with alcohol, its a slow progress. you keep drinkng and most people pass out / lose their will to drink after they've had enough.
hard drugs are generally a single portion and once its in your blood, its too late. you cant say 'hey, i've got enough for today' once you feel it hitting you. You're already doomed if you've chosen the wrong dosage from the start.
> There are responsible drinkers and responsible heroin users out there
I cant say i've ever heard of anyone ever using heroine responsibly. I'd have to take your word for it, but thats hard, considering how brutal the effects of heroine are on their users.
Somehow the vast majority of people who take legal hard drugs such as vicodin or dilaudid, don't overdose on them. There's a culture built around taking these drugs responsibly according to their directions. We have that very strongly ingrained in our culture about alcohol. I think that same culture would develop if your cocaine came in a box from CVS with proper instructions on when you can take it and what side effects to look for.
Of course people are going to make mistakes. They are going to abuse drugs. But that is happening today. Trying to solve that by keeping the drugs away sounds like the same policies in the war on drugs that we are saying aren't working and leading to legalization
I never bothered getting addicted to Heroin. You have to stick to the rules: never use more than two days in a row and don’t use it consistently, if in doubt half your dose, and never use alone but always with at least one other who knows how to administer breathing assistance until paramedics arrive. Don’t take your dose at the same time as your buddy, wait to see if the first user has trouble staying conscious, 15 to 20 minutes should do it.
Edit: fixed a word
A friend overdose in my loungeroom one evening. He’d taken a lot of Valium, a little bit of a alcohol, and then half the heroin I sold him. After a 15 minute argument he took the rest of the Heroin. I tried to tell him he’d already taken some but couldn’t remember.
Anyway, he started going a bit blue: Cyanosis. Became progressively and rapidly more difficult for him to speak and stay alert.
Called the ambulance, put him in the stable side position, watched his breathing, he was ok. Ambulance arrived, started administering breathing assistance and naltrexone. They commented he required a lot of naltrexone. He came to, they took him to hospital for observation over night. I rode with him in the ambulance and sat with him in hospital for a few hours.
No long term harm. Still friends, and I like to joke he owes me his life.
Friends don’t let friends die from overdosing on opiates.
And yet there are tons of addicts on those:
Typically, it starts with someone being prescribed opiates. Maybe they use them as prescribed, maybe they don't. If they don't, or they have the kind of genes or psychological issues that make it more likely for them to get hooked, they get hooked. Once they're addicted to the opiate, and discover how much cheaper heroin or fentanyl is on the street, compared to their oxy prescription, they start using them instead, upping their risk a ton.
From there it's all downhill unless the right kind of intervention happens, and the psychological issues underlying that addiction are resolved.
A big contributing factor, I think, is the overprescription of opiates to treat pain when it isn't 100% necessary
I’ve tried to help her over the years.
She tried going to an Ibogain clinic in Mexico and was sexually assaulted by a nurse while there. I paid for her to give it a second try for her and her boyfriend (also an addict) but after a few days clean they went back to their old life and relationships and couldn’t stay clean.
Her underlying trauma was sexual abuse as a teenager.
She’s spent most of her adult life living with her parents, using heroin, and committing petty crimes or doing sex work to stay high.
She told me that every time she’s OD’d, she knew she was going to and a part of her kind of took over and did more heroin than she knew she should but she just didn’t care.
She’s been brought back to life several times.
She’s still alive, so that gives me hope she might have some insight or be able to try Iboga again with a better supportive context for integration.
Her 10 year old son is going to have a lot of work to do as an adult to heal from this.
EDIT: as stated above, I belive in drug legalization with tax revenue going to Support free access to trauma healing centers for everyone along with an educational program that helps people understand the link between trauma and addiction.
Isn't vicodin designed in such a way that the secondary ingredient would kill you before you'd get high on the primary one?
Overdose is most common from adulterants and from not knowing the dosage one is taking due to lack of purity information.
If your goal is to stop ODs, allowing cheap access to taxed pharma grade Drugs is your first step.
The next step is using the taxes to make access to trauma healing / education free. Trauma is the root cause of addiction, so healing frees one of the need for the addictive behavior.
Somatic based therapies, psychedelic therapy, and an environment that supports healthy living.
I work with people regularly who are able to gently walk away from addictions because they’ve healed the underlying trauma.
The benefit of this is that we will also rid ourselves of the problems we face from other addictive behaviors like sex addiction, status / money addiction, religious righteousness, etc. (See the book The Perfect Pandemic for a detailed breakdown of the various dopamine triggers we humans use).
I don't think its the sort of thing people will advertise. Apparently only around 10% of users become addicts
I think that the point about GHB that most people miss is the concept of therapeutic index, a term borrowed from the medical world (I've also seen it called "safety ratio" in the context of recreational drugs, especially since they're not being used therapeutically).
That is, the amount of GHB required to get the desired effect is very close to the amount necessary for an overdose.
> I can go buy a plastic handle for $10 and if i drink the whole thing tonight i'll probably die
Merely being easy to obtain doesn't make it easy to overdose, though. That "if I drink the whole thing" is an important part.
You do not, for example, need to drink 90% of that bottle just to get "buzzed". I suspect that the average person would feel sufficiently drugged well before making it halfway through (as even a fifth, even spread over an evening, is a lot of booze).
With drugs like GHB or ketamine, one needs to do the equivalent of drinking the vast majority of that overdose-quantity-bottle just to get high enough, so it's very easy to go too far accidentally. What's worse, what that amount is, and what that overdose amount is, are weight-dependent, and they can vary at different rates.
That's not to say there's no way of alleviating that risk, or at least reducing the possible harm (like maybe only allowing them in clubs adjacent to hospitals), but simply ignoring the legitimate increased accidental OD risk is unlikely to help.
The therapeutic index for GHB is more than adequate, and ketamine is legitimately difficult to kill yourself with, to the point where the deaths I'm aware of were from drowning.
An issue with GHB is that it's distributed in a liquid form that can vary greatly in the amount of water present. When it was available over the counter in the 80s, issues were practically unheard of.
GHB therapeutic index (8) is just slightly lower than alcohol (10). However, being an illegal substance, you don't really know how potent your stuff is. Ketamine is rather high (38).
And BTW, THC (cannabis) as a therapeutic index over 9000. LSD and psylocibin (magic mushrooms) are at 1000, which also makes them virtually impossible to overdose.
That's a good point. I had forgotten that base assumption in the club scene, though it was generally much less of an issue in the rave scene, at least during the 90s.
> GHB therapeutic index (8)
Thanks. Do you have a reference for that? How does that number change with two standard drinks on board?
> is just slightly lower than alcohol (10).
One of the other properties of alcohol that could make it more difficult to reach a lethal OD, which I already mentioned, is that a symptom of a toxic does is vomiting, which can help prevent it turning into a lethal dose.
This is somewhat enabled by the tendency to consume it over time (although "binge" drinking does happen, of course). Can the same be said for GHB? Presumably not, given your next comment.
> However, being an illegal substance, you don't really know how potent your stuff is.
I think that's an issue for any illegal drug, but it's, arguably, even an issue for alcohol. How many people look at a label to determine proof/%ABV? They're not likely offered the chance with a mixed drink at a bar.
> Ketamine is rather high (38).
Is that medical or recreational? My understanding (possibly incorrect) is that the recreational dose is generally much higher, or at least less spread out over time, which can significantly affect the ratio. Is there any synergy with alcohol here that affects it?
Reading more about "safety ratio", it seems that even just the use of the 50th percentile may not be appropriate to have informed decisions on the relative danger of recreational drugs that are likely to be mixed. ED99/LD1 seems extreme, but maybe not ED80/LD20.
GHB combined with alcohol or another suppressant is very very dangerous though.
So, let's assume, for the sake of argument, that we're considering OD risk of recreational drugs, not on their own in a controlled, clinical environment, but, rather, at a club or party, where a sufficient number of people have at least 1 drink already in them and 1 more on the way plus a few cigarettes' worth of nicotine, that we can generalize that to "everyone".
I'm intrigued by what a "plastic handle" is, and google isn't helping for obvious reasons. I assume its a slang term but I've never heard or read it before. (I'm in the UK.) Care to elaborate?
https://siestaspirits.com/products/jim-beam-kentucky-straigh...
Dose standardization does clearly help judging by the nasty side effects of overdosd deaths spiking after pill mills were shut down. It is not a panacea however - tolerance varies as well. It is why trying to get clean can be ironically dangerous. Things start going south and they try their old "standard dose" again after losing tolerance when it is enough to kill a 300lb man with no tolerance built up.
I wonder if legalizing weaned rehab would help. Like say cutting their dose by 25% repeatedly.
On a related note I wonder what role genetics play with it. It would be nice if susceptibility could be read from a genetic test so they could say "Don't worry about restricting opiates for him - he'll get weakened and would always want to get off them asap anyway but he shouldn't drink alcohol when stressed or take cough syrup but should avoid stimulants for their personal addictive potential."
I know personally from legitimate medical usage there are high potential for abuse drugs that for me have me wondering how anyone could consider it fun.
It's an extremely complex system, but notice that prohibition has actually altered the way we consume drugs. For example, coca leaves can be consumed rather harmlessly. But for smuggling purposes, it's concentrated into powder. Then, its black market status makes it a sign of the wealthy and well-connected. This doesn't hold for all substances, but it's worth remembering. You do see a portion of e.g. pot smokers who have to push it really far and do dabs of highly concentrated THC. But then again, many users of pot just vape a little concentrate to minimize lung damange.
> legalizing weaned rehab
absolutely. If people want help getting off drugs, we ought to facilitate it essentially like healing a broken leg. We kind of do this with methadone, but laws make it risky and far from perfect.
> genetics
it is known that certain genes increase likelihood of alcohol addiction. It's probably the same for many other substances, too.
> high potential for abuse drugs that for me have me wondering how anyone could consider it fun. ugh same here. Had to take hydrocodone after surgery for a week. That was one messed-up high for me.
It's very hard to dose.
I dont understand this part. The potential for overdose on alcohol is high as well. I can go buy a plastic handle for $10 and if i drink the whole thing tonight i'll probably die. I think the right path is full legalization similar to OTC medicine in the US. You have FDA verification you are actually taking what you think you're taking, no weird fentanyl substitutes or cuttings. You put warning labels on describing dosages and limits. You let people use them and get treatment if they abuse it. It's the same way we treat alcohol, just we are conditioned to think alcohol is somehow way more safe than something like heroin.
There are responsible drinkers and responsible heroin users out there. I know it may sound scary but I don't think there's a major inherent harm to having methamphetamine available over the counter. Some people will abuse it. Some people are already abusing it.