his/her "judgment."

    Anecdotally, what this means is that a pharmacy clerk (not even a pharmacist) can decide to have some fun with a 78 year old advanced cancer patient who, maybe, doesn't display enough deference to the (in Tennessee, probably a high school drop-out) clerk on his/her first day on the job. Nothing, and no one, can over-rule said clerk's decision to deny the patient's medication. Now, obviously, the owner, or pharmacist, can tell the clerk to "get the hell outta the way," and consummate the transaction. But, by "no one" I'm referring to the prescribing physician."

    I invite anyone to read the Tennessee law governing the dispensing of opiate/narcotic based meds, and contradict what I'm saying here.

    But, to get an even better insight into the sort of sadists the DEA has placed between patients-in-need, and their physicians, just google up any of the pharmacist blogs that discuss this issue. You won't believe now these "professionals" truly feel
    about their customers.

    Most everyone is aware of the visceral thrill some low self esteem clerks get what a classy lady, or gentleman, appears at their checkout stand wishing to charge their purchase on a credit card.......and, being denied. Outwardly, they show such great empathy & concern, inwardly, they're doing cartwheels and hi-fives.

    Being denied on a merchandise credit card purchase is one thing, being denied on life threatening, medical situations is quite another.    


    Same in Texas... (5.00 / 1) (#29)
    by ScottW714 on Wed Jul 08, 2015 at 04:39:49 PM EST
    ...and the issue my friend would run into is they wouldn't have it in stock, and then when they would get it, say 2 days later, they would refill from that date the following month, not the date on script.  So basically whenever they were out, customers lose those days of medication.

    And it happened all the time because pharmacies are scared to stock too much which I assume because they are worried about getting robbed.

    It's business vs care, and business always wins.

    In this case Walgreens, which is a company I refuse to do business with.  For all their hype, they don't give a damn about anyone but themselves.  Which is fine, but they should not be the ones determining who gets what based on their business model for restocking medication.


    some drugs are too dangerous (none / 0) (#33)
    by nyjets on Wed Jul 08, 2015 at 05:45:36 PM EST
    Some drugs have to be regulated by a doctor. Getting rid of scripts will cause a lot more problems.

    You Mean Adult... (5.00 / 1) (#46)
    by ScottW714 on Thu Jul 09, 2015 at 09:15:10 AM EST
    ...permission slips.  Which like permission slips in school, is an idiotic system that almost begs to be compromised.

    While I agree with you, I don't agree with the current system because they are either bypassing doctors, or putting pressure on the doctors to act in a way that is not in the patients best interest.

    Pharmacist should only intervene if there is an issue with combining medications or doctor shopping.  And even then, they should defer to the doctor or doctors.  They are pill dispensers, not doctors, and they should never been given the authority to alter a doctors prescribed course of action unless fraud or or an error is detected.


    i meant prescription slips (none / 0) (#47)
    by nyjets on Thu Jul 09, 2015 at 09:47:37 AM EST
    I meant prescription slips. There is nothing idiotic about them. For some drugs, they should only be administered if a doctor says they should be administered.

    Also, I said nothing about pharmacist getting involved (though you did give several good reasons as to when a pharmacist should be involved.)


    The Entire System... (none / 0) (#54)
    by ScottW714 on Thu Jul 09, 2015 at 12:08:41 PM EST
    ...is permission slips.  You get permission from your doctor to buy a medication.  There is no other system like it, except high-school.

    For all your, 'some things need to be regulated', pretty much anyone that wants them, has them, can get them, or turns to more affordable and more lethal alternatives.  So the regulation isn't exactly doing what it is suppose to do.  If anything, it's putting the burden on the people who need them in hopes that burdening everyone will, by some unexplained miracle, keep them out of the hands of people who should not have them.

    It's insanity, and while I don't think no system would be better, the one we currently use is a joke at best.  Squeeze the people who need them believing the people who should not have them, will not get them.

    Has never worked once, ever.  If anything, as this post proves, it's doing far more harm than good.  But what is their answer, 'we aren't being tough enough'.  The fact is, what the DEA refuses to believe, is you cannot control drug use, period.  So quit burdening people who have done absolutely nothing wrong, and quit getting between people and their doctors for some unattainable fantasy.

    Grown folks in a free society do not need permission slips for things that do no harm to others.


    that is incorrect (none / 0) (#57)
    by nyjets on Thu Jul 09, 2015 at 12:30:24 PM EST
    1. There are plenty of things that require 'permission' (the correct term being prescription slips) slips in life. A driver license is like a permission slip. You need a license to drive. You need a license for some work activities. There are plenty of systems that use it.
    2. Fine some people are stupid and are going to use drugs. But I like to think most people have some sense of intelligence and will actually listen to their doctors and when the doctor does not prescribe something, and give the reason why,the patient will listen. And I have no problem with the doctor being the final authority on the subject (and if the doctor screws up, that is why you have malpractice laws.)
    3. I am also not advocating criminalizing drug use. If you do not have a prescription, you simply can not get it from the pharmacy I  no longer consider myself to be an advocate of the war on drugs.
    4. I am not saying that regulation of drugs is perfect. And the laws should not be as restrictive on doctors as they currently are. Especially for chronic pain. However, you still need it.

    Licensing in General... (none / 0) (#75)
    by ScottW714 on Thu Jul 09, 2015 at 02:01:18 PM EST
    ... is the right to something over a time period, whereas permission slips are one time use only. Otherwise people would actually take a slip of paper hand it to someone to get their keys, or to buy dynamite, or to install a fuse box.  There is a required education for licensing, whereas a permission slip has none, if they are lucky, a 'don't mix with alcohol' sticker.  There is no actual requirement other than a another human being saying OK. If applied to licensing it would mean you would take a slip of paper, hand it to someone, and they would give you your keys, or hand you dynamite, or allow you to install a fuse box.

    A license allows you to do something over time, not one time only.  It's not dependent on a particular person or their schedule, once you have it, there is no limit.  Nor are they scratched, often barely legible, on paper with no way to verify beyond calling.

    But I do like the idea, you get a license to get scripts, then your history is reviewed to ensure people aren't abusing, if they are, then it's suspended or downgraded, and a class is required to get it back, and then you do you are on some sort of probation period.  With scripts, that could be only getting 10mg instead 100, or not being allowed to get opiates.  Then the people who can show they are capable of following the rules, aren't bothered, and the people who cannot are dealt with and don't have access to something they can't be trusted with.  Same with people who resell, break the rules and you lose the right.

    IMO people who want to use drugs recreationally have access to them.  People who do not, have access, but choose not to.  I am sure there are some people not using heroin because it's illegal, but I doubt that is many.  When you have a country like Indonesia executing traffickers and still can't stop drugs, there is literally no laws that will do what people want them to do, which is stop drug use.

    I am not saying unlock the gates, but we should give everyone a chance to prove they are capable of deciding what is best for them, and give grown adults the benefit of doubt, versus treating everyone like they are and children incapable of understanding their own bodies/needs, or criminals.  That would be the approach we should at least think about.  Because this, this ain't working for anyone.


    Yeah. (none / 0) (#44)
    by Chuck0 on Thu Jul 09, 2015 at 08:27:05 AM EST
    We all have to be saved from ourselves.

    That is silly (none / 0) (#48)
    by nyjets on Thu Jul 09, 2015 at 09:50:24 AM EST
    There are a variety of things that require some regulation. You can't drive a car unless you know how to drive. Businesses need to be regulated so they don't pollute the environment. Drugs are not the first or last thing in this world that required some regulation.

    Recon, this is the second time (5.00 / 3) (#42)
    by fishcamp on Thu Jul 09, 2015 at 07:18:50 AM EST
    you have given me advice regarding my comments.  While I do respect your knowledge, your advice both times is quite thin.  I hardly think advising someone to take half a pill instead of the doctors recommended one pill every four hours is unwise.

    My past diagnoses, you disagreed with, of Jihadi John, as possibly being a sociopath, hardly requires a doctor to recognize.  There are definite character traits available online and through observation that make this easy to figure out for most laymen.  it is an extremely common problem.


    I was referring (none / 0) (#45)
    by Reconstructionist on Thu Jul 09, 2015 at 08:55:08 AM EST
     to your statements: don't worry about taking oxys; boost your dosage if that doesn't work; you won't get strung out if you are in pain.

      It is unwise for an untrained person to advise someone  he has never met and knows nothing about as to the administration of dangerous drugs or the potential complications.
      That may be "thin" advice but only because it probably goes without saying to most.



    Recon, we're talking about (5.00 / 4) (#50)
    by fishcamp on Thu Jul 09, 2015 at 10:49:54 AM EST
    Going from half a pain pill to another half later.  I'm sure his prescription calls for heavier dosage.  Your world of being legally correct is fine, but most of us live in the world of common sense.  

    Typical American government response (5.00 / 1) (#23)
    by Redbrow on Wed Jul 08, 2015 at 03:02:22 PM EST
    Punish the people who really need pain medication by restrcicting their access while the criminal's ability to distribute the real problem drugs continues unhindered.

    Just like the anti-constitution gun grabbers approach.

    While living in San Francisco police openly tolerated black tar heroin sales at 16th and Misssion. It was so open that reporter Vic Lee was able to walk right up and buy some on camera wearing his typical suit, no disguise or undercover needed.

    End both wars. (5.00 / 1) (#30)
    by lentinel on Wed Jul 08, 2015 at 04:56:56 PM EST
    End the war on pain pills. Let people use them. At least they won't turn to heroin, and die shooting up in a bathroom because the drug they obtained through the black market contained a lethal combination of substances.

    If the war on heroin were also to be put to an end, there would be an end to the black market in which "a lethal combination of substances" are sold instead of pure heroin. Doctors would have the ability to prescribe it to patients in need of relief from intense pain. And the cost would be minimal.

    When one thinks of people whose illnesses are both extremely painful and terminal, the threat of addiction as a side effect becomes especially meaningless.

    I'm sorry (5.00 / 1) (#31)
    by CST on Wed Jul 08, 2015 at 05:36:10 PM EST
    But the threat of addiction is not meaningless when you think of the thousands of people using it as a recreational drug and ruining their lives.

    Ignoring those people is doing a huge disservice to the many people trying desperately to get clean.  

    This isn't some fake bogeyman, it's a real problem and requires action in the form of access to serious detox/rehab/mental health services.  It's not something to dismiss as meaningless or ignore.  It's something to address intelligently and with compassion for both people with chronic pain and for people struggling with addiction.


    For those recreational users (5.00 / 2) (#35)
    by sj on Wed Jul 08, 2015 at 06:33:26 PM EST
    Often what contributes to "ruining their lives" is the fact that their drug of choice is illegal. And we then make criminals of the addicted.

    In any case, one can abuse anything. I read lentinel as simply addressing the issues of the pain afflicted.


    Maybe I'm not moving in the right (5.00 / 1) (#52)
    by Anne on Thu Jul 09, 2015 at 11:50:32 AM EST
    circles, but how "recreational" is heroin use - or meth, or cocaine, for that matter?  Maybe the first couple times it's just for fun, but I think it's a pretty short trip from "recreational" to "addict," more often than not.

    I'd also guess that the majority of people who end up on the wrong side of the legal system are past the recreational stage of their drug use.  What this says to me is that there needs to be more effort on treatment and less on punishment - but isn't this something we've known for like, forever?

    Right now, heroin use is exploding because it is way cheaper and easier to get on the street than pills.  

    But here's the thing: trying to solve this complicated and multi-faceted problem only through new laws and regulations is an exercise in futility.

    Do I know how to solve it?  No, I really don't.  I don't think the answer is to just open up the market and take all the legal consequences away. People aren't going to be less addicted just because the drugs are legal.

    I don't think people should be able to walk into the pharmacy and get the pharmacist to pluck some oxy off the shelf for them whenever they want it.  

    I don't think people with chronic, debilitating pain should have to beg for relief, or be made to feel like criminals just because they are taking these drugs.  

    I don't think pharmacists should be making decisions about who they will and won't dispense prescription medications to - that's the doctor's decision, and having a prescription in hand means the doctor already made that decision.

    I think alcohol is a drug, and yet all we require is that someone be of legal age and have the money to buy it.  People get addicted to it, ruin lives over it, engage in crime to get it, get in their cars and kill people while under its influence.  No one needs a prescription for a bottle of scotch or a case of wine.  But neither is alcohol a documented treatment for pain relief; the doc never says, "go home, have a couple of martinis every four hours until your pain is gone."  Drinking is fun and okay and social and all those other good things, and the liquor lobby spends billions of dollars promoting and advertising and making sure our access to their products is easy-peasy.

    Are opiates that different from alcohol, really?

    Like I said, I don't have the answers, but it seems to me that the ones we've relied on over the years aren't doing the job.


    Anecdotal Anne... (5.00 / 1) (#60)
    by kdog on Thu Jul 09, 2015 at 12:46:38 PM EST
    but I've used opiates recreationally for over ten years without developing a habit.  Specifically percs and dins.  In closely guarded moderation, they can be fun.  

    I won't f8ck with heroin though because from what I hear of the high I'd think I'd really like it and I don't wanna dance with that devil.  But I wouldn't put it passed some people to be able to use recreationally and responsibly.  Though I'd guess such people are in the minority.

    As for cocaine, I'm not a fan at all after 2-3 tries years ago, but know people who are able to use recreationally in moderation.  And others who can't, but I think that stems more from their inner demons and issues than the characteristics of the drug itself.

    The old drug war lies of use coke or smack once or twice and you're hopelessly addicted is utter and total bs.  


    We're opposites. (5.00 / 1) (#65)
    by sarcastic unnamed one on Thu Jul 09, 2015 at 01:16:52 PM EST
    I effn love coke. Therefor I stay far, far, away. So far, opioids are leaving me completely unimpressed. Which I am very OK with.

    Different strokes, different folks... (none / 0) (#71)
    by kdog on Thu Jul 09, 2015 at 01:46:19 PM EST
    after I tried coke I was like "what's the fuss?  I'm wide awake to suffer annoying post-nasal drip, I thought this was supposed to be fun?".

    Adderal is cool though when I want to stay up all night, like when Government Mule did their "Dark Side of the Mule" Pink Floyd cover late night set at Mountain Jam.  Wide awake, ears alert, no nasal drip...Big Pharma ain't all bad;)


    Yea I wouldn't lump all those together either (5.00 / 1) (#100)
    by CST on Fri Jul 10, 2015 at 09:07:37 AM EST
    I really don't know anything about Meth, I'm in the wrong part of the country for that - but I've known plenty of people who used coke recreationally, and only a few who turned that corner into problematic.  Personally, I never touched the stuff, but my first real introduction to it was through someone already in the problematic stage and I wanted nothing to do with that scene.  I've also seen people come back from the problematic stage, and never have problems with it again once they made that decision.

    Not so much with heroin.  I know a few people who have tried it once or twice and are fine.  Beyond that it usually turns into a real problem.  And the people who do try to quit often go in and out of rehab, for years.  Those are the people who are most likely to overdose as well.

    I agree with you about drug war lies and I think that's part of the problem.  People don't know what the actual affects of different drugs are, so they hear misinformation, learn that it's wrong, and just assume it's all lies.


    Yes (none / 0) (#55)
    by sj on Thu Jul 09, 2015 at 12:21:56 PM EST
    To everything you've laid out here.

    I have to admint, it drives me crazy when anyone implies that some level of criminalization is necessary.  Apologies to CST if that's not what she meant when she started talking about "recreational" users.


    to be totally clear (5.00 / 1) (#63)
    by CST on Thu Jul 09, 2015 at 01:09:07 PM EST
    I'm not talking about criminalization at all and my apologies if it sounded that way.  I'm talking about things like this specifically.

    I'm just saying that doesn't mean we sit back and do nothing.  I know right now in MA for example there aren't enough detox beds and places for people who ARE trying to get clean.  That's a problem we can do something about.

    Obviously the war on drugs is a total failure.  A continuation of that policy is not what I'm advocating at all.  But heroin is not like pot or alcohol or even cocaine.  And I think we do a great disservice when we act like it is.

    I understand there are people who are in chronic pain, and other people who have made that life choice to be an addict.  And to that I say - OK, live your life I'm not trying to tell you what you can and cannot do.  But I also know that heroin use and heroin overdoses and deaths have exploded in recent years and many of those people are young and do not want to spend their lives as addicts.  If the number can increase like that it can decrease too.  But it's not going to happen on it's own.  Public health is crucial, mental health is crucial.  

    Messaging is also important.  It's one of the reasons I think bringing pot more mainstream is a good thing to isolate it from other harder drugs.  When we tell people all drugs are evil and will kill them, and they start smoking and see it's no big deal, they are less likely to believe you when you say other drugs are a big deal.  

    I know New England and the northeast in particular are getting hit really hard.  And it's just heartbreaking to watch happen.  The growth is being caused by recreational use, I don't think chronic pain in this area has exploded the way heroin has.


    What affect do you think (none / 0) (#66)
    by sarcastic unnamed one on Thu Jul 09, 2015 at 01:21:55 PM EST
    "bringing pot more mainstream" will have per the quote jb posted above?
    This study also indicates that the problem of heroin abuse or dependence is not occurring in isolation. Past-year alcohol, marijuana, cocaine, and opioid pain reliever abuse or dependence were each significant risk factors for heroin abuse or dependence.

    I said in my post (none / 0) (#67)
    by CST on Thu Jul 09, 2015 at 01:28:34 PM EST
    I don't think we're doing anyone any favors by lumping all illegal drugs into one "bad" category.

    I think if anything it's convincing people drugs are no big deal.

    I think it's pretty clear that being ok with any kind of drug (including alcohol) will make you more prone to being ok with other drugs.  I think the more we differentiate between drugs - as a society - the less likely that is to happen.  That's what I mean by messaging as well.


    Ya, I agree with this. (none / 0) (#73)
    by sarcastic unnamed one on Thu Jul 09, 2015 at 01:53:58 PM EST
    I think the more we differentiate between drugs - as a society - the less likely that is to happen.

    Risk factors (none / 0) (#68)
    by Reconstructionist on Thu Jul 09, 2015 at 01:35:23 PM EST
     and causal relationships are different things.

      Intuitively, it simply makes sense that people who have already  tried other forms of altering consciousness will try another  Part of that is probably just personality type. Another part is probably social circle and exposure.

       To the extent that breaking the law is a barrier/threshold for some people (and it is for some) making marijuana legal might lessen their likelihood of progressing to more dangerous and illegal drugs because they haven't already become "outlaws" by smoking. I also think that being able to score at a legal retail outlet might mean some number of people won't be exposed to sellers of more dangerous substances. I think those factors will largely offset the probability that there are in fact some people who would never have  tried a different drug if they hadn't first tried weed and liked it so decided to experiment with something else.


    Makes sense to me. (none / 0) (#74)
    by sarcastic unnamed one on Thu Jul 09, 2015 at 01:56:25 PM EST
    I wonder if cigarette smoking is a significant risk factor.

    Personally, (none / 0) (#93)
    by Reconstructionist on Thu Jul 09, 2015 at 04:20:11 PM EST

      I wonder if drugs and alcohol are a risk factor for tobacco.

     I used  alcohol and a few illegal substances (no opiates or any kind of pills, I was more into hallucinogens, and tried coke a few times) before I ever smoked a cigarette. I never smoked a cig, even a puff, until I went to college.

       Sad thing is I cut way back on my drinking after undergrad and I quit even smoking weed by my mid-20s but I was hooked on cigs for another 15 years.  



    Dunno. (none / 0) (#94)
    by sarcastic unnamed one on Thu Jul 09, 2015 at 04:37:40 PM EST
    From my limited experience, the kids getting high (and trying other drugs) in HS were largely, but certainly not exclusively, the same kids smoking cigs outside the school's front gate before homeroom.

    Alc is fairly widely accepted, but cigs and pot are still on many's "verboten" list.

    If you choose to do one thing on the verboten list, will you be more inclined to do another?

    I guess this is going back to CST's point about not all drugs are the same and should not all be characterized as being on the same "list."


    Ah, I was being a little facetious (none / 0) (#95)
    by Reconstructionist on Thu Jul 09, 2015 at 05:05:02 PM EST
      I was kind of a floater in terms of high school cliques. I played sports so I spent a lot of time with the jocks, and I was a good student so I took classes with the geeks but I partied mostly with the freaks.



    Well rounded! (none / 0) (#96)
    by sarcastic unnamed one on Thu Jul 09, 2015 at 05:26:29 PM EST
    I drank first... (none / 0) (#99)
    by kdog on Thu Jul 09, 2015 at 08:14:23 PM EST
    found the sacrament second, tobacco was third.

    The gateway to nicotine for me was sex, losing my virginity to a smoker who extolled the virtues of the post-coitus cigarette. She was f#ckin' right!

    I can take or leave the drink now...but inhaled smoke is here to stay, like white on rice. Vape and edibles are cool and all...but like some junkies say about their habit, the smoking ritual is as pleasurable as the high. I got a smoke eater demon in me boy!


    I believe some level of criminalization is (none / 0) (#59)
    by Reconstructionist on Thu Jul 09, 2015 at 12:38:23 PM EST
     necessary. I don't belive in locking up addicts who peddle small quantities or commit prescription fraud because it is the only way they can afford their habits, but MANY people involved in the drug trade are in it for the money and don't touch the stuff. Medium and high level dealers are rarely addicts.

    opiates and alcohol are quite different. (none / 0) (#58)
    by Reconstructionist on Thu Jul 09, 2015 at 12:34:55 PM EST
      In some  ways alcohol is more dangerous-- long term alcohol abuse probably wreaks more havoc on the body than do opiates and alcohol induced violence and car crashes are probably a greater problem than those associated with opiates even adjusting for prevalence of use. But, and it's a huge but, while one can overdose and die on alcohol, more people die some weeks in medium sized cities from heroin overdoses than die nationally in a year from alcohol overdoses.

      And, while the progression from legitimate medical use of prescription painkillers to abuse of prescription drugs to heroin is very real, let's not kid ourselves. Many people who have severe drug problems did not start out with a scrip from a doctor because of an injury or surgery.

       Moreover, we can't go back in time and change present reality. Did "Big Pharma" engage in a huge marketing push to persuade more doctors to prescribe more and stronger opiates more liberally? Absolutely. Has that greatly contributed to the extent of the problem? No doubt. But, it didn't only contribute by causing more "doctor prescribed" addicts who have severe chronic pain. A very large percentage of painkillers were always going both directly to people who wanted to get high and obtained scrips for that reason and to people who never saw a doctor and got their pills on the black market from the get go.


    I would think... (5.00 / 1) (#61)
    by kdog on Thu Jul 09, 2015 at 12:48:57 PM EST
    that the number of addicts who started as legitimate pain-relief patients are a very small percentage of the addict community.  Most start with pills from the street or getting a script from a shady Dr. Feelgood.

    I think that depends (none / 0) (#70)
    by Reconstructionist on Thu Jul 09, 2015 at 01:40:41 PM EST
      on what you mean by "very small" and also on age group and  where you live.

       In rural areas and industrial cities I imagine you will find a significantly  higher percentage of middle aged people who got hurt took pills legitimately prescribed and then got hooked than you would among younger people in more affluent locales.


    Makes sense... (none / 0) (#76)
    by kdog on Thu Jul 09, 2015 at 02:03:54 PM EST
    Though I would think the majority of the current heroin explosion is young adults who did not start out with legitimately prescribed pain meds, urban suburban or rural.

    LA Times a couple days ago: (none / 0) (#77)
    by sarcastic unnamed one on Thu Jul 09, 2015 at 02:12:27 PM EST
    Heroin use remained highest for the historically hardest-hit group: poor young men living in cities. But increases were spread across all demographic groups, including women and people with private insurance and high incomes -- groups associated with the parallel rise in prescription drug use over the past decade.

    Well something (none / 0) (#81)
    by Reconstructionist on Thu Jul 09, 2015 at 02:29:57 PM EST
      I think Kdog alluded to in saying why he never tried heroin is a factor. Some people might not have ever tried heroin were they not already  opiate dependent due to pills, but (and I hear this frequently from clients) once they do, they think it's a better buzz and it's not only price that causes them to continue.



    Good point... (5.00 / 1) (#84)
    by kdog on Thu Jul 09, 2015 at 02:38:44 PM EST
    injecting is a faster stronger high.

    I remain convinced what causes the dependence in the first place is more mental/emotional than the addictive qualities of the drug.  The aforementioned "demons" within, for lack of a better description.

    Such a complicated case Maude, ya know lotta ins lotta outs lotta what have yous.


    it's not just injecting (none / 0) (#86)
    by Reconstructionist on Thu Jul 09, 2015 at 02:48:46 PM EST
      Many people crush, dissolve and inject prescription pills. One of the reasons Purdue Pharma is being sued is because it (allegedly) misled people as to the dangers of Oxycontin (the brand name of its oxycodone product) abuse, claiming its time release formula was a breakthrough of sorts.  The thing is all people had to do with the original version  was scrape off the coating then it could be injected (or snorted). Eventually it switched to a new formula in which the pill gets "gummy"  and can't be injected (to use the scientific term) so people began preferring Roxicontins and Opanas which are still good for shooting up.

    in the drugs' literature to not to smoke, snort, inject, etc., the drugs the doc prescribed for me.

    Interesting... (none / 0) (#82)
    by kdog on Thu Jul 09, 2015 at 02:34:11 PM EST
    it must be harder to get the pills than I thought if even people with high incomes are switching to smack...I would think money is the primary reason for the switch.

    Women doesn't surprise me though.


      Around here pills generally run a dollar per milligram. H is $100 a gram ( but $20 bindles usually are only about .1 g. In any event on that level heroin is 5-10X cheaper. The thing is with a pill you get what you pay for every time and, more importantly, you know exactly how much you are consuming.

       I see wide ranges in purity in the lab reports on heroin. some of it is so adulterated that in a mg to mg comparison it's around the same price as pills  in terms of mg of active ingredient.

     Other times it's much higher purity. That's an obvious reason why so many people OD. If you're used to 20% and get a batch of 70% you do 3 1/2 times more than you think are doing and it can be lights out. Word gets around pretty soon that certain product is good or bad (dealers have their personal stamps to identify their product) but you can always tell when a high purity shipment has hit town because of all the ODs in the first couple of days.

       In talking to people though, heroin is appreciably "better" and they might need to do only $10 worth of stepped on heroin to get as satisfied as they do from a couple of  $40 pills containing oxycodone.

      This is purely anecdotal, but I also believe the tolerance curve is much steeper with pills. I've had clients who quickly got to the point where they needed to consume staggering numbers of pills while the heroin folks seem to progress much more slowly in quantity despite the favorable price.

       I've had many  pillhead clients with habits that would cost hundreds a day at retail street. They literally have no option but to buy weight and sell enough to take their profit in product. I had one guy who was doing 25 40 mg pills  a day. That would be $1000 every day.



    Jesus Christ... (none / 0) (#90)
    by kdog on Thu Jul 09, 2015 at 03:31:55 PM EST
    I've learned more than I ever wanted to about this drug sub-culture...I'm going home to cannabis country.  

    It's gotten so bad here (none / 0) (#91)
    by Reconstructionist on Thu Jul 09, 2015 at 03:37:46 PM EST
     several city PDs are now training the beat cops to administer Naloxone because they often arrive before EMS.

    Yes, you don't move in the right circles. (none / 0) (#72)
    by Donald from Hawaii on Thu Jul 09, 2015 at 01:51:27 PM EST
    Anne: "Maybe I don't move in the right circles, but how 'recreational' is heroin use - or meth, or cocaine, for that matter?"

    I used to do so, until I gradually wised up and realized that the circle was nothing but a merry-go-round that often spun its riders into a dizzying nowhere. While I won't ever deny that I often had a really great time while I was aboard, I'm also very glad and thankful that ultimately, I was able to dismount of my own accord and walk away.

    Now, I quite obviously can't speak for others, but for me my own substance use was entirely recreational and never really got beyond that, even though I admittedly had a couple of short periods when my usage actually got quite heavy, after my divorce when I was self-medicating my own unhappiness. But at those moments, I was always able to catch myself and pull back.

    Finally, and to be perfectly honest, I quit altogether because I had gotten bored with it all. And with that boredom came the personal revelation that the only thing I really had in common with those who were also hanging out in the "right circles," was that we all liked to get high. That appeared to me to be a rather shallow and aimless existence, and so I moved on.



    that's just not true (none / 0) (#36)
    by CST on Wed Jul 08, 2015 at 08:37:14 PM EST
    Its not only the criminal element at all.

    Heroin can be incredibly destructive all on its own.

    There needs to be greater mental health support for addicts.  I realize I'm going against the grain here but this isn't a hypothetical issue for me.  My friends are dying.


    Many are effected CST... (none / 0) (#51)
    by kdog on Thu Jul 09, 2015 at 11:42:13 AM EST
    but the illegality of it isn't helping, not one iota.  It makes it worse.  

    Heroin isn't doing anything...people are destroying themselves via heroin.  We can't help them by hiding the drugs, nor are we helping them by de-facto pushing the dirtiest unsafest version of the drug available with our boneheaded policies.

    We're closer than you thing...the key is mental and emotional help and support for those who wish to kick.  Those that do not wish to kick, there is no helping them except trying to make sure their needles and their drugs are clean and pure, so if an when they do decide they've had enough of the junkie life, they'll still be alive to kick.

    We both know addicts...so we both know there is no helping an addict who doesn't want to be helped.  And as awful as it sounds, and heartbreaking as it is to witness, if a human being wants to throw their life away it is their inalienable right to do so.


    I agree with all of that (none / 0) (#64)
    by CST on Thu Jul 09, 2015 at 01:13:47 PM EST
    My thing is - this is a new trend.  It's expanding.  If it can expand like this than it can decrease too.  And a lot of people do want to get clean and the services just aren't there and they don't know how and can't do it on their own.

    In no way am I advocating a continuation of the war on drugs.  I'm just saying - this is a real problem, it's a problem we can do something about, and it's a problem we should do something about.

    And yes, I know there are some people who don't want help.  And it is what it is, I agree with that.  But I don't think that can explain the 100% increase in use and overdoses.  I don't think all those people just chose to throw their lives away.


    I hear ya... (none / 0) (#69)
    by kdog on Thu Jul 09, 2015 at 01:37:24 PM EST
    maybe unhappiness is expanding?  Despair?  Lack of opportunity?  Lack of human touch and interaction in the cyber age?  

    I agree the increase is real, the damage done is real...the reasons are a much tougher nut to crack.  Expensive and hard to get pain pills and cheap and easy to get dirty smack are but a small part of the equation...but it's the part we can address rather easily.  As is expanded access to detox and addiction treatment.

    The disease in the soul that leads to addiction is harder to address, or even understand.

    Another thing we could try in the US is the Ibogaine treatment...former addicts have sworn by it after traditional rehab failed and failed again.  It may be the key to unlock that soul disease I'm on about it.


    I Think You Missed... (none / 0) (#79)
    by ScottW714 on Thu Jul 09, 2015 at 02:14:16 PM EST
    ...the number one reason people hate other people getting hooked on drugs, the dollars.  If junkies could get their fix without the artificially inflated black market pricing, they wouldn't be taking car stereos and breaking into people's homes and doing all kinds of stupid S.

    In reality, most people don't give a rat's A that x number of people are junkies and killing themselves, they care about the crimes committed to feed those habits.  If they did they wouldn't let our government turn pill heads into heroin junkies.  People could open up their homes more freely knowing the junkie isn't going to rob them blind for tomorrows fix.

    Remove the enforcement costs of anything illegal and you remove a lot of the violence associated with the distribution, and the crimes committed by users who can't afford their habits, and I think we could get to a stage where we view junkies like alcoholics, people who need help, rather than deranged criminals who are going to steel your S.


    I dunno (none / 0) (#83)
    by CST on Thu Jul 09, 2015 at 02:36:37 PM EST
    Heroin is incredibly cheap.  It's not like the black market is raising prices that much.  If there is an increase in property or violent crime associated with it - that hasn't been reported or commented on much, so I kind of disagree with the assertion that that's all people care about.  And I think if anything - it's because they can't hold a job and are having a hard time paying rent - which is much more expensive than the next fix.

    I do think we should remove the criminalization element.  But I don't think it will have the impact you are suggesting.  I just think that locking people up is a cruel way to handle a medical problem.


    It is cheap. (none / 0) (#85)
    by sarcastic unnamed one on Thu Jul 09, 2015 at 02:47:14 PM EST
    A "stamp bag," like the kind [Philip Seymour] Hoffman had in his apartment, typically costs about $10 on the street. In New York City, a major center of the U.S. heroin trade, a bag can cost $6, or as little as $4 if you buy in bulk. That's well within the reach of a whole bunch of people, both the curious novice and the hard-core addict.

    This is kinda eye-opening:

    The typical fatal overdose doesn't involve a new heroin user. "It most commonly involves an experienced long-term user in their 30s or older, who is using daily," say Veeravagu and Lober. "They have likely experienced multiple nonfatal overdoses prior to the final one."

    Up to 22 percent of users will have a near-miss each year. [...]

    The deadliest additive at the moment appears to be fentanyl, a strong narcotic painkiller usually administered to cancer and other patients near the end of their life. In recent months, 22 people in the Pittsburgh area and 37 in Maryland died from fentanyl-cut heroin, and other states have reported small upticks. [...]

    Fentanyl isn't only cheaper and 50 to 80 percent more powerful than heroin, it also prolongs the high. Users know this. "When someone knows that there are heroin bags that are killing people or making them overdose, then we know that those are the good bags," a 19-year-old recovering heroin addict named Andrew tells CNN. "That's the sick thing about addiction."

    Often, (none / 0) (#49)
    by Reconstructionist on Thu Jul 09, 2015 at 10:15:56 AM EST
      but their premature and unwanted death often occurs as well. Well short of death, and entirely apart from penal consequences, addiction to opiates demonstrably has contributed to much misery for those afflicted and their families. Treating drug abuse as a medical/psychological issue rather than a criminal issue is one thing but suggesting the answer is a free market approach and people should be permitted to obtain substances simply because they want them is not the answer.

       That the penal model has failed to curb narcotic abuse and in some cases has contributed to making the problem worse (e.g.,crackdown on pills having the unintended but not unpredictable consequence of increasing heroin use) hardly supports the idea the government should play no role in regulating access.


    Oy (none / 0) (#56)
    by sj on Thu Jul 09, 2015 at 12:27:00 PM EST
    From one extreme (currently in place) to another (living in your head). I have no idea why you addressed this comment to me.
    That the penal model has failed to curb narcotic abuse and in some cases has contributed to making the problem worse ... hardly supports the idea the government should play no role in regulating access.

    Not to depreciate the seriousness (5.00 / 1) (#37)
    by Peter G on Wed Jul 08, 2015 at 09:38:00 PM EST
    of the issues otherwise being discussed in the comments here, I just want to say thanks to J for giving me a chance to listen again to the singing of a young Lou Reed.

    On a related note, we recently watched ... (5.00 / 1) (#38)
    by Donald from Hawaii on Thu Jul 09, 2015 at 03:49:01 AM EST
    ... "Lady Sings the Blues," a stunningly frank and ultimately heartbreaking 1972 biopic which stars Diana Ross as Billie Holiday, and focuses in great part on Lady Day's long and hopeless struggle with heroin addiction.

    The film opens bluntly with a harrowing scene that plays through the opening credits, her initial arrest, booking and incarceration by the authorities, during which she's placed in a strait jacket and suffers horrific withdrawal pains that nearly kill her.

    Later in the movie, it turns out that she had been arrested at a sanitarium by the police, where she was undergoing rehab treatment for her problem. Later, toward the end of the movie, she's denied a cabaret license by New York state because of that felony arrest and conviction. She later died in July 1959 at age 44 from a drug overdose.

    Law enforcement has had a long and sorry history in this country of getting it very wrong when dealing with opiate abuse. I've long agreed with Jeralyn's contention that we start dealing with the problem for the medical issue that it is, and get the cops and prosecutors out of the way of the medical professionals, so they can do their jobs.

    (Despite the fact that as singers, Diana Ross sounds absolutely nothing at all like Billie Holiday, her performance as the blues legend nevertheless garnered her critical acclaim for her gritty and unsparing portrait of an artist-turned-addict on the slow slide into oblivion. Ms. Ross received a well-deserved Oscar nomination for best actress that year. If you haven't ever seen "Lady Sings the Blues," I recommend it highly. It's rather long at 160 minutes, but still a beautiful and often unnerving film.)



    Correction: Billie Holiday died of ... (none / 0) (#40)
    by Donald from Hawaii on Thu Jul 09, 2015 at 04:27:27 AM EST
    ... health complications resulting from her long history of substance abuse, and not specifically from a drug overdose. In fact, according to Gilbert Millstein of The New York Times, who wrote the liner notes for the singer's posthumous 1961 retrospective, "The Essential Billie Holiday," her final days were tragic (per Wikipedia):

    "Billie Holiday died in Metropolitan Hospital, New York, on Friday, July 17, 1959, in the bed in which she had been arrested for illegal possession of narcotics a little more than a month before, as she lay mortally ill; in the room from which a police guard had been removed - by court order - only a few hours before her death, which, like her life, was disorderly and pitiful. She had been strikingly beautiful, but she was wasted physically to a small, grotesque caricature of herself. The worms of every kind of excess - drugs were only one - had eaten her. The likelihood exists that among the last thoughts of this cynical, sentimental, profane, generous and greatly talented woman of 44 was the belief that she was to be arraigned the following morning. She would have been, eventually, although possibly not that quickly. In any case, she removed herself finally from the jurisdiction of any court here below."

    Wow. Talk about abuse of authority! Law enforcement's various encounters with Lady Day during her lifetime hardly constitute their finest hour, and they rightly ought to be ashamed of themselves for having arrested her one last time for narcotics possession, while she lay on her deathbed.



    Lou Reed: a bit older, about being older, (none / 0) (#53)
    by Mr Natural on Thu Jul 09, 2015 at 12:03:43 PM EST
    Kurt Weill's September Song

    This story shows the absolute lunacy (5.00 / 3) (#43)
    by Chuck0 on Thu Jul 09, 2015 at 08:24:29 AM EST
    of this country's drug policy and the so-called War on Drugs (more like the War on the American People). The DEA is essentially creating these heroin users with the recent crackdowns on doctors and pharmacies. The registries for pain meds (PA recently passed one). How about we just stop this madness. Legalize marijuana, let doctors be doctors, and hey if someone has chronic pain, what does it matter if they are addicted to their pain meds, they need them, they will need for life. Leave people the hell  alone!

    So, what is the pharmaceutical (none / 0) (#4)
    by Anne on Wed Jul 08, 2015 at 08:17:46 AM EST
    industry doing to compound or create new drugs that relieve pain without the risk of addiction?  I'm pretty sure that people suffering from acute and chronic pain would be happy to take a drug that relieved their pain without putting them at risk for addiction.

    Big Pharma is always telling us about how they spend all these billions of dollars on research, so where are they on this front?  Why is no one asking that question?

    In somewhat related news, the cost of naloxone, the drug that negates the effects of opiates and has saved countless people from death by overdose, has seen a four-fold increase in price.

    Baltimore officials and others are alarmed at a nearly a fourfold jump in the cost of a drug used to save the lives of people who have overdosed on heroin -- a price spike that has prompted calls for state and federal action.

    City Health Commissioner Dr. Leana S. Wen says a leading manufacturer of naloxone has since spring raised the 10-dose cost from $97 to $370, with the most recent hike coming last week.

    In a letter this week to a congressional committee, Wen said the increase by Amphastar Pharmaceuticals has contributed to a near-doubling in the overall cost of delivering more than 1,000 doses annually of naloxone, which she calls a "miracle drug" for preventing overdose deaths.

    Trust Me They Are... (5.00 / 1) (#8)
    by ScottW714 on Wed Jul 08, 2015 at 10:44:37 AM EST
    ...my friend with chronic pain has a cabinet full of 'new and improved' pain drugs, from nerve blockers to the latest muscle relaxers, they are dumping all they can into her because of the heat pushing down on the only effective drugs, Oxy and Roxycontin.

    They force her to take drugs tests to prove she is on the meds, they force her to take physical therapy even though her disease is degenerative and bone, not muscle related.  Her doctor has told her numerous times that they are required to develop a plan for every patient on how they are going to reduce their medications, even if they don't actually reduce them.  I have been in the office with her, she is by far the youngest.  They aren't just doing this non-sense to young people.

    It's a sick joke is what it is.  She finally, after years found a pharmacy that stocks both types of Oxy(one is fast acting, the other is long lasting), otherwise she had to drive around as no one will tell you if they have it in stock on the phone.  That pharmacy by the way is currently under investigation.

    Beyond all the BS, she is a junkie, she has been on high doses of pain meds for...  I don't even know, but a long time.  And because of the ridiculous rules they can never issue a script early, so if her appointment, that is the same day every month, falls on say Christmas, they give her a script so withdrawal doesn't kill her.  They knowingly create junkies and they knowingly put them into withdrawal to try an ensure the wrong folks aren't taking them.

    She would pull a Larry Flint if she could, get a surgery and never take a drug ever again.  But that is just not possible and it would be nice if they would quite treating her as part of the problem rather than a person whose suffering is alleviated with medication.


    Amphastar... (none / 0) (#5)
    by kdog on Wed Jul 08, 2015 at 08:38:26 AM EST
    currently has a monopoly, hence the price gouging in a time of dire need.

    We wouldn't let a gas station or a supermarket do that after a hurricane...but somehow this is ok. The best government Big Pharma can buy.


    Add... (5.00 / 1) (#6)
    by kdog on Wed Jul 08, 2015 at 08:40:35 AM EST
    meanwhile, medical marijuana providers came up with Charlotte's Web for sick kids in a relative jiffy.  Food for thought.

    Why...it's almost like the (5.00 / 3) (#7)
    by Anne on Wed Jul 08, 2015 at 10:27:13 AM EST
    pharmaceutical industry sees a benefit in the addictive properties of pain relievers, but surely, that couldn't be...could it?

    It's affecting a lot of (none / 0) (#9)
    by CST on Wed Jul 08, 2015 at 11:09:32 AM EST
    middle and upper middle class white people now.

    Which, I think means it may finally start to be losing the criminal stigma and be seen and treated as a mental health problem.  Here's to small blessings?  I think we should let people access it.  But we should also provide more of a social safety net to those looking for an exit.  

    Improved access to the overdose drug and needle exchanges to help keep people alive.  And more beds and access to mental health services for people who actually want to detox and rehab.

    And an honest conversation in society about drug use and drug abuse would go a long way I think.

    You've kind of missed the point. (5.00 / 2) (#34)
    by Mr Natural on Wed Jul 08, 2015 at 06:33:16 PM EST
    It didn't have a "criminal stigma" until the criminal stigma was manufactured out of thin air.

    All laws, including criminal laws (none / 0) (#78)
    by Reconstructionist on Thu Jul 09, 2015 at 02:13:49 PM EST
     are "manufactured." Even laws with which I strongly disagree were not manufactured out of "thin air." Laws are manufactured to address actions or conditions which those with power believe should be regulated.

      The prohibition of alcohol was also  not manufactured out of "thin air" it was a (over)reaction to the patently obvious fact that many people ruin their lives by drinking too much and  also cause problems for others. We can agree that prohibition did not work and that it gave a boost to organized crime and promoted a disrespect for the law. We can make make similar observations about the current laws criminalizing controlled substances but to suggest such laws are not reactions to very real problems is wrong.


    I've noticed a lot of speculation (5.00 / 3) (#88)
    by Mr Natural on Thu Jul 09, 2015 at 02:53:02 PM EST
    in your posts on this thread, Recon.  You introduced one premise with "I imagine."

    Suboxone (none / 0) (#10)
    by thomas rogan on Wed Jul 08, 2015 at 11:32:28 AM EST
    Maybe raising the limit for doctors to prescribe Suboxone from 100 patients to 1000 patients would help.

    Timely subject. (none / 0) (#11)
    by sarcastic unnamed one on Wed Jul 08, 2015 at 12:39:33 PM EST
    I destroyed my knee about a week ago, surgery the day after tomorrow.

    doc prescribed tramadol and oxycodone.

    I tried the tramadol but it didn't touch the pain, nor did it make me feel particularly "good."

    Label on the tram says take 1 every 4 hours for pain. I used it 2X on one particularly night and it made it difficult for me to urinate. Can't imagine what using it every 4 hours would do. Also expect that eating one every 4 hours could lead to dependency?

    Haven't touched the oxy, maybe if I have to after the surgery.

    I know me, and I honestly don't trust me around this type of thing if I really like it. Luckily, so far anyway, it's nothing great.

    Yikes! Sorry to hear about your knee... (none / 0) (#13)
    by Anne on Wed Jul 08, 2015 at 01:11:32 PM EST
    As someone who had two major shoulder surgeries 5 years apart (somehow managed traumatic dislocations and fractures of both shoulders in two flukey incidents), I feel your pain.

    I'm not big on the drugs, though - they practically had to beg me to take something in the ER when I did the second shoulder (I didn't want anything after I had a C-section with my second baby, either).

    I did take the pills at home, but only to sleep - they tended to give me really bad headaches, and I'm not much of a subscriber to the theory that the headache was taking my mind off the post-surgery pain.

    My brother's injuries in a motorcycle accident were what pushed him off the wagon he'd been on for a number of years, and what sent him back to rehab when he started having to buy pills because the prescriptions weren't lasting long enough - he racked up a lot of debt before he got clean again, though.  Seems like there ought to be better ways to treat the very real and severe pain of someone for whom opiates are a ticket back to addiction - other than to make them suffer.

    Best of luck to you with the surgery and with what follows.  Assume you will be doing some painful PT at some point, so here's hoping it isn't too bad.

    Keep us posted!


    Thanks Anne. (none / 0) (#15)
    by sarcastic unnamed one on Wed Jul 08, 2015 at 01:26:25 PM EST
    Sorry to hear about your shoulders and your brother. I have a wife and two kids to support, I cannot go down your brother's path!

    I'm sure it'll all work out, I just want to get the surgery over with.


    You'll be allright... (none / 0) (#17)
    by kdog on Wed Jul 08, 2015 at 02:01:03 PM EST
    don't suffer in pain out of fear of addiction my friend, if I can take 'em on occasion recreationally without ending up on skid row, I'm sure you can handle it till you're no longer in pain.

    Now the vino otoh...(j/k, best of luck and happy rehabbing!)


    Sarc, sorry to hear this, (none / 0) (#14)
    by fishcamp on Wed Jul 08, 2015 at 01:12:44 PM EST
    Get well soon and catch some fish.

    my knee, caught a mess of calico and cudas.

    Hoping it won't be months before I can do it again!


    Oh, dear. (none / 0) (#19)
    by Zorba on Wed Jul 08, 2015 at 02:27:32 PM EST
    So sorry, Sarc.  I hope the surgery goes well!  You are in our thoughts and prayers.

    I can't take any of the opioids, no matter how bad my arthritis and my back get.  They all make me extremely nauseated, up to and including throwing up.  They gave me stuff after my knee surgery, I just couldn't take it.
    I would rather have the pain than the nausea, so I depend upon a lot of ibuprofen, and meditation and relaxation techniques.


    I Have the Same Issue... (none / 0) (#20)
    by ScottW714 on Wed Jul 08, 2015 at 02:39:26 PM EST
    ...they mess with my stomach to such a degree the pain is usually preferred to the nausea as well.  The nausea also keeps me wide awake and that is the last place I want to be when hurting.

    But I have figured out, taking a little pain medication and drinking makes it work much better and better than alcohol alone.  Not too much alcohol, but a strong drink and a Vicodin usually does the trick on moderate pain for me.

    That is what the police taught me in 5th grade; the multiplying effect of mixing drugs.  Funny, but true.


    that is dangerous (none / 0) (#21)
    by nyjets on Wed Jul 08, 2015 at 02:44:52 PM EST
    The only problem with that is mixing drugs is very dangerous. It is very easy to kill yourself that way.

    Funny... (5.00 / 1) (#27)
    by ScottW714 on Wed Jul 08, 2015 at 03:55:27 PM EST
    ...if you knew me.

    But I don't really need the regurgitated 80's non-sense about drugs that was hardly based on reality.

    I wasn't giving advise, just stating what works for me since I can't take the recommended dosages.


    What are you talking about? (none / 0) (#32)
    by nyjets on Wed Jul 08, 2015 at 05:44:10 PM EST
    Mixing drugs is dangerous and can be fatal. If it works for you, fine. It is still dangerous.

    I Agree (none / 0) (#80)
    by ScottW714 on Thu Jul 09, 2015 at 02:19:54 PM EST
    You went from 'very easy to kill yourself' to 'can be fatal' and I agree with that.

    Yikes (none / 0) (#25)
    by sj on Wed Jul 08, 2015 at 03:21:53 PM EST
    Feel better soon, sarc, and good luck

    Pretty important paragraph left out (none / 0) (#12)
    by jbindc on Wed Jul 08, 2015 at 01:04:28 PM EST
    This study also indicates that the problem of heroin abuse or dependence is not occurring in isolation. Past-year alcohol, marijuana, cocaine, and opioid pain reliever abuse or dependence were each significant risk factors for heroin abuse or dependence. Research has identified poly-substance use as a risk factor for overdose death; most overdose deaths involve multiple drugs (10,11). In 2013, 59% of the 8,257 heroin-related overdose deaths in the United States involved at least one other drug (9). Data presented here indicate the relationship between heroin and opioid pain relievers, as well as the relationship between heroin and cocaine, was particularly strong. In fact, abuse or dependence on opioid pain relievers was the strongest risk factor for heroin abuse or dependence. Taken together, these results underscore the significance of heroin use in the context of broader poly-substance use, a finding that should be considered when prevention policies are being developed and implemented.

    this comment (5.00 / 1) (#24)
    by sj on Wed Jul 08, 2015 at 03:21:12 PM EST
    should be grouped up there where CST calls for an honest conversation in society about drug use and abuse. Instead of the typical concern trolling about that topic -- which your excerpt perfectly demonstrates.

    Here's the deal.........(from my simple mind) (5.00 / 2) (#92)
    by NYShooter on Thu Jul 09, 2015 at 04:01:44 PM EST
    "The Hippocratic Oath," which most doctors prescribe to, states (in layman's terms) "Do no harm," and/or, "your treatment should not result in the patient's condition becoming worse than the ailment was for which he/she originally sought relief.")

    The key word missing in most of this discussion is, "judgement." Whenever we try to reduce a law's original intent into the written word all sorts of mayhem (unintended consequences) often are the result. "The War on Drugs," "3 strikes and you're out," "Mandatory Minimums," all are, IMO, examples of good intentions gone awry. And, the common denominator among them is, they were born of politics, and not good, sound, evidentiary logic/reason, or, judgment.

    There's nothing wrong with Government identifying a National problem and wanting to do something about it. And, having said that, I can, probably, end my comment right here; everyone reading this knows where it's heading...........

    Drugs are a National problem. Great, so who should we recruit to deal with it, and, who should we turn to in order to offer solutions? Our politicians, a group of, primarily, self-serving, narcissist, mostly corrupt, grifters? Or, a group of intelligent, educated, civic minded, empathetic experts in the field, and, which would include, sociologists, psychologists, anthropologists, and, assorted mental health professionals?

    After 40 years of, "lock'em up, and throw away the key," when, do we, as a nation, demand something different?


    SITE VIOLATOR. (none / 0) (#41)
    by Donald from Hawaii on Thu Jul 09, 2015 at 04:27:54 AM EST

    Well, at least it's (none / 0) (#62)
    by Zorba on Thu Jul 09, 2015 at 12:55:00 PM EST
    In Spanish, and the last one in French.  Not Turkish or some Slavic language.
    I can at least read some French and Spanish.  ;-)

    Keeping the supply where it belongs (none / 0) (#97)
    by Babel 17 on Thu Jul 09, 2015 at 06:21:53 PM EST
    I think you've got it right. Even though some people will tend to over medicate, keeping a ready, cheap, supply of pain med's in the hands of the pharmacists will help limit the profits, and the expansion, of heroin trafficking.
    And we'll actually have real numbers about what's getting consumed.