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Your Opinion about a Diacetylmorphine (Heroin) Maintenance Program in Australia

Crankinit said:
The fact that you'd rather leave them as a drain on the healthcare and legal system instead of taking a rational approach says a lot about your sense of entitlement and your lack of basic understanding when it comes to these issues.

QFT.

Shimazu said:
you know whats cheaper on society? people who support their habits through their own work.

Correct. And what about all the ones who don't, no matter how much you'd like them to? It is cheaper overall to provide maintenance than to not provide it. You seem adamant that you don't want your tax dollars spent on junkies, so why be so self defeating and support the method which will cost you more?
 
Basically I wished we lived in a world where people supported themselves, because thats how I was raised. Im sick of people who sit on their ass all day getting break after break, while my father worked his ass off his whole life and never got anything handed to him. If you want something in life, and can acquire it without negatively impacting someone else, I really dont have a problem with any drugs. Its just sad that in todays society the people who work the hardest dont get any breaks while others simply collect a check and go get their pills.

Then they have the nerve to ask why I dont like them. Like I just busted my ass all week and have to go through all the pitfalls of illegal drug buying, but someone who does nothing can go to the clinic and get shot up with dope twice a day?

Not in a million years am I going to agreee with that.

Like Ive said, if this was 100% funded by patients, whatever, have fun.
 
I have created a new thread on the discussion of the merits of maintenance generally. I would ask that any further discussion on this topic please be directed to that thread, rather than continuing to diverge from the purpose of opi8's thread.
 
ok...there are so many things i'd like to address here, as there are so many points coming up.
the last time (to my knowledge) there was an effort to trial heroin maintenance in australia, this is what happened:
1996 Bill Clinton's chief international drugs enforcer, Bob Gelbard, flies in to threaten Tasmania's legal and lucrative poppy-growing industry to stop the ACT going ahead with a heroin trial. The trial never happens.

(from david marr's article here http://www.smh.com.au/national/the-great-debate-that-no-ones-talking-about-20111203-1ocag.html)

so in other words, the pressure was placed on australia for political reasons. besides the principle involved ("we can't give addicts heroin, this is a war on drugs!" i would presume that the US government's concern was diverted pharmaceutical H.

from a medical point of view, heroin has both pros and cons in comparison to traditional maintenance drugs methadone or buprenorphine.
heroin's short duration means that a patient would need to be dosed at least 3 times a day in order to stay out of withdrawal.
this would be very time consuming for both patient and pharmacist (or whichever medical professional is administering the treatment).
on the other hand, it seems that most addicts find heroin easier to successfully withdraw from than bupe - or especially methadone. the long-lasting opioids are notorious for drawn-out withdrawals that can last for weeks or months. prescribing heroin could be an option for people wishing to avoid getting bound by the "liquid handcuffs" of opiate maintenance, to stabilise their lives a bit before kicking.

unlike street heroin, prescribed pharmaceutical stuff could be accurately tapered.
i imagine this would be much simpler than transferring addicts onto 'done or bupe then tapering.

while i don't agree with shimazu's points, i know that the concerns of many people are in line with his/hers.

the main reason that more countries don't prescribe heroin to recovering addicts is political.
heroin addiction is deeply stigmatised both socially and legally - many people seem to have a strong emotional reaction towards helping people by giving them the "bad" or "sinful" thing that caused them such trouble in the first place.

i think america is very forceful in pushing this sort of puritan idea that giving heroin to addicts is somehow rewarding them for doing the forbidden; that instead addicts should either be punished or have their habits contained (so long as it doesn't provide pleasure). it isn't just pushed on the american people, but other countries that fall under american influence.
in australia's case, this drug policy influence is anything but subtle or implied, as i quoted above. for such a threat to be carried out at the mere proposal of a heroin maintenance trial shows the intensity of opposition in some quarters.

as others have mentioned, there are plenty of other really enjoyable opiates out there that are prescribed for people in a lot of pain or very sick. diacetylmorphine is able to be prescribed by doctors in the uk (and other countries) for the same purposes, but in countries such as australia or the usa, i don't believe this is possible. that is how powerful the stigma of heroin is - which is in many ways just a historical fluke, as it is chemically so similar to morphine and other related derivatives.

perhaps these ideas are partly informed by the modern history of heroin prescription in the UK in the 1960s? my understanding is that the british heroin scene in the early 60s was almost exclusively created by NHS dope diverted by addicts?
i certainly don't want to generalise about the kind of people that become addicted to heroin, but it is well known that heroin addicts are often resourceful people!
these are often people that can lead productive lives - and if medicated correctly, they don't need to "sit around all day and use drugs". a well implemented treatment scheme is very much the opposite of sitting around all day using drugs, as addicts shouldn't have to spend as much time in scoring drugs or hustling money to get them.

i don't see why addiction shouldn't be treated with whatever medical tools are most appropriate.
addiction specialists and well informed drug treatment professionals should be deciding the best drugs to treat people with, not politicians, foreign diplomats or law enforcement.
i can certainly understand some of the arguments on both sides - it is not a simple matter - but i don't think people should be denied the most appropriate methods of treatment for highly emotive political (or economic!) reasons.

i'd much rather the government spend taxpayer's money treating drug addiction than on funding fucked up aggressive wars. it's ironic that the largest source of black market opium/heroin in the world has been under US military occupation for over a decade!
that's a whole other discussion, but the cost of invading small impoverished nations is a whole lot more than it could possibly cost to supply a few thousand addicts with pharmaceutical heroin - yet for some reason, the latter option is a whole lot more unpalatable for people.

it's a sham and we've all been manipulated for too long about drugs - people actually continue believing the hype when it's been shoved down their throats for generations. the passions that run hot in this argument are completely contrived and artificial, so much from the scare campaigns that have been used for decades about heroin is just imprinted on how the populous thinks.
propaganda is some fucking potent shit!
 
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I just dont understand why people bend over backwards to take care of junkies when they are some of the most disrespectful and ignorant people I have ever met. I treat people how they treat me, and when I can not worry about locking my car all the time, maybe Ill have more compassion. But at least where I live, its pretty obvious most of them are never going to stop.
 
Maybe because if, as it's so obvious they'll never stop, it'll save people like you money in the long run? But, I don't think most of the arguments you've presented, only to discard in the face of logic that you're obviously ill equipt to counter, matter much to you anyway. It seems you have a personal problem with 'junkies' , as you put it, with no consideration to rationality or logic. You've made that point clear, and at this point, it's pointless, not to mention disrespectful to the OP and the original purpose of this thread, to keep defending your point of view. You have no new information to add and at this point you are just derailing the thread. I've already asked you to keep on topic - any further arguments you wish to make on the point should be directed to the new maintenance thread, or will be unapproved.
 
I just dont understand why people bend over backwards to take care of junkies when they are some of the most disrespectful and ignorant people I have ever met. I treat people how they treat me, and when I can not worry about locking my car all the time, maybe Ill have more compassion. But at least where I live, its pretty obvious most of them are never going to stop.

some people consider it the compassionate thing to do to try to help the most vulnerable people in society.
IV drug addicts are about as maligned as you can get in the contemporary western world.

america might have a tradition of 'rugged individualism' but that is arguably why you have such a disparity of wealth and such huge social problems. australia has a tradition of being a welfare state that does what it can to help people that need it.
it's not as popular an idea as it used to be (again - we've been conditioned to be sceptical of welfare recipients) but it is one of the foundations of australia's democratic tradition, along with many european nations that have national healthcare schemes and such.
there is an attitude that many of us have, that says drug dependence shouldn't be treated as a criminal issue, but a medical one. that's what the idea behind this thread is about. it's a progressive notion, but that's what the world needs, not more fear, blame and apathy.
 
maybe I was being a bit harsh yesterday but the only way id support a program like this is if it were funded completely by the addicts. I dont think it is fair for non-drug users to have to pay into a program they will never even use/know what it is. I dont hate people who use heroin or opiates, I hate people who sit around all day and use drugs. Those people put a bad label on drug users everywhere, so someone like me who works 40+ hrs a week, pays all his bill and taxes on time, gets lumped into the same group simply because of a substance we both take.

Im sure there are pros to a heroin program. But to deny any cons is just wrong

Okay, so does that mean when 1 year I wrote a cheque to the tax office for $105,000 does that mean I've "paid my dues" and can get heroin maintenance for, say, 10 years. Because it's a lot cheaper to society to give them drugs than for them to end up in the health system, both physical and mental. Your arguments are ignorant and uninformed.
 
Why are you guys still feeding the troll? I can see it's a means to voice your opposing opinion but you can do that without indulging his absurd notions.
We know the contrary and voicing it for shimazu is just as ridiculous as his actions.
Please make points pertaining to the OP instead repeating the same basic knowledge that everyone should be able to formulate. Then again, some people are just fucking stupid.
If you don't have any new information to present to this topic... You can oppose/refute legitimate points, but not shimazu..
 
I have been dependant on Methadone, Buprenorphine, Oxycodone and Heroin. Im currently on bupe and still use heroin a bit. Bupe just doesnt satisfy my psychological cravings. It does a great job at holding me physically and there are probably the least amount of side-effects ive had from any opiate but I still feel the need to use other opiates, especially IV.

The Methadone was heaven and hell in a bottle/cup. For a while(1.5 years) it held me really well psychologically and physically, I still double dosed occasionally but used other opiates maybe once in that 1.5 year timeframe and rarely thought about using. Eventually the side-effects and depression that methadone is known for took me full circle and I ended up double dosing much more often, then progressed to injecting my methadone syrup which is something a lot of people do around here but is not good for you at all. Eventually I realized what I was doing was ridiculous and the side effects became too much so I switched over to bupe with the help of my awesome doctor and many, many benzos. A lot of people around here sell or swap methadone/bupe for drugs and/or cash, I think its a pretty common thing but if we were to be able to get TA doses of heroin from a clinic I think it would defeat any point in selling your TA because the reason people sell their doses to someone(usually who needs short term maintenence/isnt getting high) is so they can buy H. Methadone is pretty damn expensive on the street! People get a fair bit for the stuff, bupe not so much.

I definitely think a heroin maintenaince program would be a great idea. It could work if the program is designed with an open mind(which is highly unlikely). Methadone and bupe are both lacking in something or they have too much of something negative. Heroin is what the majority of opiate users use, why not just control it and see the dealers and the crime start dropping off.

I think it would be a great thing, its been a success in all other countries its been trialled in, why wouldnt it be good for Australia too?
 
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I'm interested to know why you think it'd be better for some people though. As I said originally, I don't know enough about maintenance to be able to comment on why heroin maintenance would work better for some than other forms, so I'm interested on your take on it.

Sorry for taking so long to reply, I had to resist posting for a while in case unnecesary emotion came pouring out.

Essentially, I beleive it should be an option for those who have tried every other method of maintenance/abstinence unsuccessfully. I know someone who's been on methadone for years, but was never satisfied and used all the time. He did a rapid detox switching from methadone to bupe, then introduced naltrexone in a hospital setting. He took naltrexone for about a year, so some might say that was successful. Except he ended up spending all his money on meth instead, plus he was more depressed than ever as well as looking the worst in his life. Eventually, he began using again, and is now in all sorts of financial and legal trouble, coupled with great mental problems. It's simply too much for him to bear and I worry that he will do something drastic. This would all be fixed if he could be prescribed heroin, or even morphine for maintenance. It's a personal story, and goes a lot deeper, but there is honestly nothing else that will save this young mans life, and he is very close to me.
 
Sorry for the double post, I posted before reading the whole thread, while I wholeheartedly support heroin maintenance and other forms of ORT I personally know someone who did exactly what you described, and they ended up on a daily dose of methadone well above 100mg (much closer to 150, and I am fairly certain they needed permission from a medical board of some kind to get over 120). This is obviously not the norm but you can't refuse to acknowledge that it can and does happen, even if you start on a low dose you can end up on a high dose relatively quickly if that is your intention, as it was in the case I am referring to. For the record though this person doesn't sell their take homes.

One of the problems with using methadone for maintenance seems to be that once the dose stops making a person feel how they want, they go to the doctor (who is generally willing to oblige) and ask for a dose increase. I don't think at present there is enough being done to adress why people develop these addictions and giving them more is seen as an easy way to alleviate drug cravings, it is way too common for people on MMT to end up on daily opioid doses multiple times greater than what their heroin using equivalent was, as a result it often results in patients being on MMT for many years or even their whole lives.

I'm 95% certain i am the someone that drug_mentor is referring to. And i just want to confirm that it is most DEFINITELY possible to get on methadone without having been addicted to opiates AT ALL. Hell i'm very baby faced and do not look rough and like your stereotypical drug user at all. I didn't even have one needle mark on my body, yet i was masquerading as an IV heroin addict.

How did i do this? Went to a normal GP, told him my bullshit story, instantly got prescribed a heap of oc80s because the detox was full for another fortnight. Spent that fortnight high out of my mind on this oxycodone. Then i went into the detox, 8 days later i came out on 30mg of bupe. Few weeks later i claimed it wasn't working for me and i was changed onto methadone. Over not even that long of a time frame i pushed my dose up and up, 140mg being my peak. I indeed did need to get a special approval to go over 120mg.

So i just want to confirm that it IS indeed possible to be a non addict, to have no needle marks, to have a clean look about yourself to have a babyface, and still be able to bullshit your way onto 140mg of methadone.

However i cannot stress how bad of an idea this is, i'm at 45mg today, getting myself off this stuff. A huge mistake and something i regret obviously. Just in case anyone is wondering, it started off awesome, but within a couple months of being on OMT i was getting zero recreational effects from the stuff. It got to the point where i could iv over 350mg of methadone and not catch any buzz at all. So nobody is getting high on OMT, even if you never had an addiction and bullshit your way onto it like i did..

By the way i was 22 when i did this, however i look about 19.

If heroin maintenance was implemented there would certainly have to be more effort put into proving addicts actually are addicts.
 
Why do you think heroin would be better for maintenance than the other options? I don't have enough experience with methadone or bupe to know about their side-effects, downsides or reasons why they don't work for some people, and the benefits heroin may have over them.

I support heroin maintenance, I just don't know enough about it to know its benefits over other treatments. Just from my fairly clueless position I would've thought heroin might've been more difficult to maintain on becuase of its short half life. Surely you'd have to have multiple doses a day? That seems like it could tie people even more so to a clinic, unless clinics were more lenient with take home doses. I just simply can't understand why or how you could have a serious opiate addiction except perhaps ppl who are scripted pain meds mainly oxy I suppose who then just start taking higher doses how you could not I.V. ? or perhaps users who have lost all their veins just seems so strange to me.
 
I read and posted in the other thread about general opioid maintenance before I saw this thread, and I mentioned that I supported the use of heroin for maintenance in that thread, and my reasons for it. The basic summary of my post from there is that people will get high if they want to, so they should be allowed to do so using their DOC, instead of having to take dangerous combos with their methadone in order to get some sort of high from their dose, or pick up a coke, speed, alcohol, or benzo habit if they gave up on trying to get high off the methadone.

I don't think that allowing diacetylmorphine maintenance would result in anymore "lifers" on the program compared to the amount of them on methadone, but even if it did at least they wouldn't have to deal with the negative side effects of methadone, as well as the dangers that are unique to methadone. Also since heroin is easier to detox off compared to methadone, you could argue that there would be less people staying on it for life. People get sick of getting high after a while, so that's why I don't think that everybody on heroin maintenance would be on it for life. As for how to transition from IV heroin maintenance to getting clean, I agree that the ritual needs to be broken. I think that a good way to go about this would be to substitute IV doses of heroin with doses of oral morphine, or oxycodone (whatever opiate/opioid the user prefers) until they are completely switched over to oral consumption, and can then taper off that way. So if they are initially given 2 IV doses of heroin each day for maintenance, then the second shot should be substituted with an oral opiate dose, and this would continue to be done more and more frequently until the user if completely switched over to oral use, at which time they can taper off while also breaking their dependence to the needle.

I noticed someone mentioned the use of heroin for maintenance in the UK, and its advantages over methadone there. For those of you interested, here is a thread on this topic, written by a BLer that is one of the few patients in the UK diacetylmorphine maintenance program.
 
I raised this point earlier, but does anyone with a bit more pharmacology knowledge know if it's possible to extend the duration of the usual XR formula pills (MSContin etc) beyond the 12 hour duration? I would think with a larger tablet, it would take longer to digest thus leading to a longer duration, but I could be totally off the mark on how the XR mechanism works there.

What I'm getting at is would it be possible to only dose them with one large XR dose of morphine (or oxycodone, perhaps, or similar) in place of twice-daily injections, since sadly there are no opiates that are both euphoric and long lasting, that I know of.
 
^ opium? pods/laudanum etc have a long half-life and a nice effect.

the problem with XR preparations is that people always try to defeat the mechanism, potentially creating more harm when they grind, cook up and shoot pills with a polymer matrix or whatever.
 
^ opium? pods/laudanum etc have a long half-life and a nice effect.

the problem with XR preparations is that people always try to defeat the mechanism, potentially creating more harm when they grind, cook up and shoot pills with a polymer matrix or whatever.

Well we're talking about supervised daily administration here.
 
yeah, people still shoot bupe and methadone though.
there's not really an easy answer to this question, but as i said earlier, the short half-life could have advantages in some situations, for a quicker detox for example.
 
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