I think that Pergamos is essentially saying that he doesn't think that secondary harm that results from regular and frequent heroin use should be considered harm from heroin. I disagree, because by that logic we can also say that HIV is harmless because nobody gets sick from HIV, they get sick from secondary infections made possible by their HIV-compromised immune systems. Secondary physical harm is still physical harm, particularly when you're looking at an addiction rate of about 23% of all users.
No, I am saying that the graph is not well made because it is putting the harm due to addiction on a different axis and then putting that on the same graph. It's like making a graph that ranks cars on fuel consumption and exhaust produced. Harm from addiction is going to eclipse physical harm from the drug itself unless the drug itself is insanely physically harmful (like, say, krokodil)
Perhaps. I think the Wiki article with Nutt's research has a graph in which 'harm to user' and 'harm to others' is graphed differently rather than the polka dot one which seems to be the contentious one. Don't know if that helps or not.
When I was responding earlier, I had written a longer post, but deleted much of it and had the leave the office to get home for my dog. Anyways...
Here's my thoughts about 'clean heroin'. It was synthesized back in the 1930s (Bayer?) and it's how we ended up with Oxycontin & Oxycodone and their ilk. The idea was to make a more stable, controllable substance than heroin. The original target audience however, were the terminally ill, so worrying about addiction wasn't the issue. The issue was not spending your last days on earth in screeching agony. All is well & good.
What we've seen over the last few years is that physicians are increasingly willing to prescribe powerful opiates for conditions that don't especially require it. Back in the day your doctor would've said "Take advil" or "get an ice pack". More recently, we've seen a great expansion in the kinds of things that people get strong pain meds for. My wife had a tooth pulled a few years ago. The dentist was very insistent that she take a script for Vicodin which she really didn't want or need. She managed just fine with OTC stuff.
A friend of one of the kids went to the emergency room with rib pain that turned out to be pulled muscles. He walked away with a script for Percocet! That's a long way off from dying of bone cancer, but what the hey. Have some opiates!
Another friend of my wife's got hooked on Oxy following a surgery. He went to his doctor and said "You know...I think I like these things too much and I'm worried that I'm dependent on them". His doctor said "Nahh....you're fine" and ignored him. Fortunately, our friend had the foresight to ignore his doctor in turn and get into a Suboxone program and get cleaned up which, thankfully he's done. Less fortunately are the two alcoholics we know who, despite being clean for 20+ relapsed (and epically so) because they received legal, prescription, opiates from Doctors.
I work at an acupuncture clinic and at a chiropractic office. As such, I get to see the medications people take and sometimes, my eyes sproing out of my head in disbelief that (a) people are on so much medication and (b) how they are able to so much as walk, let along have any kind of life at all. Crazy stuff.
So here's the thing. Legal, clean, controlled dosage 'heroin' already exists. It's Oxycontin (or similar). And lots and lots of doctors are merrily giving this to people for ailments that in the past, they never would have. As it turns out, I've seen first hand that in spite of the apparent 'cleanliness' and 'legality', it produces great amounts of harm and suffering.
[My son starting using heroin after using pills. He didn't have them legally, but his story is typical. You take a few pills every now and then and end up feeling far better than anyone should under normal circumstances. Trouble is, it's not cheap because you're paying a dollar per milligram on the street. 20mg of Oxy is $20. However, some enterprising entrepreneur will point out that $20 is 4-5 bags of heroin. Ahh, the freemarket at work!]
Thing is, even people who get legal opiates from real doctors may find themselves wanting a lot more than they're supposed to have. Then what? If their doctor is slack, they get to be doped out zombies for the rest of their days. If their doctor says 'nuh uh' and cuts them off, what are they going to do? They will do/say/think of ABSO-FUCKING-LUTELY anything and everything they can to avoid getting junk sick. Our medical system doesn't want to clean up the messes it creates (cf anti-biotics). Unless the doctors are as interested in addiction treatment as they are in prescribing opiates, all we're doing is churning out junkies on an industrial scale.