tmp-20150107

You'd be surprised. It's definitely being sold on as an opiate to addicts in UK prisons, both from being smuggled in (small, easily concealed, innocuous looking pills) and diversion from maintenance scripts (although I would have thought in a prison environment they would simply stand over you and wait until you swallow, or force you to drink a glass of water, since unlike someone on a treatment program voluntarily there are no issues about personal liberty etc. From what I've heard, the 8mg tablets are crushed into powder, divided into eighths and sold as 1mg doses for snorting (maybe injecting, but works in prison are pretty dodgy...)

Interestingly, although the treatment center I'm with offers both Methadone and Subutex/Suboxone I was never actually given the choice between the two, or informed of the pros and cons of either. I asked, and basically I was put on Methadone treatment because I happened to mention it in one of my admission interviews. No idea if this is policy driven due to pricing or something else?

Actually, I suspect it may just be a lack of training due to low funding levels, poor compensation for staff which leads to high turnover and lower quality. Thanks, NHS.

Wow! This makes slightly less angry about the hoops I had to jump through to get on a treatment program with the NHS in the UK. (Well, the part of it where prescriptions are still free.) At least they don't add to the problem by making you pay to get help...

Yes, technically the tests are to show the opposite - that you are (not) opiate naive. Someone who can pass multiple closely spaced toxicology screens for heroin (i.e. opiates are not detected) is never going to be admitted to one of these maintenance programs due to the incredibly high risk of death by overdose.

It's been known forever that all opiates are addictive, varying only by degree to some extent. At least with Methadone there was the excuse that it was chemically different...

Urban legend. With broken bones and enough injuries to be prescribed an amount of take home opiates that would be worthwhile for an addict, you'd be in hospital fora day or two at least, maybe more. One thing about addiction is that immediate access to the drug is more important than anything else. No addict is going to bother with this sort of thing just to get a dozen or so Codeine pills...

Buprenorphine has been available for as long as oxycontin. Subutex (the trade name) is sold on the street, and is a commonly abused drug in UK prisons currently, usually as fractions of a pill taken nasally.

Really, this patent is nothing to do with the drugs involved - even the idea of adding Naloxone isn't new, this is available as Suboxone, nor is the idea of sub-lingual administration. As far as I can tell what is being patented is administration in a gelatin-film matrix that dissolves very quickly, preventing diversion and resale on the street.

Remember that these drugs are not just handed out as a month's supply of pills like you would get antibiotics. Instead, they are 'supervised delivery' where the user must take the pill in front of a pharmacist. The fear is that if the pill takes 5m to dissolve, then it could be spit out and sold on once the pharmacy or treatment center has been left, so dissolving in seconds prevents this. Personally, I'm not convinced this is a problem except perhaps in prisons (see above) but then I'm also not convinced the idea is patentable...

Seems dubious.

On the methadone program I'm on, before they could start the treatment, I had to take multiple toxicology screens to show I was addicted to heroin. These places are incredibly worried about opiate-naive individuals overdosing, which can happen even with the small initial doses on these programs. Note that this is in the UK, which has a much less litigious medical culture USA as well...

Not to cast aspersions on your friend, but have you considered that he may be lying to you about only using recreationally, and using this story to explain why he's on a treatment program? One thing about heroin is that it's pretty much impossible to use regularly without becoming addicted. As a heroin addict myself I know that unfortunately deception can easily become a normal part of your life.

no problem...

this is exactly why it took me so long to get help for my heroin problem. i'm a senior software engineer, but if i admitted to my addiction at work, the stigma and ostracism from people like you would be awful. fortunately i am now in a methadone program, due to a manager much more open minded than this...

This is a little disingenuous, without further elucidation. As far as the statistic you have quoted is concerned, it tells us nothing about how dangerous cocaine is. We need to know how many out of the total population of cocaine users experience chest pain, how many of them go to an ER, and then how many of those (who in total make up 1/3 of ER presentations with chest pain) are further diagnosed with some actual serious problem...

if we don't know what the outcome of these ER visits are, then it could well be that for some tiny percentage of cocaine users there is a side effect that causes the perception of chest pain, which disappears with no ill effects after a few hours. or, maybe, this represents almost all cocaine users - 90% of them experience severe enough chest pain to warrant an ER visit, all of whom are pronounced dead withing minutes of arrival.

annoyingly, the website you linked to which details this singular datum, does nothing to clarify as to what the truth of the matter is. it certainly doesn't appear to be "advancing addiction science" in any useful way...

it seems these are common attitudes:

> [heroin's] effects are fundamentally incompatible with the "head space" geeks need to be in 24x7 to be even remotely capable of doing the work they do.

> It's difficult for me to imagine downers or opiates being at all compatible with technical work

> Meth, crack and heroin are hugely frowned upon, it's a failure to be a user of these

it depends. as a heroin addict, I need the heroin (well, methadone now, as well) to be physically and mentally well enough to work. without them, i'd be a wreck. now, if i took a large shot of heroin, i'd nod out and couldn't work, but i have had a morning injection every day for years to get going. of course, i do feel like heroin has made me slightly less intelligent, i guess the equivalent of ~10+ iq points lost, maybe. but i can certainly produce good quality technical work, and have been recognised for this by peers, so it's possible, just not advisable ;) and of course, i'm selling myself short, since i'm probably capable of much more or better, at least i hope i will be once i am properly clean - maybe this year will be the one?

interestingly, i've not met any other heroin using it professionals in real life, but probably for the obvious reason they don't want to make it known. i could probably tell if i checked, e.g. pinned, tiny pupils, that sort of thing, but i'm just not looking for it in the work environment. a consequence of trying to blend in is that it imposes a high cognitive load that takes away from other thinking i might be doing - i generally have to lie about non-work activities or be vague and non-committal, and so on.

+1

This is odd to me - how would a four year old develop a fear of needles? At worst they're an instantaneous sharp pain that lasts milliseconds, most of the time they aren't even felt...

Indeed. The bio-availability from 'chasing the dragon' on tin-foil is something like 50% or even less, although in the UK at least powdered heroin is adulterated with things like caffeine (which causes heroin to vaporize at a lower temperature) to make smoking more effective. Obviously IV injecting gives 100% bio-availability, though.