As a few people know, I am a former heroin addict. I have been in maintenance for 4 1/2 years - but not with methadone. There has been an alternative around for about 2 years now [in America], yet few people know of it. It's called buprenorphine, a drug that has been around for many many years, but now is available for maintenance purposes in a high-dose form under the brand names of Subutex and Suboxone. If you don't know what maintenance is, keep reading.

First of all, a plug: The Drug Reform Coordination Network (DRCNET)
They were founded in 1993 and have both a lobbying arm and a non-profit arm, similar to the ACLU. They release a weekly newsletter, and at the least I suggest you subscribe - you will learn alot about something that has fallen to the back burner in recent years with the massive issues created by the Bush Administration.

Much more below the fold

Diaries :: nephalim's diary :: :: Trackback ::

Let me provide a link to the ACLU for ease here: American Civil Liberties Union
I strongly urge anyone who isn't a member to join the ACLU, it is of my opinion that nothing is more important than our civil liberties, and I am worried that the "PATRIOT" Act has barely a mention at all - nevermind "PATRIOT II", which is downright disgusting. It's THESE things that could destroy this country - not the end of Social Security [although that is certainly not something to be ignored, don't get me wrong.]

Finally, one last shameless plug. A FAQ I wrote on buprenorphine, the maintenance medication I am taking Buprenorphine FAQ (in need of updating) by Nephalim(27)
It contains just about anything you would want to know about buprenorphine, a large amount of info on methadone, and the current law. I will reiterate much of it here. It also contains a bit about me, as well. If you read this and want more info, that's where to go. It's written as a FAQ - a format that is much more readable.

Anyways, enough with the plugs. Onwards and upwards.

There is another reason I am writing this, and that is because heroin, as well as other hard drugs, are about to become a major problem again. I will get into this later.

Everything I will say here will be as much in layman's terms as possible as opposed to technical terms, so don't jump on me for not getting something "technically" correct. This isn't the place for such things.

Let me end by saying this will hopefully be part of a series, assuming there is enough interest. Tell me what you want to see, and I will deliver.

UPDATE (day 2): (sorry, haven't figured out how to use update tags yet.) I have written this from the perspective of someone who is an advocate of maintenance treatment. Let me make it as clear as possible: there are people who feel this is not the best way to deal with heroin addiction. And while I strongly disagree, and am not going to un-bias my diary, as it is my personal opinion, I am going to show you the other side of the coin. Look towards the bottom of this diary to see what I am speaking of.

A Personal Statement

Let me get one thing out of the way: heroin has been stigmatized to no end, largely due to the needle use involved. However, due to the great increase of potency that heroin has had in the past decade or two, needle use is no longer necessary for those who aren't hardcore addicts. There is large growth in suburban sniffers and smokers, as well as large growth in use of prescription opiates (properly known as opioids, except for codeine and morphine, but I will use opiates anyway,) especially Oxycontin [generic name oxycodone], which spreads out to rural areas as well as suburban areas, and it's a HUGE problem. It's even hitting the rich - just look at Rush!

Now, back to what I was saying: is heroin (and other opiates) bad? Hell yes! I am not, nor will I EVER, advocate heroin use. But it's bad for one reason and one reason alone: the addiction/tolerance. Every single other reason is due to the drug war. Every last one. This is my opinion, and you are free to disagree. Let me also make clear that I am not downplaying the problem of addiction and tolerance: it's a HUGE, HUGE problem - as you will soon learn about. Now, a large group of street addicts are worthy of the stigma - there is no doubt there - just go to a crummy methadone clinic if you have any doubts. But there are also large groups of opiate addicts you have no idea existed. If you are so inclined, visit alt.drugs.hard [where mostly current users are], on usenet, and speak to some of these people. They are intelligent, thoughtful, friendly, and to some extent, as much as is possible, in control. Unfortunately that's still very little.

If you limit heroin to sniffing and smoking, let's just say that I would rather that than be an alcoholic. Alcohol causes permanent bodily harm, and even death. Heroin does not [overdose is a problem but could largely be controlled with legalization(at least for addicts) - by knowing what you are getting, and giving the cure for overdose out freely - and doesn't occur very often in those who aren't shooting. Yes, there is a CURE for overdose. The most common is naloxone, an opiate ANTagonist, which means it blocks opiates from working. You will feel like the worse kind of shit imaginable after getting a shot of that - but your life will be spared.] What else does alcohol do? It causes violent and other nasty behavior, for one. Opiates do not, except perhaps to those desperate to get what they need to feel normal. It causes far more deaths in car crashes, heroin doesn't impair your driving ability to THAT much of an extent - although it surely does - unless you are "nodding" (falling asleep.) It also has life threatening withdrawals - as do tranquilizers - heroin does not. It's just as addictive as smoked or sniffed heroin, and ALMOST as hard to get off of, in the long term. I just want to make the point that just because something is legal, doesn't mean it's "OK".

Let me say something again: I am not advocating opiate use! You WILL regret it! I promise you. You will be chasing that "virgin" high for the rest of your life, and might wind up unable to experience the pleasure you were once able to. It's not a fun life, and it's surely not glamorous. Let me also make it clear that there is no "soft" opiate (except, perhaps, opium.) Everyone starts, that is the people who aren't on the street, with "soft" opiates. It doesn't last - and even if it does, the differences between them and heroin are minimal at best. The thing that makes heroin so much different than other opiates is the so-called "rush" - it rushes your brain faster than any other opioid, and causes great feelings of pleasure, even after your tolerance is sky-high. Maintenance meds are different, and I will explain.

Alright, let's start with the basics.

The Basics

Well, in that personal statement, I have explained very much about the non-legal and non-political aspects of this, so I will largely try to keep this on topic. But there are many concepts I need to explain, first. I hope I am not boring you too much, and thank you for taking the time to read it. I promise I will get into something interesting.

I didn't tell you what maintenance is, for those who don't know, and it's a very fundamental concept to all of this. Maintenance is when you take another opioid instead of heroin, "maintaining" your addiction. At face value, that doesn't sound very productive. But it is, and I will now tell you why. At the current time, there are two maintenance medications: methadone, and buprenorphine[Subutex/Suboxone]. There was a third, LAAM, legally no different than methadone, which worked for a whopping three days, but it was pulled from the market (in the USA) because of lack of interest and the potential for heart attacks it causes (one of the few opiates, if not the only, to have such problems.)

So why is maintenance important, and a very necessary option for heroin and opioid addiction treatment? Why isn't it "trading one addiction for another"? Because depending on the study you are looking at, nevermind anecdotal evidence, your chances of success at long-term abstinence are anywhere from 5-15%. No one knows why this is, at least not yet, but even after the withdrawals are over, "the easy part" according to just about anyone, the hard part begins - long term abstinence. "Willing it" just doesn't seem to work - believe me, I have tried. Your brain seemingly gets rewired to treat heroin like the most basic of your biological needs, lasting anywhere from 6-12 months to the rest of your life. It's like trying to "will" yourself not so sleep, or eat, or fuck. Over the long term.

So that's why it's important, because your chances of abstinence are so low, and people just want to live normal lives (and buprenorphine is a HUGE step towards that goal, as opposed to methadone, I will explain.) The important question many must be asking themselves is what makes it any different than heroin? There is a world of difference between methadone/buprenorphine and heroin/other opiates. The first and foremost is the duration of action and the time to peak effects. They both prevent withdrawals for 24 hours (or more), meaning you will not be constantly running around looking for a fix, and you won't have the ups and downs of heroin - once stablized, you will essentially just feel normal - not high, not low. Your body will adjust to the drug and make itself work as if it wasn't there. Ideally, at least, there are some very unique people out there. The fact that it takes nearly 2 hours to reach peak effects means you just simply don't get high from these drugs - unless you are "niave" to opiates, that is, in which case you wouldn't be going into maintenance. As I said, it let's people live normal lives - people on methadone, undetectable, are lawyers, engineers, even doctors. You would be amazed.

Buprenorphine is different than methadone, and it's vital. I will get into the legal differences and implications in a minute, but let me get the final bit of basics out of the way. Buprenorphine is a "mixed opiate agonist/antagonist," well, actually, it's better described as a "partial opioid agonist." Describing this is beyond the scope of this diary. Let's just say there are several things about buprenophine that make it very different pharmacologically than methadone, which I will describe:

#1 - It is a much weaker drug. It won't leave you with a sky-high tolerance to opioids.
#2 - Following that, even though it's weaker, it has an antagonist effect - meaning it blocks other opioids from working (i.e. heroin.) - quite well in fact, but not as well as was originally believed
#3 - Following THAT, It seems to fix what heroin broke, and anecdotal evidence clearly implies that you are often more sucessful getting off buprenorphine than methadone.
#4 - Finally, the withdrawals of buprenorphine are mild at best in relative comparison to other opiates, especially methadone. Methadone withdrawals are a month of utter, utter hell.

There are two major downsides to buprenorphine, which I will also list for you.
#1 - As I said, it's, simply put, "weaker." This means that it can't satisfy all addicts - although the specific tolerance and level of addiction of the addict seems to play only a small role in this.
#2 - Due to it's opioid-blocking effects, the transition of getting on to buprenorphine from heroin or other opiates can be quite painful, especially if it's not done properly - and most doctors have no idea what the hell they are doing in this regard.

One final thing to say about buprenorphine - poorly understood, but it seems that it helps greatly with cocaine addicts. Getting into this is beyond the scope of this diary.

Well, I hope that's about it for the technical mumbo-jumbo. I hope you are sticking with it. On to some more relevant stuff.

The Law

So what is the law regarding maintenance treatment, and how has it evolved? When and how did buprenorphine come into the picture, and how is it different?
Let me start by saying methadone maintenance treatment has been around since the 1960s. It has very much proof as to it's effectiveness, as well as something very important: it is far cheaper, for society, to have an addict on methadone than on the streets on heroin. That's some food for thought for conservatives.

Methadone has some very strict laws regarding it's use. These laws vary from state to state, but under the Federal CSA (Controlled Substances Act, as amended, which is the federal law controlling almost all of prescription and illegal drugs,) only doctors with special certification, working in special clinics, can prescribe methadone. In most cases, "prescribe" isn't really the word. The users need to show up, every day, sometimes within as little as a one hour period, to get their methadone. Most clinics have a ridiculous rule that you must piss heroin positive in order to get on heroin - causing people who have been clean a few days but just can't take it to go out and get high needlessly. Only after testing clean and going every day for 6 months or more do you get any "takehomes." These takehomes start for weekends and work there way up, after several years, to monthly (in some cases.) Usually two weeks is about all you can expect. I don't know exactly how much of this is federal law, state law, or not law at all, unfortunately. I will look further into it if there is interest.

So the laws regarding methadone (and LAAM before it was discontinued,) are pretty harsh. It's hard to imagine anyone making it through that instead of just scoring a bag. Or getting screwed because of a momentary lapse of judgement. That brings us to buprenorphine, which comes in two forms - Subutex, which is just buprenorphine, and Suboxone, what is commonly used, which contains an extra ingredient - naloxone. This is added to prevent abuse. If taken normally, it does nothing. If injected, it causes massive withdrawals. This is what I am taking.

So what makes buprenorphine different? In 2000, under Clinton, the 106th Congress passed the Drug Addiction Treatment Act of 2000, otherwise known as the DATA. You can search Thomas for info on this, including the full text of the bill and the Yea's and Nay's. Unfortunately I can't link it, as it only keeps what is generated temporarily. The DATA amended the CSA (Controlled Substances Act) to allow normal doctors, who either meet certain qualifications or take an 8 hour class, and apply to the DEA and SAMHSA (Substance Abuse and Mental Health Services Administration), to prescribe Schedule III opiate agonists (opiate drugs), that are FDA approved for opiate addiction treatment (methadone is Schedule II - meaning this act doesn't apply to it.) You can get a regular prescription from a qualified physician, and fill it at your local pharmacy (alas, most local pharmacies, especially chains, are very reluctant to fill these prescriptions and in many cases will make up blatant lies.) The doctor is in full control of your treatment, and you can take home up to a month's supply as soon as he sees fit. This is a major step forward. Unfortunately, it has yet to spread to the streets, and only the upper-class drug addicts have been able to make use of the drug, and it's a real shame.

Methadone clinics are afraid to be put out of business, and have done everything they could to stonewall this and the FDA Approval of Buprenorphine for Opiate Addiction every step of the way. Now, even though this law was passed in 2000, there were no opiates that were Schedule III or above that were FDA approved for opiate addiction. Buprenorphine was in clinical trials for nearly two decades, being stonewalled every step of the way by everyone who had an interest in seeing addicts suffer or keeping the cash in the methadone lobby's pockets. It finally was approved by the FDA in October 2002, and available in pharmacies next January, 2 and a half years after the DATA was passed, despite ample evidence of it's effectiveness. Buprenorphine has been used in other countries with great success (although some abuse has been reported when heroin supplies ran dry, like in France,) for a long time. It is currently used in dozens of countries, including much of Europe, Canada, and Australia.

It's interesting to note that immediately before the FDA approved it, the DEA rescheduled it to Schedule III from Schedule V (the lowest.) Reading the petitions to the DEA was both fascinating and frightening, hearing misguided assholes demanding it be in Schedule II with things like Hydromorphone (Dilaudid) or Morphine. Luckily they decided not to put a stop to the whole thing by doing so, and they put it in Schedule III. They put both Subutex and Suboxone in Schedule III, which makes little sense, as Suboxone is specially formulated to greatly reduce any potential for abuse.

Now, let me finish this part off by saying that congress did something blatantly illegal when they passed this law - they delegated their powers to the executive branch, putting it into the law that the DEA can pull the plug at any time. While I find this unlikely at this time because this drug is used mainly for upper- and middle-class drug addicts, such as Rush I am sure (eventually at least,) it is still a scary thought. Even if they didn't put this little disclaimer in there, it would matter not, as the DEA could reschedule the drug at any time to Schedule II, putting it with methadone, and then the special provisions of the DATA would no longer apply.

Why this is important

Well first of all, we are going to see a huge resurgance in hard drug use - if we haven't already. Poor economic times lead to this - nevermind the HUGE crop in Afghanistan, which, luckily (for US,) will flood Europe and Russia and very little will wind up in the USA. The Heroin in the USA comes from Columbia (East Coast) and Mexico (West Coast,) and small amounts from East Asia, mostly on the East Coast. But it's still a matter of supply and demand, and I can tell you that scoring heroin on the streets of New York has never been easier.

So with a resurgance in drug problems, we have two issues - the first being getting the people that need help, help. The second being the "war on drugs" might return as it started - and that won't be pretty. With drug laws being toned down or outright decriminalized in many places, I am afraid of a backlash. The homosexual "acceptance" has had a backlash - that's for sure.

In fact, the drug war bears a great resemblence to the evolution of homosexual rights, only the drug war is further behind. First, it was a crime. Then, it was a disease. Now, (for homosexuality,) it is a right - yet still viewed as a problem by most in society. I am waiting for drug users to reach the next step.

Drug law reform needs to be properly framed, and treatment as opposed to incarnation needs to be the only option. Sending low-level non-violent drug users to jail is not only counterproductive, but a huge waste of money, and ruins many, many lives. Here in New York the Rockefeller Drug Laws were laxed - which is a big step for us here, but it is far from what can be deemed "reform."  Somehow we need drug laws that will discourage new users, even though I personally believe it to be a civil right, many others do not. I think what I do with MY body is MY right. And if you disagree, I wonder why most feel that people can do what they want with their body when it comes to abortion, but not with drugs. If proper heroin maintenance is given to addicts, the problems of heroin addict to society would virtually dissapear.

Besides that, the drug war is a complete and utter failure. It causes crime, causes people to become homeless and poor, causes needless deaths, the repercussions are endless - and this is blatantly obvious. We cannot continue such a fundamentally flawed policy, whether you believe drug use is a right or not (the founding fathers seemed to think so, I might add.)

Why else is this important? Because as I said way up at the top, there is nothing more important in my mind than our civil liberties - and it is something that must be defended - it is the last door to full-blown tyranical fascism that needs to be crossed. We must fight tooth and nail to stop any futher incursions into our liberties as Americans. (BTW, look up "liberty" in the dictionary. Tell me if you can honestly say to me that currently applies to America.)

Perhaps in another edition I will write the history of the drug war and drug use in America - and how, seemingly, drug use wasn't really a problem until the government propagandized it and created prohibition, the correct word for the current situation. Alcohol prohibition didn't work, and drug prohibition is working far less. Ending drug prohibition would go a long way towards curbing crime on all levels.

Here are some links to wet your whistle with on the drug war, and why this is important:
An Open Letter to Judge Rufus G. King III - A nice summary on the problems with the drug war.
The current DRCNET "chronicle" (newsletter)

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Thank you for reading this. I know it was long and contained lots of boring info you probably don't care about. Tell me where you want me to take this and it will be done, assuming the interest is there. I can talk about other drugs, or (/and) talk about prohibition and the drug war throughout American History.

UPDATE: It seems I have finally made the recommended diary list. I want to thank everyone for their very kind words, and let them know it's a pleasure to be able to write something that people find interesting or helpful.

Finally, I have decided to continue this into a series, with the next diary being on the history of drug prohibition and where we are now in the "war on drugs," and how exactly it's a problem. I will continue with what should be done in the future - a topic for debate - and then write some diaries on other drugs as I have done with heroin here. Please give me your input, this certainly isn't set in stone.

UPDATE (day 2): Here's what I promised, the other side of the coin. Here is a very well written post by glibfidget, who is also a former heroin addict, along with my rebuttal, to someone who feels very strongly that maintenance is not a good thing, and that abstinence via NA/AA is the way to go. I strongly disagree, and you will see both his and my arguements.

I want to say first that both he and someone down below stated that there is virtually no success rate with methadone or buprenorphine, and that it has little proven value. This is simply completely bogus, and I will provide the statistics to back up my claims.

I also want to say something very important I should have said in the first place: methadone and buprenorphine are VERY different medications, and there are strong downsides to methadone which don't exist with buprenorphine. I will make a list of the downsides of methadone that I didn't mention. And this is the reason I feel very strongly about buprenorphine as opposed to methadone - but for some people methadone is the only option - and I can say with absolute certainty that I *HAVE* met these people.

Downsides to Methadone (and compared to buprenorphine)

#1 - You have to go to a clinic every day for a long time at the beginning, which I did mention, but I didn't mention the fact that you are surrounded by drug addicts while doing so, and there are usually drug dealers parked outside (especially the lower-class clinics, there are many different "types" of methadone clinics, some for street addicts, some for upper-class addicts, and the latter is far superior.) Buprenorphine doesn't have this problem.

#2 - It is extremely difficult to get off of methadone. You have, in most cases, withdrawals worse than heroin, and lasting over a month (as opposed to a week with heroin.) Buprenorphine has extremely mild withdrawals in most cases, but they are long lasting like methadone, about a month (compared to about a week with short-acting opiates.)

Well, that's really it. I think I mentioned everything else. But these two things are very important. Let me know if I am missing anything.

Finally I want to say that this diary has been misinterpreted that I was suggesting lifelong maintenance. I was not. While that is certainly a possibility, especially with certain individuals, the goal of maintenance treatment is that you will get off of it eventually, and that should be very clear.

The Post by glibfidget including my Response

You said alot, and I hope I do your post justice in the response...

Let me say first of all that it's fine that you disagree, and I realize that I wrote the diary from one specific perspective, and I even added an update at the bottom that I needed to make it less biased, even though I AM biased in this regard. I have to say though quite honestly I disagree with alot of what you said, and I do find it "disgusting" to a large extent - but much like you, I am not going to attack you, and respect your views. You had success with a certain route, and that is important. Everyone is very different when it comes to this, and anecdotes should not be ignored. But neither should the scientific statistics. Anyway, let me get to what you said.

I gave you a 4 for the diary. Politically, I agree with most of what you said. Personally, it was well written and thought provoking; however, I find the mindset you subscribe to disgusting. I don't mean that as a personal attack on you, though I suppose by nature it is, but keep in mind I certainly don't know you. And, perhaps disgusting is a strong choice of words. And while I try not to be judgmental on this topic when I run into guys like you, that sort of mindset evokes some fairly strong gut reactions for me. Your way of thinking kept me (and people like me, ergo you) sick for a long, long time.

It did? Most of the people I know that tried to go clean tried being clean many many times, always going back to heroin. (I don't know many real-life junkies, well...not very well. Most of the people I know have been in online forums, I was alone in my habit, at least for the most part.)

Continued in next post:

http://www.dailykos.com/story/2005/1/8/17424/52761