What a world we are in when heroin looks like a benevolent shepherd compared to fentanyl. Years ago I learned from a friend who lived the life in NYC that heroin could be "managed," and that users could actually have a functional existence. This was belied by what I saw with my own eyes in 1970's New York; crumpled bodies and shooting galleries and cardboard "homes." Addiction is despair, and the levels of it we see around us seems to indicate a deep, inexorable rot of our human potential.
18
These overdose deaths are because of one thing, prohibition. The lawmakers who support drug prohibition and the justice system that enforces prohibition are responsible for every one of these deaths. When you make a drug illegal, the forces of the black market will always conspire to make the drug smaller and more potent, and therefore easier to smuggle. This process has gone on for so long that we have ended up here, with ultra potent fentanyl killing innocent people. They will blame the drug dealers and the users themselves, many of which are one and the same. They will increase penalties to try and stop it, and all it will do is make the trade in it more lucrative, more profit for more risk. All drugs need to be legalized immediately before anyone else dies. With legal, cheap, and consistent unadulterated opiates, heroin addicts can lead perfectly normal lives and often end up quitting on their own with help from the stability a legal supply brings. Beyond all that, at the core of the issue is why should any government have the right to tell it's citizens what they can and cannot do with their own bodies if they aren't harming anyone else? There is no valid justification whatsoever for the war on drugs. Drug cartels wouldn't even exist without it, and millions of people would still be alive without it. Ironically, the heroin addicts in this story, wouldn't even be looked at twice if they were alcoholics, when alcohol is much worse for your body and society then heroin.
9
What is the present state of America? "1984" with Trump and his control of what used to be the Republican Party and "Brave New World".
3
Interesting.......when the tobacco industry was faltering due to Americans stopping smoking, the industry took its product to China and poisoned them. Now, the Chinese are poisoning Americans with fentanyl. And, we shouldn't forget the Opium Wars involving the British and China. Making money, killing people-the world keeps turning.
It is possible for humans to enjoy life and let everyone else enjoy life. Unfortunately, evolution hasn't solved that problem on its own. What we need is a drug to help people think better!
2
There was a time when being an addict had a serious social stigma attached to it and most of us steered way clear of it, not anymore, these guys want their brown because the white is too harsh or they want the white because the brown won't cut it anymore... What is going on?
Did we overlook an article in the constitution granting us the right to use and abuse and get addicted because life is hard and we need a little something to ease the pain or we are young and it's our right to experiment or we just want to be cool and fit in or a dozen other reasons why society should accept us and take care of us so we can live useless lives in a mindless state.
When you take the stigma away from addiction it becomes not so bad, makes it easier for the susceptible and many who are just curious to not resist and fall away from us.
Help the addicts but stigmatize the heck out of it, publicize the ravages of addiction, like the pictures on cigarette packs, only much stronger. Fight it, don't coddle it.
4
This is old news.
The best solution (as the Times has previously reported several years ago) is to adopt a
decriminalization of drugs approach as has
been done in Portugal a number of years ago.
Results:
1. Lower death rates (See Phillip Seymour Hoffman)
2. Lower recidivism rates
3. Lower public health and/or Imprisonment costs
6
I probably sound very naive but where the heck do the people shown in this article get the money to buy these drugs? These aren’t kids who could shop lift or commit robberies. There has to be good money for the suppliers; where does it come from?!
Between this article & the article on the taxi medallions, I’m depressed & confused on a Sunday morning in May...and grateful to have children & grandchildren who have avoided this scourge.
10
Who would ever have thought there would be something with more appeal than heroin.
2
Every addictive drug promises the easy release of tension and pain, mental and physical. Everyone who uses them believes they will not become addicted. The truth is that there is no shortcut to a life free of pain.
Meanwhile, unscrupulous people will find a way to prey on those who become addicted. The popularity of drugs go in cycles. Fentanyl will soon make way for something else, new or old. Then the fear of fentanyl or heroin or cocaine, or whatever, will slowly vanish from the culture and the whole thing will start again. This is not cynicism; it's history.
Things won't change until we find a better way to "have fun" than using any sort of drugs.
3
So let's make those "addictive prescription opiods" readily available, cheaply, perhaps even over the counter (like alcohol). All the heroin/fentanyl addicts will switch to drugs made safely in pharmaceutical laboratories with well-controlled doses that essentially prevent accidental overdoses.
We don't know how to cure addiction, but we can make it a burden that can be lived with. There would be a lot less crime, many fewer overdose deaths, and many addicts could be contributing members of society (like nicotine and even alcohol addicts---should I mention caffeine addicts?).
8
I recently had eye surgery with Conscious Sedation. The ophthalmologist did an okay job of describing everything that would happen but assured me that the anesthesiologist would talk with me prior to going back to the OR and assuage any concerns. He did and I was comfortable with him. He did tell me that they would give me fentanyl which caused me to sit up and say, like the heroin replacement that everyone overdoses on. He laughed. Don't worry he said, we know what we are doing. It was an amazing experience. I can see the attraction. But I digress. We need to stop the war on drugs, the war on people who are disenfranchised, remove law enforcement as the arbitrator and politicians who think they know what is good for us, through the public safety mantra. They are the ones killing us.
7
Drug abuse is so linked to economic distress and lack of hope in the areas which are most affected by the opioid crisis , that no matter how Draconian the rules my be, there will be demand , and then supply. I haven't seen anything that suggests rehab per se "works" - treatment wiht the appropriate drugs, and counselors makes sense.
We need to consider "pretreatment:' - a coordinated network of early education, social supports for fractured families, and accessible health care - to help newer generations avoid use of substances for escape. Some will always experiment or become users, but we can lesson the the numbers of people falling into abuse.
Stiil, fentanyl control sounds impossible because it is too easy to bring it into the country and cheap to manufacture. So out best hope is to decrease demand.
For those who are long term heroin users, a legally monitored heroin supply program, like the methadone programs, sounds as if it would be more humane and cause less mayhem and illegal behavior for addicts who are not going to magically be cured. It would also relive pressure on the police.
1
It is my understanding that there are 2 kinds of Fentanyl out there. One is an animal tranquilizer ( anesthetic) the other a human pain killer/anesthetic. Fentanyl while far more potent than heroin or pills has a much shorter duration of action. That results in the addict having to shoot up many more times a day. Every injection is another chance to OD. The cost to the health care system as well as to the addict in and their families is enormous. Whether we know it or not, we are paying that price.
The comments that this is a “deserved social cleansing” are lacking in compassion and understanding that we are all interconnected.
The effect of the current legislation deprives chronic pain patients of medication needed to control their pain to live productive lives or at least marginally functional lives. It creates far greater burden on the health care system and it kills people. It is time to institute proper drug maintenance programs. The models for this exist in European countries.
As for those who think it is them and never us, it is time to realize that if causes and conditions are right, that could be you on the street with a needle in your vein.
16
I have to wonder how many legit pain patients who suddenly found themselves without any relief couldn’t handle opiate withdrawal. Heroin usage escalated during the crest of the big Opioid Crisis.
And although Heroin has been on the drug scene way before Oxy, Fentanyl was not. What amazing timing and series of coincidences collided to cause even higher death rates.
But then again, maybe there are no coincidences.
6
Tangentially . . .
I won't say how often I find peace and joy in the thought of eventually leaving this plane, this culture, this world. Yet, here are described heroin users who apparently want to stay here. I expected to find people who strove to escape. I am obviously mistaken. I find that fascinating. Truly.
5
This will doubtless offend people, but aren't the higher overdose rates a form of euthanasia? When people turn to the obliteration of heroin, then fentanyl, to escape life, isn't their life the thing from which they're desperate to be relieved?
Larry Niven had a common plot device in many of his stories, of the electrical stimulation of the brain's pleasure center becoming possible, spawning 'wireheads' addicted to zapping themselves into bliss. Of course, with such direct pleasure available, other drugs and even food become uninteresting, so most people die from that addiction rather quickly. And within a few generations, everyone who has the potential to become addicted to bliss, is eliminated.
Heroin addictions could stretch out for years, even decades, and very few people manage to break their addiction forever. Seems like with fentanyl, peoples' addictions are killing them quickly, and is that necessarily a bad thing? We do have far too many humans, maybe if people are volunteering to check out early, we should accept it.
4
The increase in deaths from fentanyl/ heroin overdoses can be laid at the feet of politicians who created an issue over prescription drug use in an attempt to look tough on white collar crime as they blurred the numbers of supposed deaths from pain killers, when upon examination were for the majority caused by combinations of heroin, cocaine, fentanyl and other illegal drugs. Yes there were abuses at pill mills by jerks that for the most part weren’t even physicians but to deny people in need of pain meds has been an unmitigated catastrophe created along the same line of thinking as fifty years ago when the pot police were claiming smoking marijuana would lead to heroin addiction, higher crime, blah, blah, blah. The politics surrounding this whole issue has been so transparent as to be laughable. Bankers and war mongers who are destroying the world are lauded as physicians trying to do their job are attacked. We need not only an overhaul of our healthcare system we need to get rid of the idiots in charge of this country on both sides of the aisle: I’m not encouraged by the push for Biden in major media to insure the status quo which is working so well for rich conservatives as well as rich liberals nor am I encouraged by the drumbeat for war emanating from both sides: we allowed the nomination to be hijacked in 2016 insuring Trumps victory, let’s not do it again, Bernie/ Warren or Warren/ Bernie 2020: anyone but Repulican lite hawk Joe.
12
What is the problem here? People choose to take illegal, unknown substances, and some die.
All the methadone, naloxone, needle exchange vans, etc do is send a message that "what you do is ok, it can be managed, if you do x you are dafe".
The notion of having a whole apparatus keeping unproductive individuals like the old-men in this story "hooked but alive" for decades is cruel and bizarre.
The message should be: "if you put unknown substances into your body, you are on your own and may die - have a nice day".
10
@Baron95 this answer is exactly why (usually traumatised) people start using hard drugs in the first place. Dog eat dog society, no empathy. Better drug yourself out of it.
16
And so we descend into previously unimaginable nostalgias--here, for heroin; in the country as a whole, for Reagan and Nixon.
The University at Buffalo is currently deciding what to do about its School of Pharmacy, named after alum and convicted fentanyl racketee John Kapoor. The smart money is on UB changing the name and keeping the blood money.
5
While heroin was and still is illegal in America, Purdue Pharma's oxycontin was and still is legal.
Being black and brown and Christian while dealing ,making and using opioids makes you a moral degenerate monster deserving criminal justice persecution and incarceration. That is an American historic reality playing upon the enduring color aka race worst demons canards and tropes of white European America's nature.
Fentanyl was made and meant for big animals. Humans are not that.
No philanthropic donations of your ill gotten opioid gains while black and brown Christian to museums are solicited nor welcomed.
1
What we have here is a simple matter of economics - heroin is produced from acres of carefully grown, often illegal crops, requiring around-the-clock protection, one crop a year.
Fentanyl analogous are made in a small easily moved factory whenever precursor chemicals are available - apparently always.
Even when opium is processed and refined into pure heroin, it is (depending on the actual Fentanyl-class of artificial opioid, 100 to 1,000 times bulkier.
A gram of heroin is @100 gram-equivalents of Fentanyl, 1,000 to 10,000 grams of some of similar analogs the medical industry never produced because they are too difficult to properly cut to a clinical dosage.
Criminal drug dealers are concerned with bulk, and will risk the trade-off of dangerous product Their non-lab-grade equipment can leave part of a batch weak, part way too strong for a user population that used to expect a fairly standard dose in a street “bag”. Many of the overdose deaths are due to the lack of quality control.
Shipping is much easier when a capsule meant to contain a single dose of medication can hold 100 to 1,000, or, reportedly, many more doses depending on the opioid the labs produce. Heroin doses are measured in milligrams, the alternative in micrograms.
Note: none of this has anything to do with oxycodone, a weaker artificial opioid that does not produce the euphoria sought by morphine/heroin users, which helps desperate chronic pain sufferers survive, sometimes regaining a decent quality of life.
11
It's one of the oldest strategies in the drug control playbook: replace a drug with something more dangerous, dry up the supplies of the safer drug, and watch the druggies destroy themselves. If I were paranoid, I'd wonder if someone invented fentanyl for just this purpose.
Or maybe because fentanyl is easier to make, it simplifies the supply chain by cutting out the poppy growers.
Remember the crack epidemic? Meth? Reefer madness? Prohibition? It seems like every so often there's a new killer drug, justifying an endless game of cops and robbers that is mischaracterized as a war on drugs.
A significant minority of people want to get high. Can't we deal with that without killing them?
11
Who wants to judge the psychic pain of the person who takes numbing drugs? IT's a dark time in this country.
11
I wonder how many people with real legitimate pain turned to heroin and fentanyl when the government effectively withdrew painkillers from the market and are now addicted or dead.
Some of these addicts never would have been addicts if not for the short-sighted, pig-headed bureaucrats in Washington. Who, by the way, were warned that this would happen.
11
I'm glad to see in the comments that so many people realize that this whole crisis is largely an outgrowth of terrible policy from Washington.
First the FDA allowed painkillers to be distributed like candy. Then, AFTER millions became addicted, they abruptly withdraw the drugs from the market.
It was an absolutely perfect policy for producting addicts and overdoses and for propping up the drug cartels -- who, if not for this, would have been struggling for income because of the decriminalization of marijuana.
It's almost like the FDA and the DEA got their heads together secretly and came up with a sequence of movies that would manufacture a crisis and guarantee future employment for all the War on Drugs people.
We are so desperately overdue for reform in Washington. The FDA and DEA have both demonstrated again and again that they are not doing what's in the country's best interest. How long will it take before the country holds them accountable for this mess and all the people who have died.
10
Really interesting story; thank you for it.
Additional fatalities among this population are not a bad thing for society in general. None of the interview subjects mention having jobs or contributing to society.
Makes one wonder if the next fentanyl will be created specifically for this purpose: to excite addicts while steadily eliminating them. It does seem like something that the government where fentanyl is coming from might dream up.
7
I think Narcan and needle exchanges and other "harm reduction" programs are just enabling addiction to continue, which is wrong. I believe that instead we should greatly expand the availability of methadone and suboxone programs. For those who claim "It's just substituting one addiction for another," well so is Oxy-->heroin-->fentanyl, but the difference is that methadone maintenance allows the addict to live a productive life instead of spending all day desperately seeking their next dose. Not to mention that it's taken orally which immediately cuts the incidence of hepatitis, endocarditis, HIV/AIDS, and whatever made that guy lose his leg. Previous articles in this newspaper have pointed out that drug-assisted treatment for addiction is woefully underutilized. I myself took methadone for 20 years and it worked very well for me. Saved my life. You pass me on the street today, I'm just some cute little old lady, and you'd never know I had a drug problem 45 years ago.
18
Do you really think addiction should carry a death sentence?
Attack making lifesaving emergency treatment available? This is insanity - or a new theory of eugenics, that those who fall prey to hard drugs like heroin or alcohol, tobacco for that matter, should be allowed to die, their deaths encouraged by denying lifesaving measures.
Needle exchange programs simply prevent infection, gangrene, hepatitis and HIV among people who are going to use anyway, even if it means sharing a dull home-made glass spike.
Needle exchange, or in NY, the simple right adults have to purchase clean single-use syringes at almost any drug store, gives a point of contact between users and people who can help them if they want help - and if the county has an immediate-admission treatment program for those who decide it’s time to quit.
Compare that to the local liquor store, where any adult will be ENCOURAGED to buy a lethal dose of addictive drug, rather than offered a chance to escape the wheel of addiction.
Alcohol addiction causes far more deaths and far more suffering than all the illegal chemicals combined.
Yet, because it is socialized, and because some users (like most users of the lighter illegal substances) use it, the NYT even has a full-time alcoholic beverage reviewer.
Of course he doesn’t review the cheap wines and distillates produced to feed the sinister side if the trade.
The tobacco industry keeps on pushing nicotine - many supplying the same carcinogens as traditional cigarettes.
4
@Eatoin Shrdlu - Yes, I really think so. Way back when I was using drugs in the 1970s I often heard the remark "You play the game, you got to pay the price." This was said by addicts when one of them (us) died. Nobody starts using heroin thinking it is harmless. Everybody knows it's suicide. You can rescue someone hanging off a bridge rail and there's an excellent chance they won't go back up on that bridge again tomorrow. But ask EMS how many times they've revived an overdose victim and *within hours* get another call that the same person has overdosed again. This is pointless. We need better treatment, not cynical "harm reduction." Yes, cynical. Let's just enable these people to go on wasting their lives and causing pain and misery to their families. They're poor, they're black, and they probably don't vote, so sure, don't *help* them, that's too expensive, just give them clean needles and a pat on the head. It outrages me. I am thankful there were no "harm reduction" programs in the 1970s.
6
Sorry guys but I have little pity. Having suffered from seizures my entire life, lived through 9/11 and worked downtown during the rebuilding of the downtown area, I've been able to earn a Masters in Finance and Advanced technology. I've worked at some of the worlds largest financial institutions and have a wonderful family. Why any "normal" person would choose a lifestyle to fail is beyond my comprehension. Little pity guys!!
59
@Steve
I congratulate you on your successful life in spite of obstacles. Please don't be smug about it.
It's totally unfair and mean spirited to put the blame on the addicts. Fentanyl addiction is sweeping the country, and not just in inner cities. Many fell into it through in-appropriately managed pain care --some of it due to evil marketing strategies of drug companies. Deaths by overdose are now more common that traffic fatalities.
It's not just a personal choice. It's not a moral failing. They don't deserve to be punished for it.
One of the biggest problems are people who look on this as a moral failing; who block funding for treatment, needle exchanges, and other proven remedies.
102
@Steve- Equating seizures with drug and alcohol addiction? You saw this article as an opportunity to post about your wonderful life and how amazing you are? I hope your wonderful family never experiences drug or alcohol addiction, its painful for all concerned, mainly because without deep pockets there is nowhere to turn to for real help. I lost my 42 year old son last month, he relapsed and within 48 hours was dead. One thing his horrible disease taught me was a deeper compassion and sense of empathy for those who suffer and struggle with addiction. I witnessed his struggle since he was a teen, on top of seeing your loved one's life slowly destroyed, families must also deal with huge costs, jaded and limited resources and the enormous lack of empathy from the medical profession and the misinformed, general public.
140
Addiction is a disease. I know someone: PhD, gainfully employed for decades, owns a home, has a sizable mutual fund. He struggles with that disease every day. He not “choose” to become addicted.
Maybe learn to have empathy for other people.
96
Go after the dealers ,charge them with murder.
Fentanyl comes from China, right?
3
Just don't forget about The Shackler Family, owners of Perdue Pharmaceutical, who deserve to die but will ay off the courts for their freedom. They are the ones behind the opioid crises.
4
Steve. you are blessed not to have the brain chemistry of the addict. Say " there but for the grace of God go I".
9
Where rehabilitation has failed, often multiple times, the answer to the addicted (and the rest of us) may be fentanyl and its consequences. Unfortunately the least desirable outcome ultimately may be the only realistic outcome.
13
@John
I don't understand what you're talking about. Why should anyone be forced to use fentanyl?
In other countries, like Portugal, when buprenorphine and methadone don't work, they give heroin. Under medical supervision, heroin is actually safe. Almost all the harmful effects of heroin use, such as infections, are the result of the drug laws.
The war on drugs has failed. The number of opioid deaths has gone from 10,000 a year with heroin to 70,000 a year and climbing with fentayl. We can give them access to legal heroin or watch the 70,000 deaths a year continue to rise.
89
@Norman Yes, we know drugs are easily available in many places because of the failed war on drugs. Still, the vast majority of Americans (approaching 99%) choose NOT to be addicted. John’s point was that for those who choose to use drugs, fentanyl and death may be the inevitable and thus logical end point.
8
@John
These “addicts” whose lives you hope are ended by overdose are people’s fathers, mothers, sisters, brothers, sons, and daughters. Most of all, they are human beings.
21
In the UK, there were apparently, in the late 1960s, a few hundred heroin affects, many from the chinese community. They got their medical grade drug from their doctor.
Then, a media scare found a few doctors selling proscriptions and they weren’t allowed to prescribe any longer.
Now the UK has thousands of addicts using street level dangerous heroin.
1
I cut my teeth as a young physician on cocaine and heroine addicts in NY. Then, came the capital of ODs during my training in Mizzou. I lost a brilliant colleague in Anesthesia and one of the best ICU nurses I have worked with to fentanyl addiction, in mid 2000s.
I still remember talking to a good friend and colleague at the time, that Hades would be a nice place, compared to where we will be if drug Overlords get their hands on fentanyl.
It is the synthetic form of morphine, if you want to understand it better.
We recently had a major fentanyl shortage due to Costa Rica being under seige with hurricane damage, and no medications being produced. But, you know what... IV fentanyl was being sold right behind the hospital in an alley!! We kept getting Fen-ODs in the ER.
A word to the non-cautious...
One dose of cocaine has the capacity to change your brain, your neuronal makeup-- it teaches your brain addiction.
Fentanyl is a different breed altogether, but its addiction potential in comparison is astronomical-- so just imagine.
Having worked with addicts in the outpatient & now mostly in ICUs where their IV abuse has destroyed their heart valves, their kidneys, their livers... their psyche!
It is an epidemic, and it is a plague.
At the risk of sounding pessimistic, I take care of these patients, have long discussions about their addiction, but in my heart I know, it is a rare patient who will overcome this monster.
26
I also wanted to add...
Physicians are usually not judgmental when they take care of drug addicts, you always ask why did they start... to better understand them. There is usually remorse but not the will to stop.
But, as a health care givers we are also humans— and when one hasn’t taken care of a patient for the umpteenth time for OD, related issues— personally something goes very silent inside me.
I may have seen hundreds of addicts, I’ve seen very few give it up, prior to damaging themselves.
I learned from the ones who succeeded, that it’s the devil on their shoulder, always ready to pounce. In that moment of self analysis, their expressions are haunting. You realize they’re dealing with an inner demon who is more real than their actual life.
It’s demoralizing, painful to watch— and at a deeply human level, humiliating.
In my minds eye, they may seem whole but are like a vase, glued back, the cracks... the scars-of-forever!
Government’s response for any initiative has been abysmal.
The future doesn’t bode well.
5
People make the decision to partake in something that is known to cause addiction with a high probability of death by overdose then they own the decision. That being said I can only feel bad for their parents and children.
2
Federal decriminalization of marijuana - at the very minimum for relief of chronic pain, chemo, epilepsy, PTSD and other afflictions identified by the medical community - would reduce the “float” of fentanyl to the point where there was little supply available to support a secondary market of illicit sales.
6
There is only one way forward: legalization and regulation. Let's end the criminalization of drugs by a paternalistic government, which is only fueling the black market and the prison-industrial complex. Addicts who don't want to quit should have access to properly dosed and labeled drugs. Addicts who do want to quit should get help. And let's stop demonizing the pharmaceutical companies. They are only doing what good capitalists do.
7
The opioid pain killer epidemic has been a major disaster. How could a society allow it citizens to be victimized such. Brought on by physicians and drug companies. Then cold turkey as the medical profession understood what it had done. Drug seekers became a daily activity at urgent cares and orthopedics offices I worked. The humiliating emotional scenes as people were often shown the door if they didn't have the control to walk out on their own. Heroin was the next step as drug seekers searched for a fix. Heroin also became the drug choice of aimless kids since pot didn't give them the kick they wanted. Now fentanyl has come to kill them. They wanted to be zeroed out of the cold world.
22
@c harris -- heroin is not prescribed by doctors or comes from the drug companies.
Fentanyl does, but you don't have to take it.
5
@c harris
This comment is astonishing for its naming of the problem that underlies all of this: "they want to be zeroed out of the cold world."
You describe the behaviors people face from the medical profession and politicians; we also need to describe the reason why this world is so cold to an increasing number of people.
We have to get to the underlying issue of why so many people want to alter their feelings and consciousness.
We are living in sickening times.
17
@ MJB -- absolutely. Meaningful human connection is the opposite of addiction.
7
Given that the philosophy of many a Republican and Trumpist is that those who fall ill for no fault of their own should pull themselves afloat somehow, and that those who arguably contributed to their health problems, from diabetes to addiction, should get "what they deserve," I suspect that all is going according to that plan. The deaths are not a bug but a feature.
This is not an exaggeration. Just consider the efforts to repeal the ACA without nary an alternative, the successful elimination of healthcare cooperatives, the refusal of the Medicaid Expansion in many states, the defunding of subsidies coupled with impossible to meet work requirements alongside drug testing barriers for welfare alongside the efforts to reduce Medicare benefits through higher copays and deductibles.
7
It’s a sad day when heroin is the maintenance drug. Once upon a time if it was out on the street that someone died of a heroin overdose the other junkies would clamor for that batch knowing it was good. They knew how to pace themselves. Instead of giving out free needles could they tell people to sniff instead? Would that be less deadly? Fentanyl does not sound fun. But maybe it’s not the worst way to die.
12
No one starts injecting at first. They start with snorting. But TOLERANCE happens fast. That’s why they quickly move to injection.
9
@Ms. Rix wowza. Uh but anyway, pertaining to your “once upon a time”, that still happens. Poppin corner be hoppin
1
@Ms. Rix
The only difference, other than a needle, between snorting and shooting any drug is the length of time it takes to reach the brain. It doesn't mean less danger or less chance of addiction.
1
Drug users come from every walk of life. As with everything, some people are extremely skilled at their craft and use drugs to good effect, with little if any detriment to their health. You rarely read about the successful attorney or professor who is chemically dependent. Yet there are huge numbers of them living normal lives. Then, there are other people who live in squalor and their life is a complete shambles in every way. It is an oversimplification to assume that drugs are the key factor of every problem. Maybe people are living a terrible and incompetent life, first, then having a substance abuse problem second.
20
But because China has not banned many of the precursor chemicals needed to make fentanyl, others believe the effect could be minimal.
That reminds me of how Walt and Jessie in Breaking Bad rob a railroad tanker car load full of methylamine imported from China to cook an endless supply of blue meth.
Who knew TV could be so educational?
4
@John Doe
You can buy fentanyl by the kilo in China from 'mom & pop' chemical companies for about $3000+. They will even help you mail it.
2
Addiction is a physical and mental sickness- those people need help. The real problem is those who make a living off of the manufacture, trafficking and selling them drugs. The country needs to "get-real" about stopping the flow. Punishment in this case should be judged based upon the damage pushers are doing to our country for the sake of profit. They are in fact destroying the very fabric of America. It could even be considered treasonous resulting in capital punishment. Speaking of CP...it shouldn't take 20 years to execute someone who is clearly guilty. America- you want to rid your country of drugs? Get tough on drug lords, trafficers and dealers.
3
@Wes
Your solution is just more of the same, and does not get to what is the underlying problem: why are people trying to alter their moods and consciousness with drugs? Why are they trying to feel good?
That is the question we need to answer. Drug dealers are meeting a need, and many have no other means of earning a living...it is a perfect storm of degrading incentive structures for the marginalized.
If you want to rid our country of drugs, more enforcement is NOT the answer. Dealing with the underlying problem is the answer.
13
The fentanyl distributors aren't being very smart. You don't really want to be killing your cliental. Much more money to be made by cutting the product to heroine potency. This way a smaller amount of a cheaper drug can make even more money.
5
I found myself having dark thoughts halfway through this article. These addicts, their lifestyle, is killing them. Their addiction fuels crime on every level. Many are now dying on Fentanyl. Dark thoughts.
8
Who knew that the fentanyl crisis has gotten so bad today that there would be those who are nostalgic for heroin.
6
Heroin addiction is highly visible in the homeless population in San Francisco. Walk around the Tenderloin and you see human beings slumped over or barely standing, swaying on the sidewalk, in one case a man with a needle still in his arm was seen sitting on a milk crate. The misery is everywhere in San Francisco and Oakland. Tent cities are everywhere in San Francisco, Oakland and Berkeley. It is a huge problem that no one seems to be doing anything about.
63
@ana Your last sentence is very interesting. As I returned from Starbucks at Fisherman's wharf just 30 minutes ago an encountered several homeless, one quite engaging and lucid, I thought the same thing. San Francisco will this year will spend $1.2 billion on direct services for about 8,000 homeless, or about $150,000 per homeless individual. Where is it going ??? Why is it having so little impact ??? How can it be more effectively spent ???? Who is getting rich of this money ????? Something is WAY OFF in this story.
12
Whether fentanyl or heroin, they are both lethal. To split hairs regarding what statistics reveals, i.e., which is more prevalent during this day and time, is meaningless unless we can get to the root of the problems. It is called professional intervention. It is called more resources for medical personnel and counselors to become community activists. An addiction is just that, an addiction. The more often one has need for a fix, the more the body demands an increase in dosage. What at first works is not enough, tolerance insidiously exacerbates this crisis.
People complain of too much government. But it is precisely what we need right now. Words are cheap coming from this administration if it does absolutely nothing to help an epidemic of mortality. Money spent on a Wall should be spent on human beings here in the US, trying but failing to survive. It is time for we constituents who care about our fellow human beings to put pressure on Congress. In fact, it is past time.
7
@Kathy Lollock
Amen to your comment, it is exactly what we need.
1
Portugal has legalized use of all drugs across the board. they have seen a remarkable downturn in crime and deaths from drugs. receiving your heroin in a clinical setting also removes the drama of obtaining street drugs thereby facilitating higher recovery rates.
63
Dear@kat
In the long run legalizing really bad stuff never leads to anything good or enduring. I do not feel legalizing assault, rape and murder would lead to any remarkable downturn in these crimes. Simple truths will always prevail.
2
@kat
Absolutely, the war on drugs has been a “Whack a mole” arms race in which the moles keep getting more and more potent, and the networks that supply them more and more violent. In fact, it seems like we exported this approach to the very Central American countries wracked by drug dealing violence that are now exporting their refugees to us.
Portugal offers a sane and cheaper and compassionate alternative. Thank you kat.
11
@kat
Portugal is not the US. It does not have an entrenched drug culture, for one thing.
For those who believe that ending drug prohibition is the solution, look at the opioid crisis. The net effect was to increase access to opioids under medical supervision, so a third regime between legalization (e.g. alcohol) and prohibition (heroin). The result has been a disaster. Opioids cannot be made broadly available. They have to be restricted, which means legal penalties for those who attempt to violate such restrictions. In other words drug enforcement.
America has dug itself into a hole on this one. There is no quick fix.
1
in my country..doctors rarely if ever prescribe opioids. if a patient is in that much pain doctors think that patient should be hospitalized and monitored or at least have that patient come in every day for chiropractic care etc...in korea most senior citizens routinely visit the orthodontist every single day.because at that age everyone has aches and pains and needs treatment and care on a daily basis. it costs around a dollar fifty for them to do this. you don't need pain killers when you get real proper care.
12
Dear @Jin
I am sorry but since I have been involved in medical care for a long time I cannot agree.Addiction exists in every population and a holier than thou attitude does not solve anything although it sure makes you feel good.Neuropathic pain and cancer related pain is not going to be helped even if you get chiropractic care five times a day.Monitoring also does not help. Appropriate use of opioids is still part of good medical care.
16
Jin try getting admitted to a hospital in the US We live in an era of one hour surgery and drive through deliveries
4
For some reason, when I read about Mr. Miller (in his 60s, and after being a life-long heroin addict) "contemplating addiction treatment in another state," I find myself skeptical about his plans.
20
@Robert Wood - You are skeptical because you don't understand what it means to be an addict. Consider yourself very fortunate. Mr. Miller, and millions like him, who struggle with substance abuse, will vacillate continually between wishing to be clean and sober and wishing for the pain (emotional, spiritual, physical) to be blotted out for just an hour or two. I can assure you that when Miller said he was contemplating treatment, he was. It's a hard life and the loose network of underfunded programs to help addicts get through the roughest parts of recovery are stretched thin and don't provide much of a safety net to help when the Mr. Millers of our country stumble and fall.
17
Dear @Robert Wood
The last time I checked skepticism about other people and being judgmental never did help nobody - probably gives you a rush.
11
@Krantz
Amen.
Not surprised that the DEA spokesperson would downplay the decreasing presence of heroin on the street, Mexican drugs is one of the supposed reasons for the wall. And, for people who think they understand addiction, take a close look at the addicts' reactions to being offered test strips. Addicts don't want test strips, they want a high. Ergo, no wall is going to stop drug use in America because addiction is not a logical orderly process. Legalize what people have been doing for hundreds of years, make it safer, get some revenue from that enterprise and use that revenue for research, prevention, treatment and rehabilitation. That would be true market driven social policy.
31
Dear @Frank
Unfortunately not everything in life has a market driven solution. The market place exists for making profit. I do not believe optimizing profit from other human beings sickness and despair is a great solution. I do not think karma is market driven !
2
@Frank
The reason the addicts don’t bother with the fentanyl test strips, is that it’s fentanyl is in all of their drugs. Hence, why test to learn what you already know? I agree with most of your comments otherwise.
1
I've known two heroin addicts in my life, both family members. Both started in adolescence self medicating for mental health issues they had no idea how to cope with or even how to ask for help with. I don't know how many kids start this way but I expect a fair number. Adolescence can be an emotional time for any young person, but we need to keep a close watch because for some there may be other issues that we can help with before they get out of hand.
37
@dlb
Ditto, I had a family member who started in adolescence for exactly the same reason. I think this is likely a very typical story. Thank you for saying this. My family did not know how to help, this was in the late 60s; he survived until into his 40s then took his own life, alone, isolated, quite mentally ill. Really terrible and sad.
Families need tools to help, and it is often the extended family (cousins, aunts, uncles) who are best positioned to help; they are outlets in a nuclear-family dominated culture.
We need extended families; we need to restore this contact. It would help, tremendously I think.
8
@MJB
Many mental health practices here in the U.S. - prescription drug based, for the most part - isolate the individual and say/do little about the family and friends surrounding him or her. Check out The Foundation for Excellence in Mental Health Care for some compassionate, wellness-based, alternative ideas.
1
I think that more emphasis needs to be placed on the drug addicted population in their sixties who have successfully managed their addiction to heroin for decades. How did they do this? Why are they suddenly suffering high rates of overdoses? Maybe what we need to do is identify these long-term heroin users and provide them with a safe source of the drugs that they have been taking for most of their lives. They are not going to stop using heroin, but they could use it safely, and providing them with heroin would also provide a unique opportunity to study the effects of long-term drug use. It is a tragedy that they are dying in such large numbers now because the nature of street drugs has changed due to the economic interests of the distributors.
32
@Paula 029
That approach is called “harm reduction strategy “. It’s being used in more forward thinking areas as one means of attack.
6
I've reworded the first sentence to make it more accurate:
"Desperation and crime have ravaged this city since before the early 1960s, fueling heroin and other substance use that remain endemic in many neighborhoods."
36
@Robert Scardino I don't buy "desperation => drugs". I came from unbelievable poverty and family abuse, and made it without even considering turning to chemicals to "fix" my problems.
7
Drug addiction is like wildfire. It destroys until it runs out of fuel. We can set backfires with treatment and law enforcement, but in the end the most vulnerable will succumb. Fentanyl will not be stopped and it will kill many of the weak and unlucky among us. Law enforcement is futile as applied to the user. Stopping the supply and treating the sick can save some. Those who overcome addiction to achieve success are commendable, but these few are not a basis for policy. We have a duty to save whoever we can. In the end, however, fentanyl will die out for lack of fuel, regardless of our effort, in the same way as a plague or pox passes.
47
@mdd I doubt it will die out. It’s like AIDS, will like a stasis. Not as large a population but still there
2
What a sad situation the addicts are in. Drug dealers are shapeshifting murders but the addicts see them as their best friends. I'm in my mid 70s and the "Drug epidemic" has only gotten worse over my entire lifetime and it's now exponentially reaching light-speed. The socioeconomic root cause is clear but there are so many other contributing factors that it boggles the mind to search for answers. Perhaps there are none.
11
@JS The socioeconomic cures are well known by most educated people. Fair wages, access to healthcare, stable communities, equal justice under the law, environmental protection, gun control. etc. All conservatives are against the solutions, so it does just get worse.
24
@NLL
So never let a crisis go to waste? both sides do the same thing they try to use the crisis to push their agenda whether it applies to the crisis or not.
Many middle-class and wealthy people do hard drugs as well.
The drug wars have been a complete disaster and often exacerbate the problem, but we can look to success stories such as Switzerland's solving of their heroin epidemic. As long as there is a demand and massive profits the will be supply.
People also need to become informed about the very low success rate of drug rehabilitation clinics. Prevention through education needs to be a top priority.
14
@NLL
AMEN. Shout it 8 million times.
1
It’s a very scary time for anyone who cares about someone struggling with addiction.
Of course it’s never been easy, but hard drugs are much easier to access then treatment and it’s only getting worse.
14
@Lee
There is treatment but no cure and treatment fails more often than not. It is a scary time and fentanyl addiction looks like a hopeless situation. Time will tell whether rehab from it can succeed.
3
As a suboxone/buprenorphine prescriber, I’ve wondered if suboxone itself has pushed the emergence of fentanyl. As more dedicated customers move to the safer opioid (suboxone) dealers losing market share. Many cocaine and heroin positive urine drug screens of my patients also fentanyl positive. So dealers out there possibly spiking the product to keep customers. Also your normal dose of street heroin won’t break through the opioid blockade of suboxone, whereas heroin supercharged with fentanyl will still get you kind of high, even with suboxone on board.
15
Andrew: My son is a 5-year user of suboxone/buprenorphine. In light of his 20-year addiction to opiates I find this to be a very"good" drug. But I had no idea that Fentanyl will break through the Suboxone block. scary but thank you for that clarification.
5
I don’t know how I’m supposed to feel about this article. I guess it’s a matter of being the lesser of two evils, and heroin wins. What commentary on our society!
9
Corporate greed has no boundaries, now with phares companies taking over a former illegal market (hard drugs). I have no illusions about the real motive behind the legalization of marijuana either.
5
@Anne
I can't let your parting comment go. Marijuana isn't going to physically addict--let alone kill anyone. Obviously many entrepreneurs don't have altruistic motives behind their advocacy--but what of it? Was it somehow better to give police a carte blanche of arbitrary power over young people and particularly young minorities because they might be carrying some weed?
How much less depressing and tragic this article would be if these former heroin users now involuntary fentanyl could somehow be converted to edibles.
2
To me addiction is personified by cigarette smoking...with all the evidence now why does anyone start? All the news discuss the problem of fentanyl and those who have discarded heroin pick up fentanyl. Not much to say. I am not really sympathetic. Especially since drug abusers kill their children, ruin their lives if not the above, and generally comprise the largest number of criminals in the US. Preying on others for their drug of choice. If they overdoes they are solely responsible, although the Fentanyl producers should be convicted as well...the manufacturers are a scourge.
7
As virtually all the illicit fentanyl is coming directly or indirectly from China, why doesn't Trump make ending its shipment from there part of his requirement for any deals on tariffs or at least as vociferously denounce China as much as he denounces the south and Latin American countries for failing to keep their people from showing up at the U.S. southern border seeking admission. After all, far more people are being killed by fentanyl from China than by immigrants seeking a better life here.
54
@Steve
The article directly addresses your question and provides a link showing that Trump has done more than any other president in this regard.
8
So this is where we to choose to exert our power as a society — not to curb the grotesque corruption embodied by Trump, not to curb gun violence with common sense regulation, not to free the babies from ICE cages, not to feed the children — no, instead of that and more, we choose to keep this harmless old junky from feeling less pain. Legalize all drugs now, then let’s get to work on our real problems.
27
@Keef In cucamonga
unfortunately we are not going to " choose to exert our power as a society " re: fentanyl or corporate opioids . I believe this piece is more of a signpost for the future of destruction in the most hopeless of situations . Obviously , the problems you list are paramount ( many more could be listed . I fear society's power is diluted and diffuse . An alert such as this article gives us a peek into a dark and dangerous dance with death .
Very well said Keep. Alas, pardon my double punning, Keef's obviously more sensible prescription is at best a pipe-dream. An America that elects the embodiment of "grotesque corruption" like Donald Trump might be moved to shed a few temporary tears about ICE-caged babies, but it is highly unlikely ever to give a toss about a "harmless old junky", let alone permit the easing of his pain.
Whether it's sex, drugs or any other sinful, illicit and unnatural pleasure we humans have devised or experience, our Judeo-Christian ethical sensibilities and/or the life's undeniable dualism mandate that it be accompanied or followed by pain or other punishment. The heroin addict pays some particularly painful prices for his periods of pleasure. They include collapsed veins, abscesses, AIDS, Hep-C, jail, unemployment, homelessness, withdrawal symptoms hellish enough to fuel the worst criminality, and early death via OD. Most of society can't comprehend why anyone chooses the life of a junky. As someone who lost a younger brother to such a shortened life, I can say with assurance the answer is because there is no "choosing". Once one biologically predisposed to opioid addiction comes within its powerful grip, it is impossible or nigh so to break it. For these folks opioid maintenance is necessary.
"Oh how awful that is!" say the rest of us, as we drink our beer, wine and cocktails, puff on our pot pipes, thump our Bibles, or rave sanctimoniously about getting "naturally high"!
1
Our war on drugs is the cause of this misery, much more than the drugs themselves which are not harmful if you know the dose (which you don't in an illegal context) and the contents/purity.
But no, we prefer to moralize and punish.
Opiates, btw, re 20% addictive, vs 15% of drinkers who are alcoholics. Opiates aren't as harmful as society thinks - it is the PROHIBITION of them that's the big problem.
"If we decriminalize everybody will do it!" Will YOU?
D.A., J.D. NYC
20
Thank you David. Most people have a beer or a glass of wine. Most people won’t drive drunk
Legalize it and control it
2
1969. Freshman year, Oregon State University. Out in the sticks in Corvallis, Oregon. The use of illegal substances back then was limited to marijuana and LSD. Men were returning from Vietnam, enrolling in school on the GI Bill and different substances started becoming popular. I was an innocent 17 year old wannabe hippie from the SF Bay Area. I fled 600 miles north 10 days after graduating from high school to dodge the draft, escape the tear gas and continual anti war protests and find some peace of mind.
In Corvallis I was introduced to a group of long haired, war weary, veterans. One , a former Army Ranger, had been severely wounded in action, and was still in excruciating pain. He had established a connection and was regularly using heroin to supplement his pain meds. Another person, heir to a wealthy NYC fortune, was not enrolled but was living "the student life" in and around campus. He routinely disappeared for three or four days and then reappeared. It turns out he was flying to NY, heading to the South Bronx, scoring a months supply of "smack" and heading back to Corvallis. He once told me as a kid he used to shoot up between subway cars. That was my introduction to hard core drug use. The circle of users was small, and they all seemed to know each other. There were no ODs. Heroin, very expensive, had made it's way to Oregon...and the seed was planted.
56
The needle exchange vans, with their injection instructions and naloxone supplies, are striking to me for 2 reasons. First, wouldn't the effort and resources that went into them have been better spent on clinical programs to treat addiction? Second, it seems like by taking some of the risk out of drug use they reduce a perhaps necessary deterrent and normalize the behaviors.
6
@Svetik
Needle exchange and other harm reduction services save lives. I’ve got 25 years clean from heroin, and the ability to get clean needles and bleach helped me to avoid contracting H.I.V. and hepatitis when I was using. Addiction is stigmatizing, and getting clean is hard enough without adding H.I.V. to the mix. Needle exchange programs did not give me the message that my addiction was acceptable behavior. But they did show me that there were people who had compassion for me when I was in the gutter.
That was in the 1990s, today needle exchange programs also save lives by providing OD kits with Naloxone that can revive an addict from an overdose. Far from co-signing addiction, such programs help addicts to preserve what little health and dignity they have while they are in active addiction.
17
@G.G. Love - It would be nice if the addicts actually used exchange but here in Seattle the junkies throw their needles on the ground the same way smokers throw their used butts on the ground.
I would never even dream of wearing sandals again in this city. Yesterday walking to the store, I saw yet another cap on the ground. I see the used syringes on the streets, the parks, even the yard to our apartment building and we are gated. They just throw them over the fence where our kids play and the dogs walk. I had to weed the entire fence area the other day and I was quite cautious while doing so.
Our city has an "open air drug market" downtown where heroin and meth is clearly sold on the street. Our police literally look the other way. This drug market is three blocks away from the Pike Place Market which is one of the main tourist attractions.
6
@svetik - These programs also keep addicts in touch with those working in the recovery community, many of whom are ex-addict themselves. Sometimes, this continuous exposure has a way of making sobriety seem attainable. But as G.G. Love says, it's mainly about harm reduction.
4
Politicians and police and physicians can discuss the "what" of addiction forever and they won't get anywhere. The question that has to be asked is "why?"
Why do some people want to escape their existence through the use of these substances. That is the hard question, because you have to look at personality and society and all kinds of difficult squishy questions that have no clear cut answer.
Enforcement wants to deal with supply, because it is a mechanical question that can be addressed. But for most of the populations, an abundance of or lack of drugs makes no difference, we're not addicts. For addicts, you take away one substance, and they will find another.
I work in finance, and the credit card division understands that no matter how many checks and balances and controls they put in place, about 4% of card holders default. I look at society the same way: about 96% are fine, but we really should be trying to help that 4%, whatever their difficulties.
34
@Buttons Cornell Whether we help the 4% or not, they will default regardless. Part of the human condition is that certain people are incompetent and cannot live a normal life. They deserve their human dignity, but it is mistake to believe you will solve their problems. You will not. My suggestion is come to terms with this aspect of our lives.
7
@Buttons Cornell
A couple of "whys" might be -
-three billionaires (Bezos, Buffett, Gates) have more wealth than the "bottom" 50% of Americans.
-23% of all American babies are born into families of poverty (37% of all babies in New Mexico). Source - Wall Street Journal, 5/6/19.
1
People go ape if someone wants to open a methadone clinic in the neighborhood. Hence, the demand for methadone treatment is far higher than the supply. Decades ago, it was proven that those on methadone are more likely to be employed, less likely to commit crimes, and more likely to be involved with their families...For a person whose brain tissue has been changed, often permanently but at times just for many years, a methadone clinic is more effective and safer for the neighborhood.
25
@Audrey
The problem is many of these people want to get high and they're not ready to go to treatment. And even those who do go to rehab success rates are miserable.
First order of business is to try to get people to not start heavy drugs. Get the pushers off the streets by arresting them and providing their clients with clean free state provided alternatives and that means heroin or whatever they need to get high. When the clients go away the dealers won't have the incentive to smuggle in the drugs.
The hidden story here is the one that challenges the conventional narrative of opiates, including heroin, leading to certain death.
Maybe we could have another in-depth article on long-term heroin addicts who survive into their 60s. And not just people who have been taking prescription pills, but poor minorities surviving for decades using heroin.
37
@Mobocracy
Exactly. Heroin addicts can fully function in society, hold jobs, and be productive.
4
There is empirical evidence that treating addiction as a disease works to reduce crime, addiction rates, OD deaths, and rates of recidivism. Portugal is a perfect example of what happens when you apply some outside of the box thinking and look for paradigm shifts. Unfortunately in the US we need to overcome widely acceptable, and perverse, cultural norms to move forward. Given the current climate in our country the necessary change will not in my life time. I can only hope it will for future generations.
27
Buprenorphine is widely available in states with good social support programs. In NY for example, Medicaid, Fidelis, MVP, CDPHP, and almost all private insurance companies will pay the full or most of the cost of buprenorphine films or tabs.
Patients on buprenorphine maintenance have some protection against overdose, have elimination of most cravings, and are given a chance to rebuild their thinking patterns and rebuild a productive life.
Eventually, when they have rebuilt a life that is not full of drug-triggers, and have practiced healthy decision-making to take good care of themselves, they can taper off buprenorphine and learn how to live life and be present, present to the thoughts and feelings they used to run away from. They can use a rational program such as SMART Recovery to help them learn to live a better life.
Most patients don't have to go to inpatient rehab, although rehab does protect a person for a month. Most patients can be treated as outpatients. Studies show that patients taking buprenorphine, and not receiving "formal Cognitive Behavioral Therapy" counseling, do just as well as those who do receive the CBT counseling. We think this is probably because the doctors do some counseling during the medical visit as is their usual custom.
So there is a way out of the opioid problem. It does involve an investment in medical programs for the buprenorphine combined with counseling and mutual support programs. It does cost some money.
20
@Richard I agree with you. I am a physician who has a DEA license to prescribe buprenorphine. Only 5 % of physicians in the US have received buprenorphine training and are licensed to prescribe it. Outside of large urban centers, there are far less buprenorphine providers than is needed.
My practice is in the Hudson Valley and that is the case there.
NYS passed specific legislature mandating that all insurance companies must provide coverage for at least one buprenorphine product.
9
@Richard
Agreed. Clinics that use Buprenorphine and programs such as SMART Recovery have much better success rates.
Combining the above with the government providing the hard drugs to those already addicted who are not ready for drug rehab would essentially solve the problem.
The drug addicts would have a choice of jail or getting their drugs free from the government. The drug pushers would still be arrested but their clients and incentive to smuggle drugs into the USA would be gone.
3
One thing is for sure. Due to lack of support and money by our government, we do not have enough sensible, evidence based methods to treat addiction in this country.
37
@Celeste
Another reason we don't treat addiction with "sensible, evidence-based methods" is because we, as a society, still cling to the idea that addiction is a crime to be punished, not a health problem to be treated.
57
The passive recognition that addicts are switching to a lower cost generic drug is pure economics. What is startling our society resigning to the fact that we cannot help addicts? We need more science on treating addiction and more in the way of mental health therapies to help people overcome the addiction.
We can do better and help improve the quality of the addict's lives and the lives of the people they ruin in their wake,
14
For time immemorial, drug sellers and addicts turn to whatever is cheapest at the moment. First we decried Oxycontin, a useful pain medication, as the cause of addiction. Then we made Oxy harder to get, so addicts turned to heroin because it was cheaper. Now fenteninal is cheaper. Alcohol remains the most abused drug.
The cause of addiction is NOT the particular drug of abuse. People take these drugs because they want to (in the words of 60's rockers Velvet Underground) nullify their lives. Why is that so attractive to so many?
65
@Boston Barry . Why is that so attractive? Possibly because these users had no guidance as small children and no hope of a decent wage as an adult. When you live packed in a city of fleas you get fleas.
Now I have no explanation why the privileged and wealthy use drugs but it all probably comes down to "no hope" and that is a mental issue, not a drug issue.
7
@Boston Barry
Maybe they lead lives that need nullification. At least temporarily. I know I did.
4
Agreed, Patrick! My husband, who has severe spinal problems and had a 3rd emergency surgery last Sept was recently told that he must go to another doctor for his pain meds and the doc he was referred to is described by his surgeon is "the most restictive in town" with prescriptions...
Even his surgeon agreed that policies restricting pain meds to those who most need them would exacerbate the opioid crisis as desperate people take desperate measures, buy street drugs to stop their suffering, and die.
Suicides among those in pain and cut off from pain meds are also on the rise.
There ARE a few doctors out there that fraudulently prescribe meds to people who don't need them without even seeing them and this is a problem. But is it a public health issue or a moral one? Are these people dying from these ill gotten meds? Not at the rate of those taking fentynl as described in this article.
Most doctors are trying to help pain patients make it from one day to the next. People in pain should be able to work with their own doctors or the result WILL BE that desperate people take desperate measures, and many more will die.
Doctors should lead policy on this issue, not politicians and law enforcement. Doctors working with individual patients should help them control their pain, not a choice between suffering and possible death from street drugs. Doctor's choices should be led by best practices, not fear.
I fear for the future, for my husband and for the nation.
98
Caroline. I am truly sorry and hope our society becomes enlightened. Maybe the 99 percent of the docs who are responsible prescribers will stop performing any procedure that would require pain meds until government agencies stop the storm trooper approach.
2
The drug trade seems 'alive and well', irrespective of the not-alive and unwell status of death by overdose. In reading Don Winslow's "The Border", a lethal combination seems to be creating havoc as well, and where Narcan may remain an afterthought, Fentanyl-laced heroin. Inasmuch as the demand will trigger more supply, the question remains: what makes us seek an escape from reality (and into drugs) if not our chronic unrelieved stress and loneliness in a society always on the run?
16
[[Heroin has ravaged this city since the early 1960s, fueling desperation and crime that remain endemic in many neighborhoods. But lately, despite heroin’s long, deep history here, users say it has become nearly impossible to find.]]
Hmmm...maybe those ravaged neighborhoods could use an injection of gentrification. Build up some property, open a few businesses, generate a little tax revenue, pay for more cops and clinics.
Thoughts?
6
@Third.Coast
Gentrification may help the neighborhood, but it will simply move the people too poor to live there to go somewhere else by displacement. If gentrification is a movement up, there will be a reaction of another place going down. Getting people off the drugs, give them a solid economic means with which to adapt to a gentrification process is the real challenge. One society keeps deeming as too expensive, hence the fifty years of blighted neighborhoods. Meanwhile, the landlords during gentrification of a neighborhood take their now much higher rental income from people willing to pay, all the way to the bank.
16
@Third.Coast
We could agree that gentrification would raise the property values and taxes. It will attract more affluent home buyers and renters. It will attract investment and commerce. However, if past is prologue, the poor will not be part of that equation. They will be pushed out of their rentals and move to a different poor neighborhood and continue their challenges elsewhere. Unless there are laws that allow rents to be maintained, they will not attend the good schools or live on the nice streets with the good stores and the healthy food. I wish it were true but it's not.
14
@Third.Coast
The 'neighborhood' isn't the problem. The people are the problem. Pushing them out just pushes the problem into other neighborhoods.
4
Most disturbing is that no where in the article is drug treatment with methadone or suboxone mentioned. This can be effective, and the only way to eliminate the risk of injecting a lethal dose. Beyond that, investment in broad education, with more money going to poorer areas and vocational programs for 21st century business and manufacturing is the way to give the next generation hope. The worse opioid epidemic is in economically depressed areas, Ohio, W Va, Baltimore.
Lastly, withholding appropriately doses narcotics to elders with fractures only leads to suffering and mistreatment with Xanax or other meds for pain related agitation. The pain meds are tapered in a few weeks when the bone has healed. I’ve had only a couple want to continue these meds. Not everyone is an addict.
108
@Elizabeth Landsverk MD
"The worse opioid epidemic is in economically depressed areas, Ohio, W Va, Baltimore"
You forgot rural America, which when last checked, is in all 50 states.
5
@Elizabeth Landsverk MD: I've spoken with addicts who say that methadone has more negative health consequences than heroin itself. Methadone is merely another addictive drug which is substituted for heroin; it's not going to fix anything (pardon the pun).
4
I've been on the front lines in this battle for years and have treated quite a few patients addicted to fentanyl. As long as we do not have Medicare for All, we will fail, because what people need to recover and to prevent addiction is a doctor that knows them and cares about them. Most of the patients I have helped tell me that both law enforcement and the medical industry, particularly the methadone treatment industry, treats them like animals. Either buprenorphine or Vivitrol can be very effective. But the manufacturer charges $1400 a dose for Vivitrol, and most of my patients cannot get it.The same industries (Pharma and private medical insurance) that got rich off opiate addiction now want to get even richer off the opiate crisis.
213
Absolutely. Vivitrol is nearly impossible to get thanks to strict state regulations. It was accessible four or five years ago (shipped straight to the provider from specialty care pharmacy) but no longer.
If upper-middle-class people with all their resources can’t access this drug, what hope is there for the working poor or unemployed?
38
@Dan Woodard MD
Strongly agree, until you got to Vivitrol (extended-release naltrexone).
When the NEJM refers to "evidence-based treatment," they mean buprenorphine or methadone.
I'd like to see you give a lecture and make the case for Vivitrol. There have been lots of articles saying that it has modest short-term effectiveness but no long-term effectiveness, and that it's being promoted as a drug-free treatment by politically-connected people who are making a lot of money out of it.
(1) They haven't demonstrated long-term effectiveness. Lots of treatments seem to work after 24 weeks, but after 3 years (or 72 weeks, for Vivitrol), the remission rate in the treatment and control group are the same. There is *one* good randomized, controlled study doi: 10.1056/NEJMoa1505409
(2) There are no head-to-head treatments comparing Vivitrol to buprenorphine or methadone. We know that after 3 years, patients on buprenorphine or methadone will be significantly less likely to die than untreated patients. Can you give your Vivitrol patients the same assurance?
(3) Here's a good overview in Stat, on the clinical and political problems with Vivitrol https://www.statnews.com/2017/06/29/vivitrol-methadone-opioids/ which references stories in the NYT https://www.nytimes.com/2017/06/11/health/vivitrol-drug-opioid-addiction.html and ProPublica https://www.propublica.org/article/vivitrol-opiate-crisis-and-criminal-justice
17
@Dan Woodard: Agree. In the context of organic food, the late Anthony Bourdain pointed out that in the US, the giant organizations in (non-organic) food production, which uses pesticides and herbicides (that in turn drive people to buy organic), are increasingly the giants in organic food as well.
Bourdain likened this to a Mafia organization that breaks your legs and then offers to sell you crutches or walkers.
7
Where is the necessary drug addiction treatment? Suboxone works, but it requires constant monitoring. I read nothing about rehab in this piece. I thought Trump was going to implement broad programs to assist the addicted. As if. . .
45
@Susan
If you're willing to plow through the peer-reviewed medical literature, you'll see that rehab doesn't work. Or more precisely, buprenorphine alone works just as well as buprenorphine plus rehab. https://www.nejm.org/medical-research/addiction
The NYT has pretty good coverage of rehab programs too. It's hard to find anything but failure.
6
This is a natural consequence of the war on drugs, which kills and harms more than it cures. We wouldn't have fentanyl, or synthetic marijuana for that matter, if not for Prohibition, which encourages criminals to come up with alternatives to established drugs. Almost invariably, the alternatives are worse than the drugs they replace. And so everything gets worse.
76
@August West
I was waiting for the reporter to ask the law enforcement people the obvious question:
Has the war on drugs failed?
Would we have more deaths if we gave legal heroin to addicts, or if we continued with the 70,000 deaths a year under our current laws?
24
@August West
This is absolutely the case and has been illustrated throughout the history of opiate abuse. Up until the government severely limited raw opium imports in the 1920s, opium smoking was actually the most dominate form of opiate abuse, even in the years before 1915 when over-the-counter sales of morphine and heroin were legal. Smoking opium is actually one of the "safest" forms of opiate use and the least likely to produce dangerous addictions. Surprise surprise, even regular users prefer less risky formulations.
Once opium for smoking became difficult to get, trafficking in heroin increased because its potency per volume made it easier to smuggle and distribute.
In many ways, the prescription abuse of opiates was something of a return to a "safer" opiate -- regulated doses of a clean product, often only widely available in smaller doses that produced fewer dependencies.
The DEA crackdown on prescription opiate diversion worked, and pill users switched over to heroin, which was more potent and dangerously unpredictable. This squeezed supplies, resulting in the same "market adaptation" as the move from smoking opium to heroin, and fentanyl became preferred for its potency per volume and less complex supply chain.
Each increase in restriction and enforcement has actually backfired, pushing markets to more potent variations -- with all the expected disastrous consequences as potency and predictability change.
14
@August West The war should continue and if the users are killed they have a death wish anyhow. They have had many chances and even if it is because their parents used they could have been so badly affected they refuse to go down that useless path...I know of what I speak and chose the right way. And the bad example was enough. It should be for all of these people. But if they are not convinced and refuse to change, well they made that wrong choice. Keep up the war on drugs.
2
In reading the article I get the sense no one knows what is taking place. What do we know? People are dying and with minor exceptions we treat this as a law enforcement matter. It hasn’t worked and it never will. We need to stop thinking we are going to arrest and incarcerate our way out of this. It has reached the point where even doctors are afraid to prescribe painkillers to people legitimately in need. One could make the causation and correlation that this attack on physicians has give rise to the street drug problem. The current system is not working.
106
@Patrick
"It has reached the point where even doctors are afraid to prescribe painkillers to people legitimately in need." Certainly the doctors have a responsibility in the opioid epidemic. By overprescribing legal opioids, minimizing their addiction potential, these doctors sought personal monetary gains at the expense of their patients' long term health.
10
@Patrick oh please, the doctors and the pharmaceutical companies created this disaster. I have had multiple injuries over the counter pain medications work much better than opiods for reducing pain. Opiods get you high and put you to sleep and are very addictive, which gets you going back to Doctor to get another prescription so Doctor makes more money, any Doctor who is regularly prescribing opiods is a drug dealer.
12
Read Dreamland by Sam Quinones. The truth is no one simple answer. Certainly big pharma and doctors are complicit, but it goes deeper and as far back as the early 1900s. There are cultural and economic causes that cross international borders. It's a fascinating, though frightening, story - a story that both informs and infuriates, but also is incredibly sad.
29