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"...they’re all saying the same thing: This was a good kid."
May 8, 2014 9:44 AM   Subscribe

Staten Island, long a blue-collar bastion of police officers and other New York City workers, is confronting a heroin epidemic. Thirty-six people died from heroin overdoses in 2012, the highest number in at least a decade, according to the most recent available city health department records; the death rate was higher than the city’s other four boroughs had seen in 10 years.
Heroin’s New Hometown
posted by griphus (65 comments total) 11 users marked this as a favorite

 
How sad. I figured there might be an issue when they announced the NYPD's overdose antidote program would pilot out there.
posted by ThePinkSuperhero at 9:48 AM on May 8


Anecdotally: a friend from a nice Long Island town told me that a lot of people from her high school had gotten into heroin after getting hooked on prescription opiates jacked from their parents' bathroom cabinets. I obviously can't speak to the truth of this, but it certainly sounds plausible enough.
posted by showbiz_liz at 9:51 AM on May 8 [2 favorites]


None of my close friends in NYC, but friends of friends are getting into it, only one that I know of is even trying to get out of it. It feels like watching a storm roll in on the horizon.
posted by Brainy at 9:54 AM on May 8 [2 favorites]


Rolling Stone also recently ran this story: 'The New Face of Heroin: The Epidemic That's Ripping Vermont Apart.

Well worth a read.
posted by Fizz at 9:55 AM on May 8 [4 favorites]


a friend from a nice Long Island town told me that a lot of people from her high school had gotten into heroin after getting hooked on prescription opiates jacked from their parents' bathroom cabinets.
Everything I've read about the current suburban heroin epidemic suggests that this is totally typical. It's a big issue in the Midwest, too, for what it's worth.
posted by ArbitraryAndCapricious at 9:56 AM on May 8 [4 favorites]


Yeah, I hadn't finished the article when I posted that, and sure enough, it gives the exact same reason.
posted by showbiz_liz at 9:57 AM on May 8


Heroin overdoses have gotten common enough here in Massachusetts that the state government is starting to equip Narcan in every first responder vehicle.
posted by backseatpilot at 10:00 AM on May 8 [4 favorites]


The heroin epidemic is another great byproduct of our half-assed Afghanistani nation-building adventure and subsequent destabilization. Due to a bumper crop of poppies, farmers who have to grow something to provide for their families and a lack of policing (so we don't alienate our allies in the region)/ ensuing corruption and of course collusion with the resurgent Taliban in the areas under their control:

1) Smuggling heroin out of the poppy fields is much easier,

2) Prices of heroin have fallen

Add these to the:

3) Return of heroin chic amid the upper classes and entertainment industry

4) Probable collusion with law enforcement (they know who the dealers are and aren't arresting them because once the "Drug War" ends so does the funding!)

and you wind up with a mountain of dead children.
posted by Renoroc at 10:00 AM on May 8 [1 favorite]


It's all over, I think: Rhode Island has seen a sharp increase in the rate of overdose deaths this year. Now many LEO agencies are getting training and supplies for all officers to carry Narcan: check it out.
posted by wenestvedt at 10:01 AM on May 8


Just last month, Rolling Stone named Vermont as the new heroin capital. My, how time flies.
posted by Ideefixe at 10:07 AM on May 8


Heroin overdoses have gotten common enough here in Massachusetts that the state government is starting to equip Narcan in every first responder vehicle.

Forget just issuing it to first responder vehicles, issue Narcan to every addict along with the simple training it takes to administer it. It's not like junkies are going to be looking for ways to get high off the stuff.
posted by item at 10:13 AM on May 8 [10 favorites]


Now many LEO agencies are getting training and supplies for all officers to carry Narcan

I have been seeing that pushed hard on the Rhode Island evening news and my terrible conspiracy theory is that all of these stories are being pushed by the Narcan pharmaceutical industrial complex.
posted by jessamyn at 10:14 AM on May 8 [1 favorite]


The naloxone or narcan (OD antidose) would be better being distributed to a more diverse range of people than just first responders. One of the odd things about this reversing agent is that it wears off after about an hour, so someone can OD, be nearly dead, then wake up so rapidly that they get withdrawls and want another fix, while the heroin they already have on board lasts a few hours before it is removed naturally from their system, and can cause another OD once the narcan's effects subsides. Anyway, that was a sad old story. Poor bastards.
posted by peacay at 10:20 AM on May 8 [4 favorites]


Mrs. lattiboy is originally from New Jersey. Most her family lives by The Shore and apparently the amount of addicts is just horrifying. Pretty much every one of her young cousins knows a few people who have OD'd and a few people who deal.

It's so odd as I kind of think of heroin as a very 60s/70s drug. I realize it ebbs and flows, but I just can't imagine a person who has grown up in the modern US every taking that first dose. Besides meth, it's probably the most vilified drug in existence.
posted by lattiboy at 10:21 AM on May 8


I know you're kidding jessamyn but the patent on naloxone has expired, so it shouldn't be too vulnerable to such corporate shenanigans. It's distributed by at least 2 suppliers in the US that I know of, and dozens internationally.
posted by Wretch729 at 10:26 AM on May 8 [4 favorites]


Forget just issuing it to first responder vehicles, issue Narcan to every addict along with the simple training it takes to administer it. It's not like junkies are going to be looking for ways to get high off the stuff.

The problem is that Narcan basically takes you straight into horrible withdrawal, so a lot of junkies are terrified of it. It's common practice now in hospitals to slowly titrate the dose just enough to get the patient breathing again, because if you just give them a big dose, they wake up feeling worse than they ever have in their lives and can get angry and violent.

Probably better to have more of this stuff around and available to people, but I would imagine that addicts would resist administering it to themselves or possibly even their friends.
posted by vogon_poet at 10:26 AM on May 8


Forget just issuing it to first responder vehicles, issue Narcan to every addict along with the simple training it takes to administer it. It's not like junkies are going to be looking for ways to get high off the stuff.

Exactly. Because you know what heroin addicts hate: something that, as peacay notes, makes the high go away. You know what they hate more: dying.

Narcan is super easy to administer (relative to shooting up) so even somebody else who is high can do it fairly competently. It doesn't even have the (flawed) moral argument that clean needle/needle exchange programs get met with -- that if you make it easier, people will be more prone to use.

Standing in front of making Narcan easier for people to get isn't taking a stand in the drug war; it's killing people.

personal hobbyhorses, I have them

I can't believe how much more prevalent heroin seems than even 5 or 6 years ago. The fact that use has moved to Staten Island, the Chicago suburbs, or Vermont isn't surprising given how much more prevalent it seems in places where it already had a foothold.
posted by MCMikeNamara at 10:27 AM on May 8 [2 favorites]


Besides meth, it's probably the most vilified drug in existence.

It's also the most potent anxiolytic in existence, with no six-week ramp-up time like SSRIs and few of the side effects of benzos. It works... except for one little thing.
posted by infinitewindow at 10:29 AM on May 8 [17 favorites]


In Oregon, they've expanded use of Narcan, cutting heroin deaths in half in the Portland area. We can also thank the Governor for saving at least one heroin user. (insert joke about Oregon's failed ACA exchange here.)
posted by vespabelle at 10:53 AM on May 8


It's so odd as I kind of think of heroin as a very 60s/70s drug.

I think this exact same article was in Rolling Stone in 1994 except talking about a small town in Texas. These LEO's could learn from prior "epidemics".
posted by fshgrl at 11:10 AM on May 8 [2 favorites]


The main thing about using drugs safely is knowing your dose. A regular heroin user will have built up a tolerance and therefore need a bigger dose, whereas new user won't. Sometimes the "teacher" forgets that and the "student" dies.

But knowing your dose requires a regulated standard. How pure is it? Is it cut with anything? Is that 'anything' baby formula or fentanyl? *shrug*

(I have my unfounded suspicions that the war on drugs includes a war on drug users, that the potency of the supply is deliberately increased by law enforcement periodically as a scary deterrent and as a cull and as away to increase public awareness of a drug problem [read: increase funding], and that this has gone on since the days of J. Edgar Hoover. This hunch derives mainly from the notion that the heroin industry doesn't have any interest in its customer base dying off, whereas law enforcement gets more funding for what appears to be a sudden and growing drug epidemic while the OD's themselves do all the work. It might be a loony thought, but it keeps me off heroin.)
posted by Sys Rq at 11:12 AM on May 8 [2 favorites]


In the depraved emotional calculus that often surrounds these issues, anything that reduces the chance of dying from an overdose is just going to make more people try drugs, and that would be bad because keeping hypothetical kids completely clean is more important than actual dead users.

No, I don't get it either.
posted by Nerd of the North at 11:14 AM on May 8 [2 favorites]


...a friend from a nice Long Island town told me that a lot of people from her high school had gotten into heroin after getting hooked on prescription opiates jacked from their parents' bathroom cabinets. I obviously can't speak to the truth of this, but it certainly sounds plausible enough.

Data point: yep, a family member did it this way. Fortunately in recovery for now. Interesting revelation from him/her - We live in a city with lots of Army. Apparently, some GIs are bringing it back from Afghanistan in pretty significant volumes.

Feel free to run with that, investigative journalists.
posted by j_curiouser at 11:26 AM on May 8 [3 favorites]


You know what they hate more: dying.

Not necessarily. At a certain point, they don't care whether they die or not, as long as it's a good high.
posted by Melismata at 11:32 AM on May 8


One of the odd things about this reversing agent is that it wears off after about an hour, so someone can OD, be nearly dead, then wake up so rapidly that they get withdrawls and want another fix, while the heroin they already have on board lasts a few hours before it is removed naturally from their system, and can cause another OD once the narcan's effects subsides.

That seems like pretty much why you'd want to give it to first responders and not the users themselves to carry around as a just-in-case. You want to give it to someone as part of the process of getting them to the hospital, or at least somewhere where they won't shoot up immediately again and where the withdrawal symptoms can be managed. The last thing you want is for someone to help their buddy drop Narcan and then call it a day.

If wide availability of Narcan led to more DIY use as an alternative to calling 911 ("hey don't call 911, I have some Narcan upstairs..."), that might actually lead to more adverse outcomes.
posted by Kadin2048 at 11:33 AM on May 8


I know you're kidding jessamyn but the patent on naloxone has expired, so it shouldn't be too vulnerable to such corporate shenanigans. It's distributed by at least 2 suppliers in the US that I know of, and dozens internationally.

Not according to this NPR story:
Only one pharmaceutical company, Amphastar Pharmaceuticals, manufactures Narcan in the dosage that's used as a nasal spray. Seven years ago, Massachusetts paid $22 per Narcan kit. Today, that kit costs $42.

posted by inigo2 at 11:35 AM on May 8 [1 favorite]


Here in Kentucky, they've been talking about our local heroin epidemic for about a year now. There's just so much sadness going around.
posted by jbickers at 11:41 AM on May 8


(I have my unfounded suspicions that the war on drugs includes a war on drug users, that the potency of the supply is deliberately increased

I've always wondered this too, and the heroin-cut-with-fentanyl thing is pretty strange. That's like buying 87 Unleaded and finding out that it's been cut with rocket fuel. If you have access to fentanyl, why are you selling it as heroin? You've got fucking fentanyl, one of the most powerful opiates ever developed. It's so powerful you don't even need to shoot it, you can just rub that crap on your gums. (Heck, one of the medical routes for it is transdermal patches; it'll go right through your skin, although probably not at a rate that would be of much interest to a recreational user.)

But yeah, if you wanted to look for a conspiracy it's a pretty good way of causing people to OD, in a way that's fairly hard to detect (cf. just cutting it with potassium cyanide or something) and just makes it look like meh-dumb-junkies-gonna-junkie. The best theories would point out that as the war on cannabis is losing ground, and the traditional drug war funding has mostly slid over towards homeland security stuff, maybe somebody decided to open a new front.

I go back and forth on whether anyone on the law enforcement / DEA side is simultaneously depraved and also confident in not getting caught enough to do something like that, but crazier things have happened.
posted by Kadin2048 at 11:46 AM on May 8 [2 favorites]


i guess i channeled bizzaro-world nypost too well.

it's hard to have any sympathy for drug problems on staten island given the history of the drug war in NYC.
That many middle-class Staten Island families send their kids to Brooklyn for treatment speaks to the pervasiveness of the problem and the shame it carries in an insular borough. “Families generally feel better when their child is out of the community,” said Karen J. Carlini, the associate director at Dynamic.
this is the exact equivalent of anti-abortion activists sneaking into planned parenthood when it's their daughter in trouble.
posted by ennui.bz at 11:58 AM on May 8


If you could get a version of it where you never habituated and could just get it from the pharmacy, it would be a mental health miracle. Someone I know with borderline started doing markedly better emotionally and it took very little time to figure out they'd relapsed. I've taken Tussionex for panic attacks before, not that I'd do it regularly, but thankfully I don't have to. Some people seem to think that opiate addiction is this decadent thing, but for a lot of people it's just the search for feeling normal. It's not something I've had a problem with myself, but I have four different things I take just to keep on a vaguely even keel, and it doesn't always work so hot.

The up side is that sometimes it means that addiction problems can be treated by just finding the meds someone should have been on the whole time, but a lot of things aren't anywhere near that simple.
posted by Sequence at 12:01 PM on May 8 [3 favorites]


If wide availability of Narcan led to more DIY use as an alternative to calling 911 ("hey don't call 911, I have some Narcan upstairs..."), that might actually lead to more adverse outcomes.

Some would say going to jail for a few years as a result of calling 911 is pretty adverse.
posted by j_curiouser at 12:05 PM on May 8


One of the things that is overlooked in the recent media coverage of the "heroin epidemic" is that new FDA regulations around prescription narcotics went into effect late last year. Before the new regs, there were a lot of pill mills giving out oxycontin and vicodin prescriptions without much care for the downstream consequences. As of December 2013, it is much more difficult to get a prescription for, say, vicodin. Doctors are no longer allowed to transmit these scripts electronically or by phone-- patients are required to have an office visit to get a refill, and they have to take the script to the pharmacy personally to get it filled. Docs are not allowed to prescribe more than 30mg/day of hydrocodone, or more than 45 pills/month, without doing a significant amount of extra work and exposing themselves to a lot of risk with the DEA.

On the face, these changes might seem like a good idea, but there were a number of critics who believed that it would simply drive people to heroin, which is cheaper and more potent, anyway. If you can't get vicodin anymore and you have a serious addiction, heroin is the most obvious choice. It's probably easier to get, and even if it's shitty, it's probably stronger.

I had a prescription for vicodin for many years due to chronic, severe migraine headaches. Thanks to the new regulations, I can't get it anymore. There are migraine-specific medications available, but they're very expensive, frequently don't work, and have some pretty nasty side effects (a single dose elevates my blood pressure into stroke territory for 2 - 3 days). Thanks to these changes, I'm in severe pain for a non-trivial amount of my life and haven't found a viable alternative.

Another complication with prescription pain killers is that many, many overdoses were/are due to the acetaminophen content in most of those drugs. Acetaminophen (Tylenol) is toxic to your liver in surprisingly low doses, and was added to hydrocodone in large amounts in many formulations. The FDA has been concerned about this for many years, because acetaminophen is found in large numbers of over-the-counter cold medicines, etc. For years, the maximum daily dose of acetaminophen was 4000mg, which was equivalent to 8 extra-strength Tylenol. Lortab 10 and most of the other hydrocodone variants also include 500mg of acetaminophen per pill. My script for Lortab limited me to 8 in a day if absolutely necessary, which put me at the absolute limit for acetaminophen even before the FDA lowered the maximum dose to 3000mg. If you get a cold, it's pretty easy to take a lot of acetaminophen and not even be aware of what you're ingesting. Many people aren't careful enough with OTC meds to realize that following the recommended dosage guidelines for Robitussin gets you pretty close to the maximum daily limit for acetaminophen, for instance. The new regulations also cap the largest single dose of acetaminophen at 325mg rather than 500mg, which is a very good change.

It's a very complicated problem with a huge number of unexpected dependencies, and I think it's very unlikely that there are simple regulatory solutions that will be free from terrible, unforeseen consequences. We'd be in a much better position to solve these problems if we stopped vilifying addicts (or even just people who have a legitimate reason for pain medication) and recognized that drug addiction is almost always a symptom of some other problem rather than the root issue.
posted by drklahn at 12:06 PM on May 8 [22 favorites]



One of the things that is overlooked in the recent media coverage of the "heroin epidemic" is that new FDA regulations around prescription narcotics went into effect late last year. Before the new regs, there were a lot of pill mills giving out oxycontin and vicodin prescriptions without much care for the downstream consequences. As of December 2013, it is much more difficult to get a prescription for, say, vicodin.


Also the formula for oxycontin was changed to make it harder to grind with a mortar and pestle.
posted by ocschwar at 12:14 PM on May 8 [1 favorite]


There seems, then, to be what is noted in one or two comments: kids get hold of prescription drugs at home, then turn to illegal drugs on the street. Also worth noting: when the Taliban was pretty much running Afghanistan, they stopped the raising and selling of the drug. When we went to war against them, they allowed it as a source of money to combat us. And that source is some 90% of heroin world wide.
posted by Postroad at 12:42 PM on May 8


I am at this very moment waiting to testify in favor of my state funding naloxone distribution. Naloxone is relatively cheap, very safe, and easy to administer. It's a generic drug that's been around since the 70s. People who use drugs have long been at the forefront of the movement for better naloxone access and much of the data we have on lay administered naloxone is from programs for people who use drugs.
posted by gingerbeer at 12:48 PM on May 8 [5 favorites]


When the Greenfield (western MA) police department posted on Facebook last week how three local women had been saved by Narcan in one weekend, most of the comments were along the lines of "Why is taxpayer money being used to fund this? They should have been allowed to die."
posted by Camofrog at 12:58 PM on May 8


Not necessarily. At a certain point, they don't care whether they die or not, as long as it's a good high.

Man I really hate people generalizing/pretending to know about stuff like this. There are probably heroin users with this nihilistic attitude (which came first?) but I've know a number of the former category and not really any in that subset. There are certainly plenty of people who have taken their lives just to get out of the cycle of addiction, but that's not really what you're suggesting.

And trust me, giving people Narcan is going to save lives even if a few people fuck it up. Around here they hand out multiple doses anyway, and explain the situation with the short half-life. Though what's *really* nice is "good samaritan" laws like in California now, where the police will not charge anybody/not even respond to a 911 call about an overdose. I have made that phone call - I didn't even know the law at the time but I sure have been a fan of Tom Ammiano since.
posted by atoxyl at 1:16 PM on May 8 [3 favorites]


> As of December 2013, it is much more difficult to get a prescription for, say, vicodin.

I guess this is why my partner had to endure severe pain when she had a new IUD put in, recently. Her doctor said, "I gave you hydrocodone last time, but I can't do that anymore." My partner nearly vomited from the pain, and she said the doctor refused to leave her alone in the room afterward until her color came back, for fear she would pass out.

Fuck everything about the war on drugs.
posted by gilrain at 1:34 PM on May 8 [6 favorites]


It's more difficult, but I have to say I think there's something going wrong on the physician side of that, too, because it's not like the stuff suddenly doesn't exist anymore, and I've now heard a couple cases of people who really should have had proper painkillers for various procedures not getting it Because FDA and I can't believe that the additional paperwork is that impossible for one-time things. It was kind of known that people with chronic pain problems were going to have a shitty time, but I can't help but think that some of this starts to seem like physicians deciding that a patient's pain is an easier thing to endure than mild inconvenience.
posted by Sequence at 1:53 PM on May 8 [1 favorite]


It's not just the people who actually need the drugs, though. Pain is really, really easy to fake (see: drug-seeking in hospital ERs)... so you get a 45 pill scrip for Vicodin and you've instantly got what, $200 in your pocket? At least?

Just one of my medications, if I sold off a month's supply on the street, would net me something like $150. Maybe less if I offload the whole amount to just one dealer.

Plus, you know, teenagers and Mum & Dad's medicine cabinet. An ex of mine used to raid his parents' medicine cabinets on a regular basis (both doctors, lots of interesting samples laying around).
posted by feckless fecal fear mongering at 2:03 PM on May 8


Drug war chickens have come home to roost.
posted by telstar at 2:33 PM on May 8 [1 favorite]


Eh, it's not a war on drugs. It's a war on poor people. It is the wealthy saying "Hey, your life sucks, and the one thing that at least gets you through the day? Sorry, taking that away from you, because being poor is your own fault and you should suffer."

(obvs cocaine and heroin are special cases due to the havoc they can wreak. But would so many people seeking Vicodin prescriptions be doing so if they could head down the street and legally buy a quarter ounce of pot? I don't think so.)
posted by feckless fecal fear mongering at 3:12 PM on May 8


About the seemingly contradictory pricing and generic status of naloxone - it's possible to get a patent on a drug delivery system of a specific dose for a specific purpose. Intranasal naloxone doses for drug overdose are patented and thus pricier than generic naloxone for IV administration. They can be given by anyone coordinated enough to stick something up the nose, relieving the responder of the need to find a good vein in a patient who has scarred veins and low or no blood pressure.
posted by gingerest at 3:23 PM on May 8


fff mongering--you said "Eh, it's not a war on drugs. It's a war on poor people. It is the wealthy saying "Hey, your life sucks, and the one thing that at least gets you through the day? Sorry, taking that away from you, because being poor is your own fault and you should suffer." Where in the world did that come from--I have no idea if that is true and neither do you. I have a very strong hunch that it is substantially incorrect and has much more to do with politics, fear, distorted media reports, genuine concern and, in fact significant abuse. I occasionally over hear the "wealthy's" conversations ( what ever or who ever that is) and I must admit I have never heard anything remotely related to that. Actually, i thought the greater fear of those inclined towards conspiracy was that the wealthy wanted to drug/sedate the poor. it would seem even more likely (though I think preposterous) that those involved in the illegal drug trade paid off politicians to make legal drugs more difficult to obtain.
posted by rmhsinc at 3:34 PM on May 8


it's hard to have any sympathy for drug problems on staten island given the history of the drug war in NYC.

Um, what the fuck? The article itself says most of the drugs came from elsewhere in the city and were then brought to Staten Island.
posted by corb at 3:37 PM on May 8


rmhsinc: an enormous number of USGov policies are, at their root, "Fuck you, poor people. It's your fault so you can suffer."

I would find it difficult to believe that there are not similar underpinnings at the DEA.

Wealthy people will always be able to get their drugs of choice. But the way the 'War' on Drugs works is that somehow those who supply the wealthy people never get nabbed... but the street-level dealers, the ones who supply the poor people, are the ones being sent up under Three Strikes legislation. A real 'war' on drugs would be lopping off the heads of the various beasts, letting the situation shake down until someone takes over, then doing it all over again until being a drug kingpin (or queenpin) is just not worth the bother or money.

There is a strong undercurrent in American thought that basically says being poor is your own fault, and too bad if you suffer. "Fuck you, I got mine" is not that far from the surface in a lot of peoples' minds.

There's a bunch of racism in there too but I'm a bit too drained from some other writing to start looking up statistics and such.
posted by feckless fecal fear mongering at 3:56 PM on May 8


Intranasal naloxone is not patented by anyone. It's not even FDA approved as a delivery device. Not that that stops anyone from using it. And the other usual use is intramuscular injection, not IV.
posted by gingerbeer at 4:14 PM on May 8


so basically what's needed is the naloxone equivalent of an Epi-pen.
posted by feckless fecal fear mongering at 4:25 PM on May 8


Where I live the needle exchange people hand out kits containing two single-dose vials of naloxone solution and two IM syringes. The naloxone has a rubber seal so you can just put the (gigantic) needle through the top to fill it. Given what heroin users do with needles every day they're gonna be able to figure this out just fine without an epi-pen.
posted by atoxyl at 5:03 PM on May 8 [1 favorite]




gingerbeer: "Intranasal naloxone is not patented by anyone. It's not even FDA approved as a delivery device. Not that that stops anyone from using it. And the other usual use is intramuscular injection, not IV."

You're completely right and I was totally wrong. I'm sorry, I was on my tablet and I read a patent application as a published patent. As to my confusion about IV/IM, I very stupidly assumed that because the action onset was so rapid, naloxone was necessarily given IV. (Also the "no blood pressure thing" I said doesn't make any sense either, in retrospect - it doesn't matter how you give a drug unless you're ensuring some circulation is happening, because without circulation there's no systemic absorption. So if I come across an overdosed person with no pulse, I should call EMS and start CPR first even if I've got Narcan at hand. Okay, good.)

It is very slightly trickier to give a good IM shot than to shove an inhaler into someone's nose, but if you don't care about hitting a nerve, which I hope you wouldn't when the person's unconscious and dying, it's probably easier. What are the other considerations? I'm guessing you'd know this intimately given that you're testifying!
posted by gingerest at 5:20 PM on May 8


Thanks to these changes, I'm in severe pain for a non-trivial amount of my life and haven't found a viable alternative.

same boat. shit is fucked up and bullshit.
posted by j_curiouser at 5:48 PM on May 8 [1 favorite]


The FDA just approved what is, in effect, the epi-pen of naloxone -- an auto-injector. We're anticipating that it's likely going to be priced somewhere in the $200-500 range, though. Not affordable for low budget community-based programs. It will probably mostly get purchased by people with health insurance that will cover it, or those law enforcement agencies who want to make use as easy as possible. Most community naloxone programs distribute kits of the IM or intranasal form. The kits cost $25-30 each, generally. The intranasal device works great, but takes a little fiddling to put together.

In the meantime, we have great evidence that arming people who use drugs, and their friends and family members, with naloxone, is very effective at reducing overdose deaths. And cost effective. Here in San Francisco, we've gone from over 100 heroin overdose deaths a year to fewer than 10.

Naloxone is a very safe drug. If you don't have opiates in your system, it doesn't do anything. If you do have opiates on board, it will knock them off the receptors in your brain (that's the non-technical description). An opiate overdose slows down your breathing, eventually to the point you stop breathing. Naloxone will interfere with that and restore breathing. CPR per se is less important, often, than naloxone and rescue breathing. And yes, call 911.

Some good context on what's going on in New York. VOCAL in NY just got their naloxone bill through the legislature and are waiting on the gov to sign it.
posted by gingerbeer at 8:23 PM on May 8 [2 favorites]


What does the Rolling Stone article mean when it says "Nearly a quarter of those who try [heroin] become addicted? That nearly a quarter of people who try it, decide they like it and keep on taking it? That nearly a quarter experience withdrawal symptoms after ceasing, even if they take only one dose? That three quarters of people can take heroin without becoming addicted?
posted by Joe in Australia at 8:24 PM on May 8


I'm just guessing, Joe, but I think the figure comes from the paper below - pdf here. On my skim: it's a study of a large population sample representative of the US, where they administered a bunch of validated instruments including a diagnostic interview. So they asked (for a long list of drugs) whether the participant had ever used the drug, how often, for how long, and so forth, and they also assessed whether the participant currently fit the DSM-III-R criteria for dependence on that drug. The criteria are briefly reviewed in the paper. The abstract's a little misleading about heroin - it's 23%, not 15%, of heroin users who progressed.
Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: Basic findings from the National Comorbidity Survey.
Anthony, James C.; Warner, Lynn A.; Kessler, Ronald C.
Experimental and Clinical Psychopharmacology, Vol 2(3), Aug 1994, 244-268. doi: 10.1037/1064-1297.2.3.244
Abstract
Studying prevalence of Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) drug dependence among Americans 15–54 yrs old, the authors found about 1 in 4 (24%) had a history of tobacco dependence; about 1 in 7 (14%) had a history of alcohol dependence, and about 1 in 13 (7.5%) had a history of dependence on an inhalant or controlled drug. About one third of tobacco smokers had developed tobacco dependence and about 15% of drinkers had become alcohol dependent. Among users of the other drugs, about 15% had become dependent. Many more Americans age 15–54 have been affected by dependence on psychoactive substances than by other psychiatric disturbances now accorded a higher priority in mental health service delivery systems, prevention, and sponsored research programs. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
posted by gingerest at 10:59 PM on May 8 [1 favorite]


> As of December 2013, it is much more difficult to get a prescription for, say, vicodin.

Why are patients shut out of the debate over prescription pain medicine?
posted by homunculus at 11:01 PM on May 8


As of December 2013, it is much more difficult to get a prescription for, say, vicodin.

To clarify, the proposed rule change would move hydrocodone and vicodin to Schedule II (they are presently on Schedule III). The comment period has recently closed, and the next step is either hearings or a final rule publication.

There do seem to be a smattering of state-level restrictions which could have played a role in gilrain's partner's difficulties.
posted by dhartung at 1:11 AM on May 9


What does the Rolling Stone article mean [...] That three quarters of people can take heroin without becoming addicted?

That sounds reasonable to me. Heroin isn't qualitatively different than prescription painkillers, it's just cheaper. Many people take painkillers without becoming addicts.

I've heard that heroin isn't actually that fun. I think it's like tobacco, in that most of the pleasure comes from eliminating the withdrawal symptoms. A first time user might be unimpressed.
posted by foobaz at 2:31 AM on May 9 [1 favorite]


NYT is going full-press on the heroin epidemic story: Addict. Informant. Mother. (Article contains graphic description of shooting up.)

Recovering addicts report a kind of emotional dullness that can linger for months, even years, a result of compensatory changes in the brain that only slowly reverse. Downregulated by overstimulation, the reward system for the ordinary pleasures in life limps along, an unreliable, rusted-out machine; the stress system, by contrast, works in overdrive, with a ruthless, hair-trigger sensitivity. Even after they have not touched drugs for a year, addicts, studies find, are more sensitive to hot and cold. And amid all that psychic ache, one memory shines exceptionally bright: That unnaturally exquisite reward.

posted by These Premises Are Alarmed at 9:23 AM on May 9 [2 favorites]


I think it's like tobacco, in that most of the pleasure comes from eliminating the withdrawal symptoms. A first time user might be unimpressed.

I actually think first time users are really, really impressed. Thereafter they chase that dragon and never really quite catch it.

From the Rolling Stone article: Eve's shock morphed into curiosity, heroin's corrosive reputation diminished by the fact that everyone compared it to a drug she'd already tried: "It's like oxys," she kept hearing, "only cheaper."

This seems to be the crux of the increase, how people who never would have imagined that they could ever try such a scary drug such as HEROIN find themselves curious and then hooked.
posted by caddis at 10:14 AM on May 9




What does the Rolling Stone article mean when it says "Nearly a quarter of those who try [heroin] become addicted?

Hmm, I thought I'd read something about it here, recently... it was this comment, by Maias. The relevant graf-
[...] About 1/3 of people find opioids *awful*. Another third find them *meh*. The final third does think they are the most amazing thing ever and about half of them say "it's the most amazing thing ever, better not do again" and the other half say "wheeeee" and become addicts. That final 15-20% is the group at risk. Which means that 80-85% *DO NOT BECOME* addicts. [...]


I found that fascinating because it runs so counter to what most people think about these drugs. But really, it makes more sense than this idea of how magically amazingly addictive these drugs are- if all first-time users were life-changingly impressed, then pretty much anybody who's ever had vicodin prescribed for pain (much less a morphine drip in a hospital) would be a junkie, eventually, and that's obviously not how it works.
posted by hap_hazard at 12:33 PM on May 9 [2 favorites]


Heroin gets hyped up so much - Trainspotting's 100 orgasms or whatever. Some people probably *are* like "wow that's the best thing ever" but I think it's probably more common to be slightly underwhelmed while still finding it really good in a more subtle, insidious way. It might sound silly to compare H to weed, but if any of you were ever every-day stoners think about how you got that way. If you have a drug that just kind of makes everything better (and depending on dose is fairly compatible with going about your day as normal) it's hard not to end up using it all the time.
posted by atoxyl at 1:03 PM on May 9


That final 15-20% is the group at risk. Which means that 80-85% *DO NOT BECOME* addicts. [...]. About the same odds as playing Russian roulette with a 6 shot revolver.
posted by rmhsinc at 3:57 PM on May 9 [1 favorite]




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