Heroin

Inspired by some discussion about whether locking up drug uses is any more tolerable than locking up perpetrators of hate speech I did a little digging on Wikipedia to confirm my understanding of the medical implications of Heroin use. Wikipedia lists the following complications that can arise from Heroin use:-

1. For intravenous users of heroin (and any other substance), the use of non-sterile needles and syringes and other related equipment leads to the risk of contracting blood-borne pathogens such as HIV and hepatitis, as well as the risk of contracting bacterial or fungal endocarditis and possibly venous sclerosis.
2. Poisoning from contaminants added to “cut” or dilute heroin
3. Chronic constipation
4. Addiction and an increasing tolerance.
5. Physical dependence can result from prolonged use of all opiate and opioids, resulting in withdrawal symptoms on cessation of use.
6. Decreased kidney function. (although it is not currently known if this is due to adulterants used in the cut)

Of these 1 and 2 are primarily a problem associated with illegality. If heroin was legal then quality would improve.

Number 3 is obviously uncomfortable but in and of itself not generally a serious medical problem.

Number 4 is a given. The hit that heroin creates is highly addicative. Number 5 is merely the other side of the same coin.

Number 6 is the only real medical implication included in the list. However when you dig into the first source document that Wikipedia links to in relation to this it actually says “Use of marijuana, amphetamines, heroin, and other drugs was associated with elevated, but not statistically significant, risks for mild kidney function decline.” In other words there is a risk but not a big one. Alcohol consumption is know to cause similar problems.

Let me be real clear. I don’t recommend to anybody that they mess with heroin. It is very addictive and in my opinion the implications of possible legal sanctions and the economic cost associated with addiction is not worth it. The pleasure benefit does not endure with extended usage in any case. However the ongoing criminalisation of heroin use is stupid. All the significant negatives associated with heroin use stem from criminalisation not the actual substance itself. If harm minimisation is the goal then prohibition is a dismal failure.

40 thoughts on “Heroin

  1. No disagreement here. The current approach to drugs has clearly failed and is arguably exacerbating the problem.

    The main problem I see with drug law reform is how to manage the negative externalities associated with drug use in the event that drugs are legalised and firms are permitted to profit from drug production and sale. Given the existence of socialised health care, legalisation would in effect lead to taxpayers footing the bill for the benefit of drug users and their (legal) suppliers. So I think there still needs to be an element of regulation – suppliers should be taxed just as cigarette companies are for the externalities they create.

  2. Also worth noting is that if you stick an HIV contaminated needle into your arm the probability of actually contracting HIV is apparently 67 in 10000. Not good but a long way from guaranteed. The law of averages would suggest that you need to engage in such an activity around 150 times before you get infected. And obviously not every shared needle contains HIV.

    http://en.wikipedia.org/wiki/HIV#Transmission

  3. Mitchell,

    Legal heroin would have less medical costs associated with it than tobacco. Tobacco use increases the chance of lung cancer and a multitude of debilatating and/or killer diseases.

  4. Terje,

    I don’t dispute that, in theory anyway. It would be interesting to run a comparative medical trial of ‘clean’ heroin users vs tobacco users and see what came of it, though I suspect you may be proven right…

  5. Opiates ought not be thought of as all that bad. But Heroin can never be good because of its method of transmission into the body.

    Its too much all at once. Its just going to overpower your endorphines and leave you endorphine-defficient the rest of the time.

    The other thing is that every needleman has woken up one time in his life and his mate who he was shooting up with has died. Died peacefully but died.

    To me the rest of drug legalisation is a no-brainer. And we must legalise heroin also. But heroin is one drug where the transition probably does need some harm minimisation.

    The deal with drugs is you want to lure people into slow-release. For example alchohol is a potentially seriously damaging drug. Yet light-beer between 8.00pm to 10.00pm for a 9-5 worker ought to be considered almost a HEALTH DRINK. Whereas if you are having a triple-shot of Bundaberg rum in the mornings as a “heart-starter” then that doesn’t speak too much for a productive and healthy future.

    No group of old Chinese men chilling out with opium in the evenings, to help with the aches and pains of old age, and the loneliness of life on a new continent, ever did anyone any harm.

    But jacking opiates up your arm. Thats pretty dangerous stuff.

    My idea for transition was to have a smartcard and make all these drugs very cheap to the user but the harder the gear is the more he has to contribute to his own superannuation fund. So to have low-octane hash cookies is cheap and only leads to a small forced payment to the users own superannuation. Light beer is sold everywhere and has no taxes imposed upon it and requires only a small forced payment to the users super…..

    But the hard liquor is also dirt cheap. But requires a much greater contribution to the users own super.

    And jacking heroin up your arm costs about 50 cents. But maybe thats $20 dollars for your super, and maybe another $10 dollars towards paying off your mandatory defibrillator and oxygen bottle that you’ve bought on credit under the scheme. And a certified person that is going to be able to sort things out if you get greedy and your heart stops and all that…….

    But if you want to chew low-octane heroin gum thats $2 a pack and only 50cents going to your super.

    Now this is not a forever thing. I’m only talking about an immediate transition to decriminalisation the whole lot in one hit.

    A FAST BUT SAFE TRANSITION ought to be our internal motto.

  6. “The law of averages would suggest that you need to engage in such an activity around 150 times before you get infected.”

    Mathematics aint that simple 🙂

    67 * 150 = 10,050… but

    1 – ((9,933/10,000)^150) = 0.635

    Or a 63.5% chance.

    That’s assuming the initial 63/10,000 figure was correct… hell of a risk to take tough.

  7. Drug prohibition also creates crime. It creates a crime industry were nasty people profit from human misery. It also means that cops waste their time chasing after this type of criminal that prohibition creates which takes away their resources for fighting real crime.

    Let people be responsible for their own actions and let the cops chase after wife beaters and rapists!

  8. Fleeced – you have calculated the risk of infection after 150 jabs with an infected needle. That is not the same as the average number of jabs required to get infected.

    I agree that nobody would be advised to jab themselves with an HIV infected needle. I certainly wouldn’t. And HIV is hardly the only risk. However most shared needles are not going to carry a disease and if heroin were legal it is unlikely that many people would be sharing needles. Diabetics jab themselves every day and seem to cope well enough with the procedure. I have a diabetic friend who takes some delite in injecting himself in front of strangers just for the reaction it gets. The primary medical implications associated with heroin use stem from prohibition not chemistry.

    If people want to make a point about illicit drugs being really destructive to your health then heroin isn’t really a good example.

  9. BUT BEN! What would we do with all those excess prison guards and police, and all those prisons, after we’ve ended drug prohibition? Decriminalisation would also need intensive retraining for the losers, though I suppose the prisons could be turned into boarding schools, or spartan holiday camps.

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  11. Almost all users iniate heroin use when they are young risk-takers. They are myopic in outlook with high discount rates. There are significant health risks of using heroin – your mortality each year is around 2% above the rest of the population. Heroin use is not a rational choice and there are no rational addicts.

    Being addicted means having a compulsion to use and an obsession with obtaining supplies – not very attractive.

    The moral argument that people should be free to do what they like provided they don’t harm others is something you can choose to accept as a libertarian – I don’t accept it. But you cannot deny that the costs of being compelled to use a drug for the rest of your days and for risking a variety of health concerns is a serious one.

    I am pleased that you do not encourage people to ‘mess’ with heroin. There are better things you can do with your life than using drugs – fly a kite with your kids or younger siblings in the local park, take up ballroom dancing or birdwatching. I think it is important to accent the positive in life not daft preoccupations with mind-numbing drugs.

  12. Sure. However prohibition should also be discouraged because it wastes lives. There are better things to do with your life than lock people in cages for making unwise decisions.

  13. HC, people will never increase their rational thinking abilities if you simply make substances that are bad for them illegal.
    Also, you say “almost” all users take it up when they’re young. Why should the presumably rational oldies also be penalised. Or why not make heroin use illegal for those under 18.

    Heroin is not as addictive as the naive general public have been led to believe. Also, withdrawal is generally quite mild. And heroin withdrawal is far less dangerous than alcohol withdrawal. There is no danger of death as with alcohol withdrawal (that can put your heart under a lot of strain).
    Here’s an excerpt from a recent book “Romancing Opiates” by Theodore Dalrymple:

    “The distress that addicts do feel is based solely on their beliefs about the withdrawal of the drug: it’s purely psychological. Studies have shown that addicts aren’t able to tell whether they’ve been given morphine or placebo, such that symptoms like nervousness and restlessness came and went based on what they were told about the contents of their injection (28)”.
    “However, addicts are extremely adept at faking such distress in the hopes of wheedling a prescription from the often-gullible doctor. Most doctors accept the standard view that withdrawal from opiates is a terrible ordeal, despite substantial evidence to the contrary, such as the addicts displaying no great signs of distress when secretly watched by the doctor. So the doctors routinely prescribe the addict drugs like methadone”.

    The fact is that every drug addict and every gambling addict and every other addict makes repeated choices to engage in their activity. Even though it becomes harder to resist, the choice to stop is always available.
    Commonly, addicts choose not to think too hard about their predicament. This mental evasion is also a choice, and making things illegal doesn’t address this problem. An authority dependence mentality (fueled by government forced prohibition of non-violent crimes) makes this problem worse in fact.

    HC, no one here is advocating heroin addiction. Quite to the contrary. Legalization may enough reduce useage rates.
    Legalizing heroin would dramatically reduce the profit margin, thereby most likely reducing supply. Also, just as in Amsterdam with marijuana, those who didn’t use before legalization, still don’t use.
    Would you rush out and buy heroin from your local shop? No, and neither would I.

    The best argument for legailization is that you will decrease crime rates and overall cost to the community – both in economic terms and in security.

    If someone wants to give up on life, or kill themsleves, you can’t do anything about that anyway – enforcing bans does not address this person’s real problem and can reinforce their irresponsible mentality which is part of the original problem.

  14. It’s a bit like the argument over obesity- it should be left to the people to choose to exercise their will power. The people who lose weigh are those who voluntarily choose to do so, not those put on programs by others. Certainly the government should not be handed the control of our diets!
    What next- mandatory sex, because it’s been found to be beneficial? And make sure that some of those sex sessions are homosexual, and most heterosexual, to reflect percentages of the community?
    I would not advocate drug use, or homosexuality, but banning them does not solve the problems. The libertarian perspective should surely be to call on the government as our LAST resort, not the first!

  15. Nicholas is right, if you take the idea of banning things that are bad for you to its logical conclusion you can see how ridiculous this idea becomes.

    The problem is that over time people forget how ridiculous bans are and they get used to putting up with the bureaucratic inconveniences and expense that is forced on all of us.

  16. Graeme: Intravenous drug use in and of itself is a result of prohibition.

    Before prohibition the most common form of taking Heroin was by drinking it in a liquid form. It was a relatively common over-the-counter cure for coughs, colds (and everything else).

    The patent medicine craze of the late 1800s in the US was primarily due to heroin, where patent medicine salesmen would travel the countryside selling bottles of “Magic Elixirs” purported to cure all your ills. And due to their high narcotic effect, they were actually pretty effective.

    Heroin was legal in Australia in this form until the 1950s.

    The reason people now take it intravenously is because prohibition has made it so much more expensive. You couldn’t afford to drink it now, unless you are a millionaire.

  17. Yobbo – I was under the impression that the reason people inject heroin nowadays is that it produces a much more intense high.

    Tim R – on the contrary, all studies have shown that legalisation does not reduce drug consumption. It increases useage. I also wouldnt call the public ‘naive’ for not being aware of the effects of heroin on the body. I would call them ‘smart’.

    Graeme makes some good points in #6 (yes – it’s not often i write that). I would see hard drugs made available at the local GP practice. They would be sold to users who would have to submit to counselling and rehab programs. I would also want the govt to impose a health insurance levy onto the price to pay for their medical treatment down the road (similar to the tobacco tax).

  18. We don’t make people buy alcohol or tobacco at the local GP. And neither should we with heroin. I’d support light regulation to keep it away from kids and to sell it in standardised quantities such as alcohol. There are other drugs that might warrant serious regulation but in my mind heroin is not one of them.

    I agree with Pommy that legalisation tends to increase usage. However I believe it also reduces harm and saves the law enforcement and prison resourses for more important initiatives.

  19. “Yobbo – I was under the impression that the reason people inject heroin nowadays is that it produces a much more intense high.”

    It produces a more intense high with the quantity you have available, yes. Buying a bottle of cough syrup with Heroin at current prices would cost thousands or tens of thousands of dollars, as opposed to a quantity suitable to be injected which will run you about $50.

    Apart from that the only real difference is that it will hit you quicker, because it doesn’t have to go through the stomach to get into your bloodstream.

    It’s possibly to intravenously inject alcohol too. It’s much cheaper (5ml instead of 500ml) and the effect hits you quicker. However, most people don’t do it because it’s safer, more convenient, and reasonably cheap to consume it in liquid form.

  20. Should note here that the homeless and others without the means to buy alochol frequently do inject it.

  21. Well Pommy, I don’t know what studies you’re looking at. Because most of the journal articles I’ve read on Australian drug law enforcement conclude that the policing of drugs had little impact on useage and on availability.
    We’ve seen big increases in drug use during this century in the face of prohibition around the world.
    Look at the recent rise of ice for example. Meth-amphetamine (ice prior to recrystallisation) has been illegal for a long time in Australia. More and more chemical precursors have been banned. Now I can’t even buy pseudo ephedrine tablets without panadol in them (which I usually don’t want if my nose is running).
    Marijuana use has not increased for the Dutch (aside from the tourist industry).
    Alcohol consumption rose in the US during prohibition especially amongst women.

    But I personally think that when it comes to drugs, gambling, over eating or any personal vices, people largely do what they want regardless of the law.
    Prohibition is not the way to convince people to be healthy. And it is not libertarian.

    I think we agree the public are naive of the effects of heroin. I agree they are smart to have no interest in the details of heroin’s effects, but that doesn’t change the fact that the public are not smart to so willingly be scared into supporting prohibition with the huge cost and increased crime that arises from this.
    eg/ Look at the rise of a politician such as “No Pokies” MP Nick Xenaphon. He’s been extremely sucessful as a politician mainly because he wants to forcibly “protect” people from themselves. This is the antithesis of libertarian ideas, and I see this guy as being potentially very harmful to society.

  22. Bravo, Terje, for taking on a tough, unpopular subject and recommending an effective but (again) unpopular stance.

    If you are for gun rights you have to be for drug rights too. Drugs don’t kill people, people (using them unwisely) do.

    Putting people in cages for using/selling drugs is no different than doing the same for using/selling guns. It has no positive affect on the rate of social harm.

  23. Spot on. But for me, its quite a simple issue that boils down to a really simple question about the initiation of force.

    “Whether you love or hate drug use, no matter what you think of it, do you think its a proper function for a police force to arrest and imprison drug users ?”

    Or even more simply, describe it in terms of meddling.

    “Would you personally hire security people to break in and search your neighbours home if you suspected there were drugs ?”

  24. Trinifar: If you are for gun rights you have to be for drug rights too

    Too right! Robert Anton Wilson (RIP) founded the Guns and Dope party on that premise. Their position paper went as follows:

    Little Tony was sitting on a park bench munching
    on one candy bar after another.
    After the 6th candy bar, a man on the bench across from him said,
    “Son, you know eating all that candy isn’t good for you.
    It will give you acne, rot your teeth, and make you fat.”

    Little Tony replied, “My grandfather lived to be 107 years old.”

    The man asked, “Did your grandfather eat 6 candy bars at a time?”

    Little Tony answered, “No, he minded his own f*cking business.”

  25. Nicholas: What would we do with all those excess prison guards and police, and all those prisons, after we’ve ended drug prohibition?

    The guards could all become bouncers at newly created Heroin bars. It would be the sweetest job ever as they would have nothing to do!

    As for the prisons themselves: Boutique living for the terminally rich and bored.

  26. Or you know how CEO’s etc have been known to frequent dominatrices? Faux prison would give them the break in responsibility that they crave without the stigma of being nipple cuffed, gagged and beaten into submission.

  27. No, actually, Ben, I didn’t know that. Thanks for that revealing (shudder) insight into the lives of the rich and bored.
    If we started our own Guns, Obesity and Drugs Party, the G.O.D. Party would also gather all the religious votes! That could be why RW DIDN’T go on to become President- the religious vote is very important in America, and the G.D. Party doesn’t sound as blessed.

  28. Has anyone else noticed that the Recent Comments column looks like a confessional? It’s disspiriting to see all these libertarians ‘on Heroin’! Ben, get control of your life! Get OFF Heroin!!! For the love of G.O.D.!!!

  29. Bravo, Terje, for taking on a tough, unpopular subject and recommending an effective but (again) unpopular stance.

    Cheers. However on this blog it seems like a reasonably popular stance. Of course I think that it would be a tough nut to sell politically because heroin has been demonised for decades.

  30. This report seems to imply that the downgrading of cannabis to a Class C drug in the UK has led to lower useage. Good news. However, at the same time, use of harder drugs has increased. Not so good.

    http://www.timesonline.co.uk/tol/news/uk/article2738569.ece

    I wonder whether a lot of the allure of drug using is its illegality and hence ‘cool factor’. Perhaps legalisation would remove the fashion victims.

    Perhaps the way forward is to make free trade coffee illegal.

  31. I wonder how one measures the “hardness” of a drug. Heroin is commonly characterised as harder than tobacco but I can’t figure out the basis for this description. Is it related to how much pleasure the drug brings, how much damage the drug does to you, how addictive it is or merely how long you will spend in jail? Maybe it comes from the notion of doing “hard time” or maybe from the type of people that deal in the product.

  32. From the wikipedia article Terje links:

    “In the United Kingdom, heroin is available by prescription, though it is a restricted Class A drug. According to the British National Formulary (BNF) edition 50, diamorphine hydrochloride may be used in the treatment of acute pain, myocardial infarction, acute pulmonary oedema, and chronic pain.”

    Sounds like the kind of thing you want when you’re old and sick.

  33. Terje,

    There is not hard measure. The classifications are educated guesses but nonetheless reasonable guides. There is no way to accurate define how addictive a drug is, that depends on the person and the circumstances of drug usage. Context of use is very important in determining response to a drug. There are also psychosocial factors at play. For example, there are some subtle changes in receptor density for dopamine D2 receptor which can occur during social deprivation and this appears to predispose towards latter addiction. Tentatively, one could argue that chronic poverty, alienation, and a sense of not belonging to a group may predipose some individuals towards addiction.

  34. Heroin is my libertarian purity test. Either you can look past the decades of government propoganda and embrace the idea of freedom or you can’t. You decide. No spirited defence of freedom of speech will buy you a pass – we all support freedom of speech.

  35. Heroin is a strong drug. some may say after doing heroin first your hooked and is a point of “no-return”. what do you guys think? is it really a point of no return?

  36. Pingback: Decriminalising Heroin? « Thoughts on Freedom

  37. I tried to talk to a colleague about this same issue recently (http://laurynangela.wordpress.com/2009/09/18/why-are-morals-and-laws-so-difficult-to-separate/)… People seem to have difficulty relinquishing the notion that “if it’s bad for you, the government should get involved”. If heroin was legalised and regulated, a lot of the issues associated with it would be minimised, and the ones that wouldn’t could be addressed for what they are: personal addiction, or health problems. Not crimes.

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