tmp-20150107

You'd be surprised. It's definitely being sold on as an opiate to addicts in UK prisons, both from being smuggled in (small, easily concealed, innocuous looking pills) and diversion from maintenance scripts (although I would have thought in a prison environment they would simply stand over you and wait until you swallow, or force you to drink a glass of water, since unlike someone on a treatment program voluntarily there are no issues about personal liberty etc. From what I've heard, the 8mg tablets are crushed into powder, divided into eighths and sold as 1mg doses for snorting (maybe injecting, but works in prison are pretty dodgy...)

Interestingly, although the treatment center I'm with offers both Methadone and Subutex/Suboxone I was never actually given the choice between the two, or informed of the pros and cons of either. I asked, and basically I was put on Methadone treatment because I happened to mention it in one of my admission interviews. No idea if this is policy driven due to pricing or something else?

Actually, I suspect it may just be a lack of training due to low funding levels, poor compensation for staff which leads to high turnover and lower quality. Thanks, NHS.

Wow! This makes slightly less angry about the hoops I had to jump through to get on a treatment program with the NHS in the UK. (Well, the part of it where prescriptions are still free.) At least they don't add to the problem by making you pay to get help...

Yes, technically the tests are to show the opposite - that you are (not) opiate naive. Someone who can pass multiple closely spaced toxicology screens for heroin (i.e. opiates are not detected) is never going to be admitted to one of these maintenance programs due to the incredibly high risk of death by overdose.

It's been known forever that all opiates are addictive, varying only by degree to some extent. At least with Methadone there was the excuse that it was chemically different...

Urban legend. With broken bones and enough injuries to be prescribed an amount of take home opiates that would be worthwhile for an addict, you'd be in hospital fora day or two at least, maybe more. One thing about addiction is that immediate access to the drug is more important than anything else. No addict is going to bother with this sort of thing just to get a dozen or so Codeine pills...

Buprenorphine has been available for as long as oxycontin. Subutex (the trade name) is sold on the street, and is a commonly abused drug in UK prisons currently, usually as fractions of a pill taken nasally.

Really, this patent is nothing to do with the drugs involved - even the idea of adding Naloxone isn't new, this is available as Suboxone, nor is the idea of sub-lingual administration. As far as I can tell what is being patented is administration in a gelatin-film matrix that dissolves very quickly, preventing diversion and resale on the street.

Remember that these drugs are not just handed out as a month's supply of pills like you would get antibiotics. Instead, they are 'supervised delivery' where the user must take the pill in front of a pharmacist. The fear is that if the pill takes 5m to dissolve, then it could be spit out and sold on once the pharmacy or treatment center has been left, so dissolving in seconds prevents this. Personally, I'm not convinced this is a problem except perhaps in prisons (see above) but then I'm also not convinced the idea is patentable...

Seems dubious.

On the methadone program I'm on, before they could start the treatment, I had to take multiple toxicology screens to show I was addicted to heroin. These places are incredibly worried about opiate-naive individuals overdosing, which can happen even with the small initial doses on these programs. Note that this is in the UK, which has a much less litigious medical culture USA as well...

Not to cast aspersions on your friend, but have you considered that he may be lying to you about only using recreationally, and using this story to explain why he's on a treatment program? One thing about heroin is that it's pretty much impossible to use regularly without becoming addicted. As a heroin addict myself I know that unfortunately deception can easily become a normal part of your life.

no problem...

this is exactly why it took me so long to get help for my heroin problem. i'm a senior software engineer, but if i admitted to my addiction at work, the stigma and ostracism from people like you would be awful. fortunately i am now in a methadone program, due to a manager much more open minded than this...

This is a little disingenuous, without further elucidation. As far as the statistic you have quoted is concerned, it tells us nothing about how dangerous cocaine is. We need to know how many out of the total population of cocaine users experience chest pain, how many of them go to an ER, and then how many of those (who in total make up 1/3 of ER presentations with chest pain) are further diagnosed with some actual serious problem...

if we don't know what the outcome of these ER visits are, then it could well be that for some tiny percentage of cocaine users there is a side effect that causes the perception of chest pain, which disappears with no ill effects after a few hours. or, maybe, this represents almost all cocaine users - 90% of them experience severe enough chest pain to warrant an ER visit, all of whom are pronounced dead withing minutes of arrival.

annoyingly, the website you linked to which details this singular datum, does nothing to clarify as to what the truth of the matter is. it certainly doesn't appear to be "advancing addiction science" in any useful way...

it seems these are common attitudes:

> [heroin's] effects are fundamentally incompatible with the "head space" geeks need to be in 24x7 to be even remotely capable of doing the work they do.

> It's difficult for me to imagine downers or opiates being at all compatible with technical work

> Meth, crack and heroin are hugely frowned upon, it's a failure to be a user of these

it depends. as a heroin addict, I need the heroin (well, methadone now, as well) to be physically and mentally well enough to work. without them, i'd be a wreck. now, if i took a large shot of heroin, i'd nod out and couldn't work, but i have had a morning injection every day for years to get going. of course, i do feel like heroin has made me slightly less intelligent, i guess the equivalent of ~10+ iq points lost, maybe. but i can certainly produce good quality technical work, and have been recognised for this by peers, so it's possible, just not advisable ;) and of course, i'm selling myself short, since i'm probably capable of much more or better, at least i hope i will be once i am properly clean - maybe this year will be the one?

interestingly, i've not met any other heroin using it professionals in real life, but probably for the obvious reason they don't want to make it known. i could probably tell if i checked, e.g. pinned, tiny pupils, that sort of thing, but i'm just not looking for it in the work environment. a consequence of trying to blend in is that it imposes a high cognitive load that takes away from other thinking i might be doing - i generally have to lie about non-work activities or be vague and non-committal, and so on.

+1

so, you can browse my comment history [0] for more detail, but here's the gist:

- heroin addict for ~20 years, smoking and iv injecting, plus crack cocaine

- senior software engineer at startup, contributing to open source and speaking at conferences and meetups

- now trying to quit, using methadone replacement provided by uk national health service

my work situation helped by very supportive boss who knows about my problem, and encouraged me to take steps to fix it when he saw my work was suffering (time management for things other than 'obtaining heroin' often suffers as a heroin addict) but not told anyone else.

there was a bad situation at a previous job where i had good health insurance that enabled me to enter a private rapid detox program (then naltrexone implants to stop opiates having any effect for the next six months, plus CBT/counselling) but then my immediate manager got me fired essentially for completely arbitrary and made up reasons, but i was unable to do anything about that due to not wanting anyone else to know i was an addict.

various interesting things happened to me while travelling to conferences or remote customer offices, often in other countries. it's actually fairly easy to buy heroin on the street anywhere in the world, it turns out, even without speaking the language.

if you'd like more information, feel free to ask me anything and i'll try and reply if i can.

0. https://news.ycombinator.com/threads?id=tmp-20150107

This is odd to me - how would a four year old develop a fear of needles? At worst they're an instantaneous sharp pain that lasts milliseconds, most of the time they aren't even felt...

Indeed. The bio-availability from 'chasing the dragon' on tin-foil is something like 50% or even less, although in the UK at least powdered heroin is adulterated with things like caffeine (which causes heroin to vaporize at a lower temperature) to make smoking more effective. Obviously IV injecting gives 100% bio-availability, though.

Like 'skellera says in the sibling comment, heroin is an incredible time-sink. The methadone programme I am on (provided free by the UK NHS) is something that will let me gradually reduce the amount of heroin I'm taking, and eventually yes, get clean. After a couple on months in, I'm down to ~25% of what I was taking daily before, and that should reduce further to zero over time.

A methadone maintenance program will gradually increase the amount of methadone prescribed, while the user reduces the amount of heroin they take, until the user is 'stable' and no longer using heroin. After that I certainly would like to then stop taking methadone too, but in some cases the maintenance can continue indefinitely and it would still be considered a net positive outcome...

Heh, heroin does cost about that much, same for methadone, at least in the UK. I can get 100ml of 1mg/ml methadone for GBP 10 which will keep me stable for a day or two; a GBP 10 (i.e. 'tenner bag' or 0.2g) of heroin is enough for a single IV shot for many users. Of course, depending on your tolerance, that may well not be enough, but my point is that 'legal' heroin would probably be much cheaper than current 'street' prices. I'm not sure how cannabis prices have varied in places where it's legal in the US, though - do taxes bring the price back to parity with the old 'street' level? I'm guessing it's going to be complicated by the fact that it's still illegal in other states?

The point of medical heroin, or other harm reduction programs, is to allow people to get on with their actual life without the all consuming addiction being front and centre all the time. I'm currently on a methadone program in the UK (there aren't any heroin based programmes as far as I know here) and it lets me keep up my job as a software engineer without daily worries about having to make sure I can score and not be 'sick' (i.e. withdrawing) and unable to work or go to the office. A heroin prescription would accomplish the same thing for me, and for people in a worse situation - perhaps unemployed or homeless - it would mean even more, since they could devote their energy to rebuilding their life.

Personally, I don't really need a safe injecting space - I own my own home and have a pretty stable lifestyle, but again, I can see how for other addicts it would be incredibly helpful. Again and again, as seen in other comments, it can be seen how despite objections these places provide an objective positive benefit to society.

Indeed, it's entirely possible for people to take heroin at the weekends or similar, and put it down without problems, and I know several friends who do it irregularly without getting addicted - although only smoking, I've never heard of anyone injecting IV heroin who wasn't an addict...

Interesting. This is very similar to my story, I use heroin for much the same reasons as you describe, but I've only started on the recovery phase. Now I'm a little worried about what might happen once I finally move onto methadone for good ;(

> list of New Year’s resolutions [from 2014] and in red marker, the word “quit.”

This is so true. Most addicts actually DO want to stop, but it's fucking hard. And trying to explain to an employer "Hi, I'd like a month off, so I can start quitting heroin. Oh, and when I get back to work after that, I'll be unpredictably angry and depressed, with an uncontrollable sleep cycle..." I have notebooks with TODO lists going back a decade plus with the words "Quit Heroin" somewhere near the top, and I'm still trying. I don't know how to get employers to be sympathetic towards what is, after all, just another (mental) health issue - well, maybe that answers my question ;(

I'd be interested in how many software engineers have drug addiction problems, I don't know how common it is. And there should really be some kind of self-help group for us to discuss issues and provide support for each other, since most addiction support networks assume you are homeless and unemployed, and focus on providing that basic structure and stability to their lives. As an employed engineer, I have that, it's the next steps I need help with.

This is one of the things I'm frightened of. I'm a successful software engineer, you've probably heard me speak at various conferences, I contribute to popular open source projects, but ... I have a twenty-year heroin habit. So, any minor interaction with law enforcement has the potential to spiral into a drug related cluster fuck, just as happened in your case. I'm fortunate that my employer is aware of my situation, and I'm working my way towards being clean long-term, but if I was in the US I think my situation would be far more precarious. I wish you luck getting yourself back together, and you have my utmost respect and congratulations for kicking the heroin cold turkey - nobody who has not been there themselves can ever properly realise what an achievement that is - keep up the good work, I know it will be a struggle every day from now on. I hope you get the rest of the help you need.

So you're suggesting that anyone who is addicted to heroin should be jailed, as long as the prison system is trying to rehabilitate them from this alleged 'anti-social behaviour'? Surely a better system is to treat the addicts symptoms with programs that provide methadone or buprenorphine replacement and management, and also provide therapy or counselling as required.

Sounds about right. As a heroin addict, I have seen people who are completely clean relapse after maybe three days of taking it daily again, and I have even noticed signs of withdrawal in people who have only taken the drug a couple of times, but on consecutive days. In general, it is the repeated consumption without giving your body time to return to its baseline state (which can take up to three days, depending on the drug and its half-life) that causes the physical addiction - all the scare stories about 'one hit and you're addicted' are just that; stories.

For anyone needing opiates as pain medication, I would suggest taking them only in response to acute pain, not as a regular dose, although this may not be possible for chronic sufferers. It's a difficult situation, the best painkillers are horribly addictive and socially stigmatized.

I know exactly how you feel. I fell into the same trap with heroin, and now, as you point out, it controls everything. But, again, it wasn't a bit-flip from normal to junkie, it was a slow process, then one day I realised that yes, the bit had flipped, and there was nothing I could have (easily) done about it, except to have led an entirely different life and been a different person. And that's the problem. After twenty years of heroin addiction, it defines you, in a way that makes it hard to give up. Rationally, of course, you know you should; but the habits become so ingrained that it can be hard to see how to change. The only time I managed to quit for longer than a few weeks was when I had a naloxone implant surgically inserted that made it physically impossible for opiates to work. Six months later, when it stopped working, I was back on the drugs, just to see if it was OK to try it, and within a week - blam! - addicted again... I know this sounds depressing, but I do feel there is scope to get out. But, if you are introverted like me, then heroin will have increased and strengthened that bubble around you, making a barrier between you and anyone else. It's hard to form close friendships at work when you have to lie all the time about a huge part of your life, your drug habit, and the isolation feeds back into more heroin use when you're alone, as a vicious cycle. So, quitting on its own is never going to work. You must (and this is what I am trying to do) replace the drug with something else, a hobby, some form of socialising, and work hard to make that a part of you, a part of your life, instead of the drug. And that also means cutting off your junkie friends, starting fresh, which when you're in your forties or fifties is no easy task - by now we've made most of the friends we'll ever have, and starting again is difficult. So, sorry I don't have any good or easy answers for you; but I wish you good luck going forward, and I definitely share the pain, and know how hard it will be. Take care!

On that note, a friend of mine (unknowingly) used water he thought was clean, but that came from a glass my cat had been drinking from, to dissolve heroin for injecting. The resulting infection nearly caused him to lose his leg - the lab analysis of the wound revealed the infection was caused by cat-saliva bacteria.

Anyway, just saying there are dangers from pets and allowing them to share your environment. Although, I let my cat take bites out of my food sometimes, and that seems OK so far.

Yes, from the article:

> 10-day supply of an illicit drug — a gram of heroin

I'm a heroin addict, and that would keep me going for about a day and a half ;(

As an intravenous heroin user, I regularly inject into my veins and the pain, while not non-existent, is pretty minimal, unless I cannot access the vein due to thrombosis/collapse. This has always worried me, since it can take me half an hour to place a shot, and in hospital I have had multiple nurses and doctors try to insert a cannula over similar lengths of time. In a life threatening situation I have often wondered what would happen when the EMT could not get access. The existence of IO needles is interesting, therefore, since on IVDA patients they will still work - I just wonder how common a piece of kit they are in UK ambulances and A&E departments?

No, but you can slip into injecting heroin easily enough. I started taking ecstasy, amphetamines and LSD in the party scene in the early nineties. One day some friend turned up with a wrap of heroin, and we smoked it on foil - it was great. fast forward couple of years or so, and a friend introduces me to someone who sells heroin. It was good the first time, so why not. I keep the number, and buy some occasionally - I have contract job that pays hundreds of pounds a day, so cost isn't an issue. I also start taking cocaine as well, because why not, there's a guy in the pub selling it, and my friends like to party. Heroin is pretty good for relaxing after hard night snorting coke, so I take more. Eventually it's more heroin than cocaine, and one day I wake up and realise I don't have flu, I just haven't had any heroin for over 24 hours. Hello, addiction, and the joy of withdrawal! Anyone sensible would quit, but I still have a good job, and I'm earning even more, so why not keep doing it, I can afford it. And it just carries on from there - it's just part of your life, a thing you do, along with going to work, eating sleeping etc. And since you're in this deep anyway, why not try injecting?

So, that's how it happens. Now, there's a lot of places this can go off the rails. If you don't have a good job, and the ability to keep working at it, then you're going to have problems. And if you don't keep up appearances, people will start to wonder what's up, so you have to work pretty hard at hiding the drugs and the habit - if your boss or colleagues find out, no more job, money and there goes the funding for your habit.

Not sure what my point is, except that a heroin habit can get hold of someone quite easily, even people you probably wouldn't expect.

> Weed doesn't kill.... heroin does nothing but kill

Not at all. There are plenty of people using heroin that are not your typical junkie, just like there are many recreatioal weed users that aren't unemployed stoners. Take me - I've been working in IT for twenty years, and have been a heroin addict for just about the same length of time. My career is going pretty well, I'm in charge of a team of engineers, I speak about my particular subject at conferences around the world regularly, I have plenty of work up on GitHub that people use.

What does kill people is stigmatizing addicts, and preventing them from getting the help they need to allow them to live a normal life and become usefully employed. Instead, attitudes like yours mean they are forced to become criminals and marginalized.