Terra Sigillata

Heroin Hits The Heartland

Posted by Abel Pharmboy on May 31, 2009
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When one thinks of a heroin user, thoughts most often come to mind of a person living in squalor in a big metropolitan city or that of an artsy, poetic hipster (while there are many literary works on the life of heroin users, my all-time favorite is Basketball Diaries, an autobiographical account written by Jim Carroll during the ages of 12 to 15. From this description of Carroll’s two works on his life with heroin at the catholicboy.com website of Carroll scholar, Dr Cassie Carter: “After reading about 30 pages of the Diaries, [Jack] Kerouac stated that ‘at the age of 13, Jim Carroll writes better prose than 89 per cent of the novelists working today’”

And when one thinks of drug problems in place like Ohio or Iowa, clandestine synthesis of the drug in trailers is usually what I first think of.

These notions are shattered on the front page of today’s Sunday New York Times in an excellent article by Randel C. Archibold with Antonio Betancourt.

Heroin is a semi-synthetic derivative of the natural product, morphine. The water-soluble hydroxyl groups on the molecule are acetylated (with acetyl chloride) to produce a molecule, sometimes called diacetylmorphine, with greater ability than morphine to cross the blood-brain barrier. When injected, heroin produces an intense euphoria that radiates throughout the body in a manner that morphine cannot. While it is difficult to quantify how “addictive” a substance can be, most of my neuroscience colleagues would rate injected heroin among the most addictive substances known.

The lynchpin of the spread of heroin across suburban populations is its surprisingly low cost today:

Investigators say that Arthur Eisel was not alone in switching from a prescription painkiller to heroin. It gives a similar, euphoric high at a fraction of the cost, $10 to $20 for a “balloon” — one dose, usually a gram or less — as opposed to upwards of $60 for a typical prescription pill dose on the street.

The article is more of a personal family story of the late Arthur Eisel. But it certainly opened my eyes as to how prevalent and inexpensive heroin is in the most unlikely of places.

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Comments

  1. #1 Comrade PhysioProf
    May 31, 2009

    I wonder how many overdoses would be prevented if heroin addicts could legally obtain heroin of defined purity and potency, and thus could properly control the dose?

  2. #2 Mark montgomery
    May 31, 2009

    I agree with Comrade PhysioProf. The majority of heroin overdose deaths would end the day they legalize heroin. Heroin should be legal. Mexico just legalized possession of small amounts of all drugs. Switzerland just legalized heroin. Portugal decriminalized all drugs in 2001 and their experience has been positive. Now if you are caught with a 10 day supply of your drug or less you face an administrative court, not a criminal court, but in practice they are just not arresting people. A group of 10,000 very serious policemen, prosecutors, attorneys and citizens have formed a group to legalize ALL drugs, Law Enforcement Against Prohibition (http://leap.cc ) They see what happened when we legalized alcohol in 1932 as a good example of how drug legalization would work. This foolish war on drugs has lasted 37 years and cost us over a TRILLION dollars and we are not an inch closer to stopping drugs. How many millions of Americans are we going to lock up in prison for decades? Mark Montgomery boboberg@nyc.rr.com

  3. #3 David
    May 31, 2009

    several factors contribute to overdoses. not all would be helped by legalization:

    first, there’s a narrow “therapeutic” range, particularly for opioid-naive users. second, there’s tremendous inter-individual sensitivity to opioid effects. third, chronic users habituate and end up using larger doses, which would be fatal to new users. But most users (and in fact many doctors) don’t understand that. Probably the only factor I know that legalization would alter is the highly variable purity of street-traded drugs but that’s just one of many issues.

  4. #4 Klem
    May 31, 2009

    I also agree with Comrade PhysioProf. One hundred years ago heroin was sold over-the-counter in the US, and problematic use was about the same as today. Note, the Pure Food and Drug Act of 1906 required accurate labeling of purity and dosage, especially for products containing heroin, cocaine, etc. It’s disgusting that one of the stated strategies of today’s drug prohibition is to keep down the purity of street drugs.

  5. #5 Bill
    May 31, 2009

    Yes, there are many variables that contribute to an overdose, but the biggest is by far the unpredictability in purity, closely followed by users that take a break, and forget that their tolerance has decreased. Legalization, with tough restrictions set up similar to alcohol would make so many people’s lives a better place. Crime rates would be nearly eliminated if drug dealers could open up a legal shop, there would be less robery, and most importaint, less death. As someone who’s about to make the switch from perscription painkillers to heroin, it’s just the logical choice. Cheaper, better, what more could you ask for? And I’m not surprised the switch from drugs like oxycodone to heroin hasn’t happened sooner.

  6. #6 leigh
    May 31, 2009

    OD from prescription opiates (recreational use or otherwise) isn’t exactly rare, what makes anyone think that known-dose heroin would be any safer?

  7. #7 Josie
    June 1, 2009

    Thank you for linking this.

    I’m an Ohioan myself, and just a few years ago a close family member of mine succumbed to heroin. I’ve been following the drug since we learned of his addiction, and more wholeheartedly since his death, and I would really like to see some of the common misconceptions on the drug shattered with more people.

  8. #8 DrugMonkey
    June 1, 2009

    leigh@#6:

    http://www.lasvegassun.com/news/2008/jul/07/rising-use-painkillers-taking-deadly-toll/

    The skyrocketing use and abuse of prescription narcotics in Las Vegas is accompanied by a similarly startling increase in the number of fatal overdoses, a Sun analysis has found.

    Fatal overdoses involving prescription painkillers more than quadrupled in a decade and now exceed those involving illicit drugs, according to data compiled by the Clark County coroner’s office.

  9. #9 H.Claus
    June 3, 2009

    Switzerland did not fully legalise heoine, but it considers it as a prescription drug, end being addicted is considered being ill. So people who are addicted are treated like people who have a kidney illness : every morning they go to the hospital for a controlled shot, they get a talk with a trusted person etc; The systems seems to work and seems to have two benefits : less money available for organised crime, so less organised crime and the fact that you have to queue for a drug shot is so un-cool that youngsters consider addiction as something for older baldheaded people.

  10. #10 leigh
    June 4, 2009

    @DM: thanks, that definitely reinforces my point.

  11. #11 Comrade PhysioProf
    June 6, 2009

    The skyrocketing use and abuse of prescription narcotics in Las Vegas is accompanied by a similarly startling increase in the number of fatal overdoses, a Sun analysis has found.

    Fatal overdoses involving prescription painkillers more than quadrupled in a decade and now exceed those involving illicit drugs, according to data compiled by the Clark County coroner’s office.

    On its own, this doesn’t mean jack diddly shit, and you know it, holmes. What matters is the relative *rate* of fatal overdoses between prescription and street opiate users. Nice try, though.

  12. #12 DrugMonkey
    June 7, 2009

    Your initial comment, PP, tnds to suggest you feel that with a known content supply there wouldn’t be overdose. I am addressing the percept.

    I understand what you mean about rate but from a policy perspective if you take an action that will increase the number of users than raw numbers are highly relevant.

  13. #13 Comrade PhysioProf
    June 7, 2009

    I understand what you mean about rate but from a policy perspective if you take an action that will increase the number of users than raw numbers are highly relevant.

    What evidence is there concerning the likely effect of highly regulated legalized heroin on the number of users?

  14. #14 MJF
    August 19, 2009

    in 1982 a program was created in Liverpool, England that had dramatic and instant results. Heroin addicts were given free and clean needles as well as prescribed free heroin doses for their participation. The rules of the agreement were simple; you must be an addict, you must not commit any crimes and you must receive drug counseling while in the program. Breaking any of these rules would result in the immediate removal from the program and loss of access to free heroin. The researchers found: 1. Crimes such as home invasion, burglary, and muggings all decreased because addicts no longer had to steal to support their habits 2. None of the participants had contacted HIV 3. The addicts in the program had an increased rate of beating their habit and getting clean 4. Drug use in the area surrounding the clinic had gone down due to participants no longer needing to sell drugs to support their habit as well as other sellers leaving the area from loss of buyers. In 1995 the program was shut down, forcing people back on the streets, and within two years twenty-five of the former patients had died.

    What some call prescribing heroin in a regulated program is “sending the wrong message”, it shows that whatever it is we are currently doing in the US has never given similar positive results.