Newsgroups: alt.drugs,talk.politics.drugs
Subject: Heroin & opiates - good overview
From: civl097@csc.canterbury.ac.nz
Date: 9 Sep 92 12:46:05 +1200
Organization: University of Canterbury, Christchurch, New Zealand

Here is  very good, *well-referenced* article on heroin which I extracted
from the NEWS about 18 months ago.
I've reposted here, without the previous poster's permission,but I can't
imagine he'll mind.
--------------------------- read on -----------------------------------
Subject: Re: death sentence for drug users
From: den0@quads.uchicago.edu (funky chicken)
Date: 13 May 91 02:50:05 GMT

In article <1991May12.131321.4087@elevia.UUCP> alain@elevia.UUCP responds
to my claim that heroin "IS reasonably safe and a lot of fun" by writing:

>	Considering that my only source of information on heroin
>	is the Voice of Daddy Knows Best, and his little brothers
>	in propaganda, I can safely say I know fuck all about it.
>	I will not necessarily assume that their lie means heroin
>	is safe and fun.  Since you said this, can you please tell
>	us more, and document it please?

Sure, Old Man.  I assume that the provocative part of my statement concerns
its safety and I will therefore not discuss the issue of whether heroin
is fun. 

Let me first qualify my provocative statement by saying that heroin use
CAN BE reasonably safe, if used in a smart manner.  Heroin in itself seems
to pose no real health problems, even when it is used for long periods of
time.  G. Dimijian in "Contemporary Drug Abuse" (in _Medical Pharmacology:
Principles and Concepts_ ed A. Goth, p. 299) describes an 84-yr old
physician who had been a morphine addict for 60 years and seemed to have
no mental or physical problems from the addiction.  In general, it seems
that middle-class heroin/morphine addicts are no less healthy than the
general population (see D. Musto and M. Ramos (1981) "Follow-up Study of the
New England Morphine Maintenance CLinic of 1920," _New Eng J Med_ 308(30):
p. 1075-76; J. Ball and J. Urbaitis (1970) "Absence of Major Medical 
Complications among Chronic Opiate Addicts" in _The Epidemiology of Opiate 
Addiction in the United States (eds J. Ball and C. Chambers), p. 301-6.)    
There may be some problems associated with long-term controlled use of H,
but they aren't well documented and they are certainly not comparable to
those associated with either tobacco or alcohol.

So where do the health problems of heroin come from?  Primarily from the use 
of needles, the presence of adulterants in the drug, the poor nutrition and
health care associated with the hard core addict liife-style; and the
violence associated with said life-style.  Before I discuss these, we should
note that all of these factors except adulterants are controllable by the
user.  The many "chippers" (that being the term for non-addicts who use
addictive drugs in a controlled fashion; see, for example N. Zinberg and
R. Jacobson's (1976) "The Natural History of 'Chipping,'" _Amer J Psych_
133(1): p. 37-40.) who avoid injections (usually by "chasing the dragon"
ie smoking it) have few problems.

Let's start with needles.  There are two reasons to use needles: it gives
a bigger rush, and it makes more effective use of the drug.  This second
reason is, of course, only a consideration because the drug is expensive
and difficult to get.  The problems with needles are that you inject a
lot of crap into your body (adulterants and dilutants), you run the risk
of infecting yourself with something (HIV or a Hepatitis virus), and
you wreck your veins and skin.  Most IV Heroin users are constantly
plagued by irritated, infected skin.  Hey, you inject talc into your skin,
that's what you get.  Even the quinine (which is believed to have originated
in heroin during an outbreak of malaria among addicts) can cause 
numerous health problems (there's a large literature on the problems of
adulterants and dilutants in heroin and cocaine).

The life-style that an addict leads is generally pretty unhealthy as well.
Often, addicts don't get an adequate diet.  Vitamin deficiencies are not
uncommon.  Constipation caused by a combination of poor eating that the
effects of the drug on the bowels can lead to haemorrhoids.  Chest
infections seem pretty common too, especially among cigarette smokers.
Then you've got the problems of trafficking in the (potentially) violent
underworld.  Joe and Leishman (et al (1982), "Addict Death Rates During 
a Four-Year Post-Treatment Follow-up," _Amer J of Public Health_ 72:
p. 703-9.) found that 28% of deaths among addicts were from violence (17%
were from natural causes, and 44% were drug related).

So, it would seem that if one had clean heroin from a reliable source
and avoided the IV route, there'd be few health problems.  Potential
problems would arise from becoming addicted and becoming unproductive
or from accidentally ODing.  It seems that "Chippers" avoid addiction
by setting strict limits on their use ("I'll only do it on weekends"
being a common limit).  In the lab, it takes a couple weeks of 3 shots
a day before one gets withdrawl symptoms.  So, if you avoid hanging
around hardcore addicts, it is not that hard to avoid an addiction.
The existence of non-addict users shouldn't be surprising.  It is only
because of silly people like Anslinger and Henry Giordano (head of the
FB of Narc, who testified that anyone who used H more than six times
would become an addict).  Admittedly, controlled heroin use is
difficult to locate, since the users stay out of trouble to the best of
their abilities.  However, if we look at who has used heroin daily
(a nice substitute for the vague notion of 'addict'), we find substantial
numbers of regular users who have never taken H on a daily basis (see,
for example, J. O'Donnell's (1976) "Young Men and Drugs," _NIDA Res Mon_ 5, 
p. 13, where only a third of the users taken from a cross-section of
American males had ever used H daily).  In fact, considering the small
amount of H in street samples, it is a wonder that users can even
become true addicts.  (As a side note, many of the people who present
themselves or are presented by the Feds to clinics are not physicially
dependent on cocaine, heroin, etc.) D. Waldorf's _Careers in Dope_
provides examples of H addicts who have held employment for long periods
of time.  So, even addicts can hold down jobs.  Dr. William Halsted,
a great surgeon and one of the founders of Johns Hopkins was a
morphine addict.  Surprise surprise, they aren't all the domestic version 
of Viet Cong, despite what the Man tells us.

Overdose is a probably largely due to people not knowing the purity
of their H, the presence of adulterants which act in conjunction
with the H, and addicts misjudging their tolerance.  Using non-IV
routes probably reduces the chances of ODing.  R. Gardner (1970) in 
"Deaths in UK Opioid Users 1965-69" _Lancet_ 2: p. 650-3 found that
26 of the 42 accidental ODs recorded happened after a period of
abstinence, so maybe 60% of ODs are from misjudging tolerance.
Since abstinence is often forced, I can only imagine that most ODs
could be avoided entirely by proper measures. 

Oddly enough, British addicts, who get clean heroin, have about as high a 
mortality rate as Americans who shoot street shit (see T. Bewley et al (1968)
"Morbidity and Mortality from Heroin Dependence, 1: Survey of Heroin 
Addicts Known to the Home Office," _Brit Med J_ 23 March: p 725-26).

Tolerance is a funny thing.  Addicts have been known to die from their
second shot of the day after dividing their daily amount into three
piles.  It would therefore seem that their tolerance had been reduced since
the first shot.  Someone conjectured that tolerance was partially a matter
of place-conditioning and that addicts who shoot in a particular gallery
get conditioned so that their body begins to gear up for a shot when
they go their and that therefore they have higher tolerance there.  When
they shoot up someplace else, their body isn't ready and they OD.

Before I quit typing, I'll say something about the myth of "pushers."
John Kaplan (1983), in his excellent book _The Hardest Drug_, points
out the numerous holes in this myth.  The idea of the "pusher" is that
a dealer tries to get people hooked through free samples so that
he can have a helpless and reliable market for high-priced drugs.
This model works pretty well for cigarette companies.  However, it
is totally off the mark with respect to H sellers.  To begin with, as
Big Bill Burroughs has documented, the model is empirically wrong
since there is no clear distinction between users and sellers.  Most
users sell to their friends, making a little profit.  In the social
network of users, some will sell on a large scale, but typically not
for a long period of time, as it is a hassle.  The only real organization
in drug dealing is at the higher levels where the drugs are purified,
smuggled, and cut.  Furthermore, ignoring empirical facts, the image
of the pusher is pretty unsound.  It only makes sense to spend time
hooking people if you plan on selling to them for a long time and they
will not be able to go elsewhere.  Neither condition tends to be true.
Addicts are notoriously unreliable customers.  Furthermore, as I have
already mentioned, it is difficult to get hooked on H.  Addiction is
rare within the first 6 months of H use. (See Kaplan, p. 27).  So, 
you'd have to be giving out samples for a while before you had an
addict customer.  Finally, associating with non-addicts is the surest
way to get busted.  Dealers stick to themselves; they don't hang out
on play grounds.

Anything I left out that should be discussed?

>William "Alain" Simon
>                                                   UUCP: alain@elevia.UUCP

--Matt Funkchick
-------------------- end of reposted article------------------------------

Brandon Hutchison,University of Canterbury,Christchurch
                  New Zealand
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