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.

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.   

Poor, Puny Anonymities

Poor, Puny Anonymities

 

In 1919 a divided Supreme Court upheld long prison sentences for four marginally employed anarchists in New York for printing and passing out a few poorly written pamphlets opposing use of the U. S. military against the Russian Revolution.  Justice Holmes wrote a stinging dissent that, with its “clear and present danger” test, soon became the bedrock of modern free speech law.  In that dissent he called the defendants “poor, puny anonymities”.

Poor, puny anonymities is a good description of the victims of the War on Drugs.  These should be contrasted to those whose exposure to affluenza has immunized them to the consequences of this war.  Both groups are targets of the Drug Warriors, but their fates are totally different.

The vast majority of the Drug War victims are truly poor, puny, and anonymous.  They are the young, under-educated and –employed, powerless, and usually black or brown.  They are the ones who are stopped and frisked on city streets and profile=stopped on the highways.  They disproportionately fill the jails and prisons and suffer the civil, educational, and employment consequences after release from confinement: confinement that is itself disproportionately long compared to their affluent counterpoints.  Michelle Alexander, in The New Jim Crow, has done much better in describing their plight and fate than I can even attempt.

The children of affluence face a different fate when they become ensnarled by the Drug War.  Their infection of affluenza immunizes them from its pathological effects.  A recent trial in Texas gained notoriety when a thirteen year old by pleaded guilty to four counts of criminal homicide when his drunken driving spree resulted in four deaths.  The judge sentenced him to ten years probation with his parents agreeing to place him in a private rehabilitation facility at a cost to them of $450,000 per year.  The judge explained that the youth could not control himself because his over-indulgent upbringing shielded him from the consequences of his earlier wrong-doings and had totally failed to teach him either right from wrong or self-restraint.  In an interview, a psychologist who had testified as an expert for the defense, described the boy’s condition as a case of affluenza.

Both the affluenzaics and the poor and puny run afoul of the Drug Warriors (although the poor are targeted in much greater numbers, but the aftereffects of affluenza include immunity to Drug War casualties.  While no Prof. Alexander has appeared to document and analyze the fates of these affluent few, everyone can easily create his own top ten list of offenders.  A few of the better-known stories can hint at the scope of their immunity.

Politics provides some good examples.  Mayor Rob Ford of Toronto, when shown a video of him smoking crack cocaine, admitted it but excused himself as having done it in a “drunken stupor”.  Not only did he receive no punishment, he is running for re-election with high popular support.  Republican Congressman Trey Redel was not quite as fortunate: after being caught buying cocaine in a police undercover operation, he received probation and is still serving his time on the floor of congress and considering a run for re-election as well.  Democratic Congressman Patrick Kennedy (of the Hyannis port clan) did resign from congress after causing an Ambien-influenced car wreck, spent a short stay in an expensive rehab spa and now is a highly visible Drug Warrior on the celebrity speech tour.  These three affluent druggies spent a total of zero days in jail.

The world of entertainment presents the most lurid pictures of affluenza immunity – from marijuana-centered hip hop lifestyles to Miley Cyrus toking a joint on You Tube.  But even in the entertainment world some affluenziacs are more outrageous than others.  Louis Armstrong was arrested and assessed a small fine for marijuana possession in L. A. in the early 1930s.  For the next thirty years he smoked it almost constantly and, according to legend, insisted that all of his band members get high before any performance.  Willie Nelson’s tour bus was found to carry marijuana in Sierra Blanca, Texas.  The sheriff offered not to file charges if Willie would sing a song in the sheriff’s office; to his credit, Willie turned down the offer with the scorn it deserved.  Lindsey Lohan’s drug-abusing behavior has had her in and out of court on a regular basis for years.  The number of times she has appeared in court is probably greater than the number of days she has spent in jail.

The best story of all illustrates both ends of the poor-and-puny to affluent spectrum.  Rush Limbaugh, darling of talk radio, developed a craving for opiates that he satisfied with black market OxyCotin.  Unwilling to run the risks of making criminal purchases himself, he coerced his maid into buying for him.  She was arrested while making a parking lot purchase.  The maid was convicted and sentenced for Prohibition violations, but Rush – instigator of the transaction – continues to be the number one bloviator of the airwaves.

Andre Gide, the French literature Nobelist, once observed that the Law in its infinite majesty forbids to both the rich and the poor the right to sleep under the bridge.  Drug Prohibition reveals the dark side of that maxim.  It shows Lady Law peeking around her blindfold to plant her thumb solidly on the scales of Justice, weighing down the poor, puny anonymities while elevating and coddling the Affluent.  Now is the time to insist that she rebalance her scales.    

 

 

The News That Didn't Happen

The News That Didn’t Happen

On Wednesday, the first legal pot shops opened in Colorado.  News cameras from around the world focused on their doors, but the real news is what didn’t happen.

The health news is what didn’t happen in emergency rooms around the state.  Not a single overdose death was reported.  No patients were treated for bad trips.  Fewer trauma patients than normal were admitted, mainly because of a decrease in serious traffic accidents. (However, a few new minor injuries were reported when newbies burned their fingers or eyebrows while trying to light that first joint.)

Reporters covering the police beat also found mostly no stories.  The cops worked very few impaired driving wrecks (that number had been going down dramatically ever since the legalization of medical marijuana).  The bars were quiet with few fights to be broken up.  They were only sporadically called for domestic abuse cases.  Except for a few murders and robberies the state was quiet.

While the schools are closed for the holidays, they are expected to resume with no news.  They will have no more absentees than normal.  Stoned highschoolers will not be giggling and disrupting classes.  No more teenagers will be nodding off in class than in this year.  The band will still play Sousa marches, not Grateful Dead jams.  Football and basketball teams will still concentrate on their practice drills.  Even the teachers will pay attention to their lesson plans.

No news was the story on the street corners and in the alleys as well.  That dejected looking man slinking around the corner was a dealer who had not made a sale all day.  No alley was blocked by a truck unloading a ton from Mexico.  No immigrant with calves like cantaloupes was arrested with a seventy-five pound backpack.  The local news did not lead with a story about a gang shoot-out.

Everything was not quiet; some businesses generated news.  The do-nut shops had waiting lines outside the front door and the convenience stores sold out of Doritos.  Pizza delivery men worked overtime, and Netflix set a new record for movie downloads.

And the first “official” customer in Denver was a veteran suffering from PTSD, a condition not included in Colorado’s medical marijuana statute.

This “news story” is clearly a work of fiction, but it is based on decades of study and observation.  As such, it is my best prediction of what the effect of legalizing marijuana will be, not only in Colorado and then Washington, but across the nation.  To the average person the only visible effect will be a few signs bearing green leaves along some commercial streets.  The more sophisticated will also notice significant relief in their tax burden, both from increased revenue and from decreased criminal justice expenses.

The biggest domestic news story of 2014 may well be that nothing happened – and that nothing happening is spreading across the nation.

Happy New Year!

Happy New Year

 

The dawn of a new year has long been surrounded by customs.  One I grew up with is eating black-eyed peas to insure good luck in the coming year.  One widespread custom is to make (and quickly break) resolutions to improve one’s life in the coming year.  In place of the usual, boring resolutions to diet and lose weight, to exercise more, and to climb Mt. Everest, I would like to suggest some alternatives that, if enough of us could meet them even partway, would improve our world.

1.    Vacation in Colorado or Washington this year.

2.    Write or email at least three of your elected representatives about drug law reform this year (local, state or federal).

3.    Send a Letter to the Editor of your local paper – even if it’s not published at least one editor will be educated by reading it.

4.    ‘Fess up! The world needs to know that engineers and lawyers and insurance salesmen smoke pot – not just stoners and gangbangers (you may have to wait until you retire or even die – like Prof. X before you do this one).

5.    Talk about drug tests, locker searches, and drug dogs prowling the hallways at a PTA or school board meeting.

6.    RAISE HELL!

7.    OK, you can include this one too: climb Everest.

If just a few of us keep some of these resolutions, 2014 can be a great year.

(Feel free to add your own resolutions to the list as a comment.)

May everyone have a happy, prosperous, and green New Year!

CHEERS!

Oh, My Achin' Back!

Oh, My Achin’ Back!

 

As medical marijuana programs have come into effect in various states, they have exhibited one surprising common factor: overwhelmingly the greatest number of users take it to alleviate pain, many of them young otherwise healthy males.

This appearance of healthy-looking young men has stirred the passions of the Drug Prohibitionists: “These are just stoners using the medical law to avoid arrests and just get high.”  They view the medical use laws as simply a conspiracy to get around the drug control laws.  Unfortunately, their argument shows almost total ignorance of medical treatment of pain and of the health problems of young men.

Pain is both one of the most widespread and hardest to diagnose and treat of medical conditions.  Pain – from a thorn prick on a finger to the chronic intractable neuropathic aftermath of trauma – is a human universal; everyone has some experience with it.  And the search for relief is also universal.  Walk through any drugstore and see rack after rack filled with painkillers.  Morphine is a staple in every operating suite.  Vicodin (an opiate mixed with acetaminophen) is the most prescribed drug in the U. S.  Pain presents doctors with two problems.  First, it is hard to diagnose; medicine has not developed a painometer.  Most tests are useless in detecting pain and doctors must rely on the patient’s own subjective reports.  Second, while some pain (like that finger prick) is self-limiting and some may be relieved by surgery, a lot of it is incurable and chronic; it can only be alleviated by (often life-long) palliation.  Many of the drugs used for that treatment are opioids with their attendant risks of overdose, dependency, and sedative interference with routine activities.  When compared to the risks of the opioids and to the side effects of the OTC pain relievers (gastric bleeding and severe liver damage among others), the more benign marijuana seems the better choice.  In its earlier life as elixir of cannabis its main uses included treatment of migraines and PMS and menstrual disorders.

Just as the Prohibitionists do not understand the problem of pain, they also do not understand the lives of many young men.  While society is more egalitarian than ever before, careers based on physical strength are still predominantly male and young: construction, mining, oil and gas production, mining, transportation, to name a few; and young men are disproportionately active in athletics[1].  These activities share an increased exposure to pain, both recurrent (and often daily) pain from muscular exertion and strain and more serious pain from trauma incurred during that activity.  Sitting for a while in an emergency room or reading a civil court document will shock anyone by the numbers of injured young males.

Both parts of the Prohibitionists’ arguments are wrong: healthy-appearing young males do suffer di9sproportionately from pain.  And the only way a doctor can diagnose pain is by talking to the patient.  No lab test or high-tech scan objectively reveals pain (although they sometimes may show a possible cause for the reported discomfort).  Their smoking gun is merely an illusion shaped by a cloud of ignorance.

I have focused on young men only because the Prohibitionists have focused on them.  I have not intended to ignore the very real pains suffered by the rest of us.  Young women have their special pains as well (and many of them engage in those occupations I listed as the domain of young men).  They suffer from PMS and menstrual cramps.  They strain muscles from lifting and carrying heavy toddlers, wet laundry, and loaded grocery bags (Yes, Dear, we men sometimes help with these chores a little bit).  Just imagine the pains and traumas of an exotic dancer spending all day in those ridiculous but sexy high heels and doing stunts on the dance pole that would challenge an Olympian.  Workers of both sexes spend all day hunched over a keyboard or on their feet as sales clerks.  And as for my body that has withstood three-quarters of a century of wear and tear….

Yes, young men (and the rest of us) do have pain and marijuana can help them; and yes, doctors recommend they use marijuana without conducting full physical examinations, just as they recommend Tylenol or Vicodin.  Pain and its treatment are part of everyday reality.  Marijuana should not be forbidden and locked away; it should be on the open shelves between the aspirin and the acetomenaphen.    

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[1] Look for a posting here on “Athletes and Marijuana” in the near future.

Green Christmas

Green Christmas

 

Here’s wishing you a green Christmas.

May all the greens in your house be strong and dank.

May you vacation this next year in Colorado or Washington – or both.

May your own state be as sensible as they are in 2014.

May your regular family doctor prescribe the medicine you actually need…

and may you purchase it safely from a licensed pharmacist.

May you never be stopped and frisked by a street cop,

Or undergo a “routine stop” by a traffic patrolman.

May the Greatful Dead carol on your lawn.

May you find a hand-blown bong in your stocking.

May all your holiday cookies contain the magical ingredient.

May the smoke from your pipe encircle your head like a wreath.

May Sativa Claus grant all your wishes.

Merry Green Christmas to all and a happy legal new year!