You lump in cocaine as though all schedule 1 drugs are equal. You are having two different conversations. One of them is complicated (why are LSD, peyote, and marijuana classified with opioids? why are they enforced and punished so unevenly along race and class lines?)
Opioids are critical medical tools for pain management. The solution is to have doctors decide when it is necessary and to have pharmacists manage its distribution. Why this works is that doctors and pharmacists will be delicensed and possibly go to jail for this, and they generally have a highly asymmetric amount to lose from doing so.
Opioids are unlike any other drug. Look at national death statistics. Read this article. If they weren't so necessary for critical pain management and hospice care they'd be completely illegal.
Heroin is dangerous because of cuts like fentanyl and various contaminants, not because you just inherently die randomly after using it.
One could use heroin your whole life with no ill effects. In that way, it's comparable to coffee.
Addicts simply need cheap access to legal heroin to stop using. Only after that's taken care of can they start getting their life back on track and to be about something other than drugs.
Heroin and especially heroin addiction is extremely dangerous, many people die. However, it doesn't have the deteriorating affects that you describe. Heroin users that don't die and are able to get over their addiction have few long term health affects. It's not at all like smoking or alcohol.
It eats you from the inside because everything else in life fall away in importance of being high, and if manage to get clean you are essential on a tightrope the rest of your life and the temptation haunts you all the time. It ruins your ability to feel truly happy or fulfilled by anything besides heroin. You are a day or two away from the morgue the rest of your life.
The addiction cycle usually ends in a place where Hep, sepsis, and HIV are comorbidities. But the long term health effect is the addiction and brain structural changes. Just because it's mental health doesn't mean it's any less real than lung cancer or cirrhosis.
Users are currently resorting to crime to acquire their heroin because it's illegal, not because heroin inherently makes you evil.
That's not quite right. Heroin users definitely resort to crime to fund their addiction. They are not "evil" for being addicted, but they do become desperate. And if you're desperate, you're more likely to do "evil" things.
Most do not immediately resort to crime. Imagine you were addicted to some expensive substance. You'd likely try hard to keep whatever job you had to fund the addiction, then if that fails you'd pressure family to fund it. If family stops paying, then you'd sell whatever property you had. When that's over you may turn to illegal "jobs" such as prostitution or dealing drugs yourself. Only finally, as a last desperate resort, would you try to steal or commit other crimes.
Addiction is not "evil", but it results in desperation. When one is starving for bread, they're more likely push the boundaries of their morality to eat, maybe steal, and in extreme cases maybe worse. Desperation can make people do evil things.
If heroin was not illegal, and therefore not extremely expensive, users would not have to resort to crime to afford it.
Now imagine heroin was legalized and/or freely available: noone would bother to commit crimes, and would be able to start living a regular life since they don't have a single reason to exist anymore. One of their basic needs are taken care of.
It's amazing how quickly we've forgotten prohibition. When you make something illegal that there is a demand for, an illegal market pops up.
If heroin was legal, it's does not necessarily follow that it would be much less expensive. In states that have legalized marijuana, the price is roughly the same (and often more) than black markets.
> it's hard to afford daily heroin with a regular job without resorting to crime.
Regular jobs typically pay more than petty crime. The reason that heroin addicts resort to crime is not because their regular job doesn't pay enough, it's because they can't hold a regular job because they're addicted to heroin.
> Now imagine heroin was legalized and/or freely available: noone would bother to commit crimes, and would be able to start living a regular life
I'm not sure that many heroin addicts (legal or otherwise) can live a regular life.
> If heroin was legal, it's does not necessarily follow that it would be much less expensive. In states that have legalized marijuana, the price is roughly the same (and often more) than black markets.
Heroin is extremely cheap to manufacture, and it's of course also not patented anymore. There's no point to discussing this, really.
> Regular jobs typically pay more than petty crime. The reason that heroin addicts resort to crime is not because their regular job doesn't pay enough, it's because they can't hold a regular job because they're addicted to heroin.
This is partly true. It's a large topic. A heroin habit will take a lot of time, since you're doing a lot of waiting around for dealers. But it depends on the job, though. These days, Americans are very close to losing everything in the time of one or two paychecks. Add a heroin habit of hundreds of dollars a day on top of that, and you need something else.
> I'm not sure that many heroin addicts (legal or otherwise) can live a regular life.
I think far more people are using heroin and keeping a regular life than you realize.
All the ways heroin can kill you are direct consequences of its prohibition.
Most people die from heroin by overdosing (taking too much). Very often, this is a result of mixing heroin with other drugs and pushing the limits of what a human body can tolerate. If it were legalized and regulated, maybe some accidental overdosing could be prevented, but there would be plenty of deaths.
Heroin is pretty different from other drugs because it's pretty easy to die from it. It's nearly impossible to die from smoking marijuana. Even alcohol is safer if you're not driving a vehicle: you're far more likely to pass out before you get alcohol poisoning.
Heroin is significantly more dangerous. A slightly higher dose or a new formulation can easily kill you.
There's 2 groups of heroin overdoses.
1) Varying amounts of cut like fentanyl. Due to heroin being illegal, users have no way of knowing whether their drugs are pure, so it's hard to gauge the dose. The exact same dose can kill you if there's a little too much fentanyl.
2) Taking the same amount after e.g. rehab or tolerance break. Due to the way heroin tolerance works, after a while of not using it, your body will reset the tolerance. So you come out of rehab and of course you want to do heroin again, and many unfortunately start right at their old (extremely high) dosage.
Legalization would obviously help no. 1, but I also think it would prevent deaths due to no. 2, since users would not have to go through rehab until they're actually ready for it. When the system forces you to stop, most users will just immediately start again when they have the possibility.
First, you're assuming that legalizing heroin would result in a high quality pure product. Considering that heroin addicts are desparate for heroin, it's pretty likely that they would go to cheaper black market sources with the same quality problems we have today.
Second, legalizing heroin would dramatically normalize it, very likely resulting in many more people becoming addicted to it. Even if the danger of the drug decreased, it would almost certainly be offset by the large increase in new addicts.
In terms of saving lives, I don't see how legalizing heroin can help.
> First, you're assuming that legalizing heroin would result in a high quality pure product. Considering that heroin addicts are desparate for heroin, it's pretty likely that they would go to cheaper black market sources with the same quality problems we have today.
I don't feel like this is a genuine argument on your part. If it was available in an affordable, high-quality manner, very few people would continue to use dirty, cut and illegal versions.
I think legalizing it is a good start, but an ideal scenario are heroin treatment clinics like we see in Switzerland or Denmark. They are 100% free and obviously use pure drugs.
> Second, legalizing heroin would dramatically normalize it, very likely resulting in many more people becoming addicted to it. Even if the danger of the drug decreased, it would almost certainly be offset by the large increase in new addicts.
I don't think that everyone would start using heroin after it was legalized. Most people are still extremely afraid of it due to e.g. media characterisations. Even so, as I've already postulated, I don't think there's any inherent danger in using it, so it's really a moot point to be honest.
This was probably the main cause of overdose deaths before fentanyl came along. In one study 45% of the deceased also had a blood alcohol level, and 30% were on Benzodiazepines (one Swedish study had benzos present in 55% of fatal overdoses).
https://sci-hub.se/10.1080/09595239996743
>The majority of cases involved heroin in combination with other drugs: alcohol (40%), benzodiazepines (30%)and antidepressants (9%). In only a third of cases was morphine the sole drug detected.
https://sci-hub.se/10.1046/j.1360-0443.1996.911217652.x
>Fatalities involving only heroin appear to form a minority of overdose occasions, the presence of other drugs (primarily central nervous system depressants such as alcohol and benzodiazepines) being commonly detected at autopsy.
From what I’ve heard, most addicts prefer heroin to fentanyl, even though it’s less potent on a weight basis.
It's less risky then fentanyl most of the time.
Brompton cocktail: https://en.wikipedia.org/wiki/Brompton_cocktail#Variants
>Some specifications for variants of Brompton cocktail call for methadone, hydromorphone, diamorphine (heroin), or other strong opioids in the place of morphine.
Like others are saying, other powerful opioids are used instead.
A GP could also prescribe it no problems. Indeed there are a small number of people that get it prescribed if other drug treatments have failed.
Always follow the money.
So if following the money is the answer, why doesn't this happen?
Pain is a complex phenomena.
This has caused a lot of problems with pain treatment. We used to think heroin was okay, then we realised it was addictive. So we moved to other opioids thinking they weren't as addictive, but they are all about as addictive as morphine and diamorphine. We started reducing the quantities of the opioids and adding other meds like paracetamol / acetaminophen. This led to fucking stupid meds like coproxamol -- a mix of dextropropoxyphene (an opioid) and paracetamol. This opioid is very toxic, and it was killing many people in the UK until the licencing changed. And then we tried other meds like NSAIDs and etc. Some of them sort of work for some pain, some are very good for a specific type of pain. But they all have side effects.
We split pain up in different ways. We talk about chronic (long term) pain or acute pain. We talk about medically unexplained pain, and the implication is that the other pain has a medical explanation.
The public have three incorrect beliefs about pain treatment.
1) Opioids are effective
2) Pain is either real or imagined, and imagined pain isn't real pain.
3) The aim of pain treatment is always to eliminate all pain and anything less is a failure.
Turns out none of these are true.
Opioids are a good choice for a limited number of patients. It's really important that people get all the opioids they need at end of life, for example. Or that people going through surgery have them available if needed. But for long term pain they're a bad choice. The person in pain ends up taking very high doses of opioids, with all the side-effects that causes, and they're still in pain. We can see their function - the stuff they do every day - is much reduced. We also see some conspiracy-theory style thinking here - "morphine is dirt cheap and this non-opioid you've got me on is really expensive, because you're in the pocket of big pharma".
We know that patients reject psychological treatment for their pain. They'll say "but my pain is real, it's not all in my head". But many pain patients experience benefit from psychological treatment. (Imagine a purely physical disease like t1 diabetes. Even these patients will get benefit from a psychological treatment. Clearly I don't mean that mindfullness will control blood sugars, but the 3 questions "can you do your bloods every day?", "can you take your insulin at the right dose and right time every day?" and "can you adjust your diet and lifestyle?" -- these are all firmly psychology).
Sadly, lots of people in pain will not experience relief from that pain even if we give them high dose opioids. So pain treatment should be looking at function. The aim should be to allow someone to live their life even if they still have pain.
For one example of this see "Sean's Story" https://www.england.nhs.uk/south/2019/06/25/seans-story/
There's also a visit to a pain-management clinic in a section of this radio programme: https://www.bbc.co.uk/programmes/b04wv052