The Pharmacracy of Consent

[navkat]

Likely but it doesn't account for the fact that there are plenty of people who "cook" their oxy and get themselves in the shit too.

People who abuse opiates are always chasing and aren't in a frame of mind to use flawless judgement so accidents happen.

[AFK]

That's a very important point.  Usually, once someone is in the dependent stage of addiction, rational decision making goes out the window.  So even if someone addicted to opiates knows very clearly the purity of the dosage, the chances that proper caution will be exercised are fairly slim.

This is why, at least in terms of prescription opiates, there are attempts to formulate new versions of pills that become inert when crushed.  Unfortunately, I think the funding for that research is inadequate and so it isn't moving along as it should. 

[navkat]

That's a very important point.  Usually, once someone is in the dependent stage of addiction, rational decision making goes out the window.  So even if someone addicted to opiates knows very clearly the purity of the dosage, the chances that proper caution will be exercised are fairly slim.

This is why, at least in terms of prescription opiates, there are attempts to formulate new versions of pills that become inert when crushed.  Unfortunately, I think the funding for that research is inadequate and so it isn't moving along as it should.

That sounds incredibly dangerous, expensive and suspicious, opening a whole new precedent for drug companies to manipulate use of their product, pass favorable legislation for themselves and take yet more control out of the doctor's hands.

[navkat]

And dangerous because if you're putting something in the pill that makes it inert when crushed, how can you possibly ensure stability in a mass-production scenario? Pn management meds are prescribed on a "take as-needed" basis so now you've got only the pt who really needs them receiving a unpredictable product and the abusers will find a hack.

[AFK]

That is definitely a valid concern, and thus why any kind of alternative whether it is this, or something else, needs to have adqueate funding and research behind it so it works.  But the way this prescription drug abuse issue is getting out of hand, there are calls from everywhere for something to be done. 

[Roly Poly Oly-Garch]

Likely but it doesn't account for the fact that there are plenty of people who "cook" their oxy and get themselves in the shit too.

People who abuse opiates are always chasing and aren't in a frame of mind to use flawless judgement so accidents happen.

Well yeah, slammers slam...opiates or otherwise. If it's water soluble people will jab it in. I was just thinking that if you could wave some magic wand and completely negate the possibility of a hot shot, slow release may actually be more dangerous than spiking.

...but then it just occurred to me that you can't vomit up a shot.

The more I realize how much I don't understand about lethality, the more thankful I am that I don't have a taste for downers.

[BabylonHoruv]

Do I agree that methadone is essentially more harmful than a heroin (or in many modern cases now, Oxycontin/Lortab) addiction? Fuck no. FUCK NO. I've watched someone kick, dude. You have no idea. If taking methadone as a tool to "step down" from that shit is working for some people, let them be.

I think there's a definite bias against methadone because it's what The State provides as a solution. Just because it's allowed, doesn't mean it's the worst.

...Then there's that damned unpredictable Instant-Kill-Quick potential Heroin has. Be hard to compare any real or imagined side-effects of Methadone to "whoopsy, I dead." Haven't read research knocking Methadone (cause I don't care), but even if it's more lethal than Heroin there's no way it's as unpredictable.

But on the other hand...FUCK THE MAN, MAAAAAN!

That's mostly because heroin is illegal, so the dosage and purity isn't known.  Heroin of known dosage and purity isn't any more likely to kill someone than morphine is.

From what I've read methadone is more toxic than heroin, but it is also less addictive so it makes sense as a way to step off heroin.

What are you talking about? People fuck with their Oxy all the time and die. Opiates are CNS depressants, you take too much, your body forgets to do shit like uh, breathe and uh, pump blood, bruh.

Oxy and lortabs are of known dose and predictable pharmacokinetics to these patients. The problem is, they don't care and/or they aren't careful. They take too much, wrong route, take with alcohol, etc. Then they wind up on the back of a truck with someone like me pushing narcan into their ass.

Oxycontin is Oxycodone, Lortabs are Hydrocodone, neither of those is heroin.  Yeah, they are in the same family of drugs, so is Methadone.  They also have fun stuff in them to slow down the period of time over which the dosage is released, which, again, leads to unknown potency. Largely because of the way people try to circumvent the time delay mechanisms.

[minuspace]

Excuse my curt interjections, I'm really busy at the moment (maybe should not have started a thread).  Still, the distinction I was thinking about is between consensual and violent crimes...  I know there's different kinds of people and that some drugs may not be suitable for all, however, what is happening in Mexico at the moment is unacceptable, on all levels.

[navkat]

I don't understand what you're saying that hasn't been said or what point you're trying to make. Your original point was that the main reason for heroin deaths has to do with unpredictable fluctuations in dosage and purity in the supply.

I rebutted with the fact that purity and dosage is predictable in other opioid meds and there are still behaviors on the part of users that lead to death.

The point was made that perhaps users are "chasing the dragon" in a fashion that increases risk of OD due to the slow pharmacokinetics of the enteral (GI tract) route of administration and (implied) slow-release additives.

I made the point that many users are using other routes of administration and circumventing the additives by crushing and "cooking" pills. There are plenty of methods to do this but the quick-and-dirty methods used most often are crushing the pills for insufflation and dissolution in water for IV use.

How do these significantly change the predictability of the purity,  pharmacokinetics and bioavailability of the drugs?

What does the fact that I'm talking about other opioid-receptor medications (and not specifically herion) do to negate my point that introducing a predictable, unadulterated supply of heroin into readily-available circulation won't eliminate irresponsible, careless or altered mental status-related life-threatening behaviour?

[navkat]

Excuse my curt interjections, I'm really busy at the moment (maybe should not have started a thread).  Still, the distinction I was thinking about is between consensual and violent crimes...  I know there's different kinds of people and that some drugs may not be suitable for all, however, what is happening in Mexico at the moment is unacceptable, on all levels.

I don't understand what that has to do with the OP. You were bringing up the dangers of methadone as opposed to decriminalization, no?

[AFK]

I didn't see anything in the OP about crimes.  This thread seems to be meandering in a couple of different directions at once.  What is your central question that you want to ask?  What is your thesis if you can boil it down to one sentence/question? 

[BabylonHoruv]

I don't understand what you're saying that hasn't been said or what point you're trying to make. Your original point was that the main reason for heroin deaths has to do with unpredictable fluctuations in dosage and purity in the supply.

I rebutted with the fact that purity and dosage is predictable in other opioid meds and there are still behaviors on the part of users that lead to death.

The point was made that perhaps users are "chasing the dragon" in a fashion that increases risk of OD due to the slow pharmacokinetics of the enteral (GI tract) route of administration and (implied) slow-release additives.

I made the point that many users are using other routes of administration and circumventing the additives by crushing and "cooking" pills. There are plenty of methods to do this but the quick-and-dirty methods used most often are crushing the pills for insufflation and dissolution in water for IV use.

How do these significantly change the predictability of the purity,  pharmacokinetics and bioavailability of the drugs?

What does the fact that I'm talking about other opioid-receptor medications (and not specifically herion) do to negate my point that introducing a predictable, unadulterated supply of heroin into readily-available circulation won't eliminate irresponsible, careless or altered mental status-related life-threatening behaviour?

it won't eliminate irresponsible behavior, but it will significantly reduce the incidence of overdose.  Time release medication is, essentially, of unknown purity because the speed at which the opiates will release, when altered to allow for rapid release for recreational use, is not consistent enough to be predictable to a junkie.

Morphine is the closest legal equivalent to Heroin, it is not usually adulterated with time release chemicals and the incidence of overdose is much lower than with either illegal heroin or doctored up time release meds.  It's not as easily available as oxys or lortabs, which undoubtedly contributes to the fact that there are less OD's, but that it is of truly known potency also plays a role.

[minuspace]

I didn't see anything in the OP about crimes.  This thread seems to be meandering in a couple of different directions at once.  What is your central question that you want to ask?  What is your thesis if you can boil it down to one sentence/question?

I am trying to develop the idea of America's focus on "mental hygiene" as a form of crusade or inquisition.  The ritual persecution of drug addicts in the US, the ceremonial homicides in Mexico...  It's not a new thought, just a way of framing the issue so that people do not automatically assume that "drugs are bad"...  Off the cuff, I was thinking about those posters on pd that forwarded an idea regarding the end of war by illustrating how people are really just at war with the past...

[navkat]

I didn't see anything in the OP about crimes.  This thread seems to be meandering in a couple of different directions at once.  What is your central question that you want to ask?  What is your thesis if you can boil it down to one sentence/question?

I am trying to develop the idea of America's focus on "mental hygiene" as a form of crusade or inquisition.  The ritual persecution of drug addicts in the US, the ceremonial homicides in Mexico...  It's not a new thought, just a way of framing the issue so that people do not automatically assume that "drugs are bad"...  Off the cuff, I was thinking about those posters on pd that forwarded an idea regarding the end of war by illustrating how people are really just at war with the past...

Don't get me wrong, I agree with you. I'm a big proponent of both Harm Reduction and Cognitive liberty. I think it's preposterous to outlaw the very concept of altering one's mental status for pleasure. Unfortunately, the way our scheduling laws are written, they circumvent the anti-prohibition constitutional amendment and use a standard of legal nomenclature that defines "use for anything other than therapeutic purposes" as "abuse" and determines level of control by weighing recognized therapeutic use against "potential for abuse" (ie: how fun they are). That's why most of our decriminalization campaigns are focused around proving legitimate therapeutic purposes instead of outright challenging constitutionality of the legal "grey area" that is Nixon's FDA/DEA scheduling act.

I have a somewhat libertarian approach when it comes to drug use but I don't kid myself into buying that decriminalization will fix everything by creating a fair market environment. We still have corporations putting lead paint in the kid's toys...failing to check their work, cutting corners, recalling baby formula...until you can guarantee me the corporate requeteers have suddenly grown a conscience, I'm never going to believe Joe Schmo on the corner of 10th and Lex isn't going to step on his blow with something nasty when he runs out of baby laxitive.

That's not even addressing the sickness itself of being an addict. We still have problems with alcoholism. Alcohol is legal.

It's not a black and white issue at all. At all. And I think people trying to simplify it on either side of the argument is both naive and irresponsible aside from being just lazy/self indulgent.

[AFK]

I didn't see anything in the OP about crimes.  This thread seems to be meandering in a couple of different directions at once.  What is your central question that you want to ask?  What is your thesis if you can boil it down to one sentence/question?

I am trying to develop the idea of America's focus on "mental hygiene" as a form of crusade or inquisition.  The ritual persecution of drug addicts in the US, the ceremonial homicides in Mexico...  It's not a new thought, just a way of framing the issue so that people do not automatically assume that "drugs are bad"...  Off the cuff, I was thinking about those posters on pd that forwarded an idea regarding the end of war by illustrating how people are really just at war with the past...

Meh, I think American's view on substance use and abuse has shifted quite a bit over the past few decades.  To be sure, there is definitely still stigma attached to being a drug addict, but I don't think it is as bad as it was.  I think more and more are coming to understand substance abuse in the disease model and as an important public safety issue to address. 

Unfortunately, we are still in a position that is very consequence-oriented when we need to be shifting to more of a prevention-led model.  (My bias as a substance abuse prevention practitioner, to be sure)  This tends to be the favored model of Republicans, they lean more in that direction where Democrats, usually, will be more about prevention and increasing access to treatment. 

My views on the question of legality are known and noted so I won't touch that part of the discussion.  But if you really want to know you can do some thread archaeology in this sub-forum.