Tuesday, February 11, 2014

Death By Heroin

Death By Heroin


Philip Seymour Hoffman died last week, his death apparently heroin-related.  He was a popular Oscar-winning film actor, and since his death closely followed substantial outcroppings of opiate-related deaths around the country, the news media have gone wild with the story.  But was his death a consequence of heroin use or of the laws against heroin?  Answering that question involves looking at three issues: the safety of opiates, including heroin, themselves; the kinds of deaths suffered by opiate users; and the effects of the drug Prohibition laws on those deaths.

The opiates are incredibly safe drugs.  Their use goes back at least 4,000 years.  In the last fifty years before their Prohibition (c. 1860 – 1914) opiate use – primarily opium but also morphine and heroin – was widespread and compulsive use was viewed as a significant social problem, but overdose deaths were extremely rare.  These opiate-related deaths started becoming common only after the major maintenance clinics were closed in 1925.  Even now, pure heroin overdose deaths are rare.  Experienced users can build remarkable tolerances.  One addict at the Lexington Narcotics Farm was recorded as using over 1,600 mg. a day – about ten times the lethal dose; and Fentanyl, a synthetic opioid up to one hundred times stronger than heroin, is routinely administered for several chronic pain in doses equivalent to 3,000 mg of heroin daily.  The only side effects of opiates are constipation and the risk of withdrawal symptoms roughly equivalent to the flu if use is stopped.  An addict maintained on pure heroin can lead a long, normal life.  The lives of three men are illustrative of what a heroin addict’s life can be.  Dr. William Halsted became addicted to heroin and morphine before age thirty and used them daily until his death in his seventies.  In that time he became “The Father of American Surgery”, helping form n Hopkins, served as chief of staff, instituted the use of rubber gloves, and developed the techniques still used for hernia repair and mastectomy. William Burroughs used heroin regularly from his thirties until his death in his seventies.  His novels written during that time included Junky and Naked Lunch, and he is viewed as a major influence on modern American literature.  Philip Hoffman serves as a bridge between the ability to function as an addict and the dangers imposed by suppressing heroin into an underground market.  He was a heroin addict before age twenty-two, and before his death at forty-six, had appeared in over fifty movies, been nominated for Tony awards, and won an Oscar.  His death with a needle still dangling in his arm raises the issues in the next section.

Many heroin users die from opiate-related causes, but few of them die heroin-caused deaths.  Many become homeless because of the pressures of living in a black market and paying Prohibition-fueled premiums for a cheap commodity.  They die from malnutrition, exposure, or violence endemic to life on the streets.  Most of the other deaths are caused by impurity, adulteration, or substitution common in unregulated drugs or from the consequences of unsterile injection techniques.  Almost all of the recently reported deaths involve mixtures of heroin and Fentanyl, a hundred times stronger than heroin as noted above.  These are probably overdose deaths – but overdoses of Fentanyl, not heroin.  A heroin user unknowingly injecting Fentanyl is trying to take a sip of water from a fire hose.  For several decades heroin users have died when their suppliers substituted Fentanyl for the heroin they expected.  As an illegal market, heroin’s supply has wavered from drought to flood, and when it is scarce Fentanyl steps in and death results.    Other adulterants or substitutions can also be fatal.  A large number of Dallas teenagers died after injecting a heroin mix called “cheese”, which was a combination of heroin and Tylenol RM that contains diphenhydramine (Benadryl).  The required label for diphenhydramine lists death in adolescents as a possible side effect and warns that combination with opiates can strengthen the actions of the drug.  Autopsies showed low or moderate levels of heroin and high levels of diphenhydramine.  Another episode near Houston resulted in the deaths of about twenty men.  They bought and injected what they thought were usual doses of cocaine, but the drug was actually 60% pure heroin: what would have been their expected high if were cocaine was a fatal amount of heroin.  Poor injection technique can also be deadly.  Injection of air bubbles or solid contaminants can cause embolisms or thromboses, either of which can cause instant deaths.  When the body is found with the needle still imbedded, that is usually the marker of this kind of flawed injection.  Overdose, which takes over an hour at the least, allows plenty of time for the user to remove the needle.

If this analysis is correct, countries with legal heroin available should have much lower opiate-related deaths than those that Prohibit the drugs.  Four examples support this assumption, and, to the best of my knowledge, none show contrary results.  As mentioned previously, opiates were freely available In the U. S. before 1914 and habitual use was recognized as a problem, but opiate-related deaths were virtually unknown.  Incidentally, before the Harrison Act heroin was generally snorted, smoked, or taken orally; injection only became common after tight regulation made pure drugs hard to obtain.  Switzerland has distributed free heroin to addicts for almost two decades and the Netherlands has recently joined them.  Deaths have virtually disappeared, related property crimes have gone down, and the rate of use has not increased.  The best example is England, which started allowing doctors to distribute heroin to addicts in 1914.  They continued to do so until the Thatcherite regime stopped the process in the 1980s.  Both the number of deaths and the rate of drug-trafficking crimes shot up.  The English resumed supplying opiates to addicts and the death and crime rates dropped.  In comparison, Scotland continued strict Prohibition and continues to have death and crime problems.

This year marks one hundred years since the passage of both the Harrison Narcotics Tax Act and the first Hague Convention on narcotics.  They have created a century of Death By Heroin.  If a society can learn from its history, the world should have realized by now that Prohibition does not stop drug use, but it does impose an unconscionable toll of death, misery, and crime.  One hundred years is enough.  Stop this failed experiment and end Prohibition now.

Saturday, February 1, 2014

Legalizing It

Legalizing It


The news media have been alive with talk about legalizing marijuana for some time now, especially since the 2012 votes in Colorado and Washington.  But no one is really sure what legalizing marijuana means.  The easiest way to answer this question is to just apply the words literally.  It simply means to apply rules and regulations to an already existing lawless market, thereby bringing safety and order to that market.about

The marijuana market exists now.  It existed before the Marihuana Tax Act was passed.  Many in states along the Mexican border were using it by 1915 (The federal government issued its first large study before 1920). Use in the military was so common that the Army Surgeon-General issued a report in 1932 (His conclusion: marijuana presented no risk to effectiveness, discipline, or health and no regulations were needed). Musicians in Chicago and Kansas City used it in the 1930s (Louis Armstrong was arrested for possession in Los Angeles) and it was common in Harlem and Boston.  And it will continue to exist whether its Prohibition ends or continues.  Federal government surveys show that more than 15,000,000 people use each month.

But that market is different from the market for prescription drugs or automobiles or blue jeans.  Because of Prohibition the marijuana market is law-less.  It operates in the dark where the law cannot reach: a black market.  Legalization does not mean creating a market – that already exists; it only means applying the usual rules and regulations to that market: bringing it into the light.

Markets without regulation are always expensive and destructive at every step in the process.  Manufacturing or processing the goods are hazardous both to the consumer and to the neighborhood.  Before the Pure Food and Drug Act, millions died from spoiled meats or adulterated foods; and bathtub gin, denatured alcohol and jakeleg killed or crippled tens of thousands during alcohol Prohibition.  Most of the deaths attributed to heroin are actually due to adulterants, substituted drugs, or unexpected potency; the same can be said for all of the reported MDMA deaths.  Marijuana has also had its purity problems with herbicide, pesticide, and fertilizer contaminants.  These poisonings have been almost eliminated from food and drink (including alcohol) by modern regulation and inspection.

Preparing drugs illegally also creates unnecessary hazards.  Bathtub gin stills exploded, burning down crowded tenement apartments.  Illegal meth cookers spill hazardous chemicals and explode in populated neighborhoods.  Marijuana growhouses burn from improper electrical installations and innocent passers-by have been killed by booby traps at illegal grows.  But Jim Beam and Jack Daniels have been safely distilling whiskey for generations; and licensed pharmaceuticals have safely manufactured methamphetamine (yes, it is a legal prescription drug) for eighty years.  Legal marijuana would be grown and processed as safely as tomatoes.

The most dangerous part of an illegal market are the people who run it.  The combination of artificially high prices and high risks of imprisonment or death attracts only the most ruthless and violent to compete in it.  During alcohol Prohibition, modern organized crime got it start in the mobs that ruled Chicago and New York with tommy guns and bribes.  After repeal lowered prices and overt regulation forced these gangs from alcohol into the other Prohibition-based markets of prostitution, gambling, and drugs.  The height of the cocaine era was dominated by first the Colombian, then the Mexican Cartels, who elevated violence to military levels.  They have also been prevalent in the marijuana trade.  These Cartels combine with local street gangs at the retail level of the market.  Repealing Prohibition replaced the murderous gangs by law-abiding breweries and distilleries.  Legalization and regulation by repealing marijuana would accomplish the same transformation.

The marijuana market existed before the passage of the Marihuana Tax Act; it has not only continued, but has flourished and grown since; and it will continue into the foreseeable future.  The only question facing Congress and state legislatures is whether that market will continue to fester in the dark of a criminalized black market or will it be brought out into the healthy sunlight of a legal market kept well and strong by rules and regulations – rules that protect not just the consumers in that market but also the by-standers whose lives, homes, and livelihoods are jeopardized by the Prohibition parasites that repressive laws foster among them.  Legalizing the marijuana market will protect everyone.