Streams

Assessing the Heroin Epidemic

Monday, July 07, 2014

Lawmakers and the media are reacting strongly to the recent heroin "epidemic" -- but do the numbers bear out that claim? And, more importantly, is the reaction to the rise in heroin a viable solution? Journalist Michael Tracey recently wrote about it for Al-Jazeera. Plus: Howard Josepher, President & CEO of Exponents, discusses the history of heroin epidemics and the various alternative treatments to the addiction at the personal and policy levels.

Guests:

Howard Josepher and Michael Tracey

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Comments [33]

gene from NYC

Yes, I know, poor child, I know. It's all a big bad government conspiracy, isn't it?

So: now we can see it's the "Whatever happened to personal responsibility??" crowd's rigid mantra that's driving your gross misrepresentations of the science of addiction. I knew something had to be up, but thanks for finally making that clear. Readers may now make informed evaluations of your postings.

For most of our reasonably intelligent WNYC listeners, however, I suspect it's your facility with gratuitous insult that brands you as a partisan ideologue as much as your facility with, oh yes, bilge.

Anyway, you're exposed. I'm done. It's just a p-ing match now.

And you obviously have a lot of Kool-Aid to void.

Jul. 09 2014 11:13 PM
Mr. Bad from NYC

Also, for anyone who doesn't know the "NIH" studies referred to by Gene are not, strictly speaking, pure "NIH" studies, they are NIDA, a branch of NIH whose bias towards public policy is not only obvious but SELF ADMITTED. NIDA stands for "National Institutes On Drug Abuse". For instance:

""As the National Institute on Drug Abuse, our focus is primarily on the negative consequences of marijuana use," a spokesperson told the New York Times in 2010. "We generally do not fund research focused on the potential beneficial medical effects of marijuana."Generally, as in almost never."

http://www.dailykos.com/story/2013/04/06/1198688/-What-NIDA-Means-for-Marijuana-Research

Everyone in the scientific community knows NIDA exists to find evidence, ANY scientific evidence no matter how slim or suspect, to support the public policy prescriptions of it's political masters and the notion that addiction is a "disease" is one of the most important public policy positions advanced by the political establishment as it allows for flexibility in the management of the "drug problem". I won't go into the merit of that view except to say that to me bad science is bad science and fraud is fraud. NIDA science is biased and policy driven. Enough said.

Jul. 08 2014 07:46 AM
Mr. Bad from NYC

Whoops, pasted wrong link:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3314045/

Is this JUST more "bilge" or are you going to use your middle school level science understanding to refute this guy? Gene. Just stop Gene. It's time to stop posting...and stop preying on people. You sound like nothing if not a predatory rehab shill like the ones I wrote about several posts ago.

http://f.kulfoto.com/pic/0001/0015/47t2114508.jpg

Jul. 08 2014 07:22 AM
Mr. Bad from NYC

@ gene from NYC

Uh, yeah Gene, the NIH is a completely unbiased observer of the ongoing debate and has NO interest in supporting a public policy position or preferring a scientific view supported by it's foremost sponsor and underwriter the US gubment... but listen Pal: You're not that bright, anyone can see that, so here is a more RECENT article (2012) from the NCBI (a branch of your favorite policy group the NIH but more importantly the branch that actually deals with biomedicine and gene research) that explains in plain, relatively simple terms why addiction is not a disease:

"Addiction does not meet the criteria specified for a core disease entity, namely the presence of a primary measurable deviation from physiologic or anatomical norm. Addiction is self-acquired and is not transmissible, contagious, autoimmune, hereditary, degenerative or traumatic. Treatment consists of little more than stopping a given behaviour. True diseases worsen if left untreated. A patient with cancer is not cured if locked in a cell, whereas an alcoholic is automatically cured. No access to alcohol means no alcoholism. A person with schizophrenia will not remit if secluded. Sepsis will spread and Parkinson disease will worsen if left untreated. Criminal courts do not hand down verdicts of “not guilty by virtue of mental illness” to drunk drivers who kill pedestrians.

At best, addiction is a maladaptive response to an underlying condition, such as depression or a nonspecific inability to cope with the world."

http://www.wnyc.org/story/assesing-heroin-epidemic/#commentlist

Read Gene Heyman's (2009) book whydoncha? You might learn something, probably by accident cokie... stay sharp.

http://www.macleans.ca/society/health/addiction-new-research-suggests-its-a-choice/

P.S.

Please stop using the word "bilge" in every post... it's ponderous man, freakin' ponderous.

Jul. 08 2014 07:14 AM
gene from NYC

Talk about a troll--

You "provided a link"--a link to what? A 22-year old op-ed by a notorious gadfly anti-addiction crusader, plastered on some blog site (the oh-so reputable "LifeProcessProgram.com")?

And you have the gall to pretend to WNYC listeners that this represents the science on the subject??

Back in the real world, all anyone interested in the science of genes and addiction has to do is go to the NIH site. There they can see the latest research--they don't have to go back 20 years--from regular, normal scientific sources. Look, Ma! No blogs!

You want links? Just one example, this one on alcoholism. http://www.niaaa.nih.gov/search/node/genetic%20addiction.

Oh hell, they can just use google. It's established science. They'll find hardly anything on your little theory that addiction is a "chosen lifestyle." Sheesh.

Hell, have all the theories and pet peeves you want, I don't care. But be honest about it. It's your spouting bilge while pretending it's science that's despicable. We've got way too much of that already in this world.

Jul. 08 2014 05:31 AM
Mr. Bad from NYC

Also, just to be clear since you apparently don't catch onto nuanced arguments I wasn't arguing, ever, that a phenomenon like "addiction", as scientifically nebulous as it is, doesn't exist.

In the sense that the word describes a condition where a person becomes habituated and physically and/or psychologically dependent on a substance it is as good a term as any other. My point was and continues to be that "addiction" is not in and of itself a disease but a chosen lifestyle.

Jul. 07 2014 09:12 PM
Mr. Bad from NYC

You sure take a long time to not say anything but thanks for the source free, incoherent, and poorly argued rant ... I mean what does "mechanisms of addiction, including the actions of target receptors in the presence of addictive elements" mean, if anything? It sounds like a 5th grader trying to describe the function of the chemical synapse between neurons for a science project...do you REALLY think you know what you're talking about or are you just trolling me? It's gobbledygook, word gumbo, an argument from of pure bluster made in ignorance not only of scientific facts but findings too. At least I referenced some experts and provided a link. Where are yours? And which is it, my friend, a "pet drum" or "tin drum" or I dunno what... do you even know what expression your trying to use? Give your coke addled brain a rest and spare me another red herring laden monologue OK buddy?

Jul. 07 2014 08:56 PM
gene from NYC

Mr. Bad:

Wow. I know gross scientific misrepresentation is all the rage these days, but your arrant, deliberate bilge is pretty shocking anyway.

You can beat your little tin drum all you want, cherry-pick to your heart's content, but the fact remains, science in general accepts the broad terms of addiction as well as some genetic factors, and in fact has investigated and documented mechanisms of addiction, including the actions of target receptors in the presence of addictive elements. For many people, including me, the established, normal science of addiction is well-confirmed by personal experience and common, everyday observation.

I know that addiction research has been developing since at least the 30s. It did hit a snag in the 50s-60s, when the tobacco industry, for obvious reasons, propagated the idea of "habituation" instead. Your pronunciamentos seem to build on this tradition.

Today, there are other industries--and several social ideologies--that I can think of that would benefit from a de-emphasis on the science of addiction, and indeed, their blustery propaganda can and does flower on internet bulletin boards.

Normal science accepts that fact that there is much, much more to learn about the interplay between addiction, genetics, and other--yes, including social--factors.

I do note how ideologues always pretend to know everything, and that may impress some targets; but thankfully, in the world of actual science such pitiful attempts to reframe and redefine the issue of serious addiction carry little weight.

Jul. 07 2014 05:57 PM
Howard Josepher from New York City

To the mother who called in about her addicted soon; obviously your son is incapable of staying off of opiates wondered if you looked into medically assisted treatments like methadone or buprenorphine? There are also treatment programs that will work with someone without requiring them to be abstinent. Changes can be made without a person having to hit a bottom. The important thing is for your son to be engaged in some kind of supportive process that is not demanding he do something he is incapable of doing. Programs like this are hard to find as 90 of drug treatment programs offer only abstinence as a way out. That may be a goal but it doesn't have to be the starting point.

Jul. 07 2014 05:08 PM
Mr. Bad from NYC

@ gene from NYC

Again, thanks for illustrating my point better than I ever could though I'm pretty sure you have no idea what "biology" or "DNA" is or you wouldn't suggest something so inane as what you wrote. Your personal anecdotes do not constitute scientific evidence (nor do my own) but at least mine our supported by the latest science. Human beings share 99.9% identical DNA and though certain expressions of interacting Allele's MAY result in a genetic predisposition to certain traits (like being susceptible to getting drunk faster) there is NO EVIDENCE for any "addiction" Allele combination, or support for the entirely made up idea of "addiction" anywhere in science. "Addiction" is a social/legal construct not a defensible scientific phenomenon. Habit and psychological/physical dependence are not a "disease".

"Popular books that insist that alcoholism is purely a “genetic disease” appeal to an understandable desire we all may feel for simple answers about painful subjects, but they do not have a sound scientific foundation. Those who actually do research on the genetic inheritance of alcoholism speak far more cautiously, often downplaying the inheritance of alcoholism:
Robert Cloninger: psychiatrist and genetic researcher, Washington University: “The demonstration of the critical importance of sociocultural influences in most alcoholics suggests that major changes in social attitudes about drinking styles can change dramatically the prevalence of alcohol abuse regardless of genetic predisposition.”[39]
George Vaillant: psychiatrist and alcoholism researcher (paraphrased in Time): “Vaillant thinks that finding a genetic marker for alcoholism would be as unlikely as finding one for basketball playing. . . . The high number of children of alcoholics who become addicted, Vaillant believes, is due less to biological factors than to poor role models.”[40]
David Lester, a leading biological researcher at the Rutgers Center of Alcohol Studies, after reviewing several surveys of genetic research on alcoholism, concluded “that genetic involvement in the etiology of alcoholism, however structured, is weak at best.”[41]"

http://lifeprocessprogram.com/the-truth-about-addiction-and-recovery-are-people-born-alcoholics

Jul. 07 2014 03:26 PM
Peg

@Steve - I wasn't saying that insulin use "markedly interferes with the users ability to function." In fact it's use allows the diabetic the ability to function and that not using interferes with ability to function. As I have observed friends and family who have an opiate 'addiction' (for whatever reason - chronic pain or physiological addictive propensity) the lack of the opiate greatly impares the individual's ability to function and they are able to function when they are taking the drug. There are plenty of people who use opiates who are working along side of all of us. Many physicians use opiates and function. What seems to happen over and over is that those with a need for the drug will seek it out so they will appear 'normal' - so that they will be able to function. When doctors began to stop prescribing these drugs, those in 'need' turned to the streets.

I think we need the medical system to work with opiate users instead of labelling them as abusive outcasts. And suggestions to use methadone or suboxone to break the 'habit' are really just substituting one very addicitve drug for another as both of these treatments are very addictive also.

Jul. 07 2014 01:30 PM
gene from NYC

Mr. Bad:

Nonsense. You're just beating your own pet drum for some reason. Of course one's societal circumstance has an effect. Doesn't mean addiction doesn't exist.

I could do and did do LOTS of drugs. I could do cocaine till the cows came home, with no problem. Other poor souls wound up with perforated septums. I'd heard cocaine was addictive, but for me and my DNA--it clearly wasn't. I'd heard heroin was addictive, and boom! I sure felt the biological pull.

The addiction that snuck up on me was nicotine. Now THAT was hell to break.

Jul. 07 2014 12:06 PM
Mr. Bad from NYC

The elephant in the room is death or more specifically a terrible fate. Nobody wants to admit to themselves that some people, owing to circumstances beyond their control, suffer and have no hope because THAT would imply that that same fate might befall them too... which is terrifying. People take a look at a drug user and they want to pity their "disease" (which they by they grace of god don't have, of course) or blame them for their plight. Both views put a lot of distance between the hard truth that life, even in a developed society, can be just as capriciously cruel as one lived in the state of nature and that we are all more than happy to ignore human suffering and get on with our lives. Into this vacuum steps the "Drug Rehab" charlatans and their disease model who run a fantastically profitable business NOT curing a mythical disease... it's all pretty tragic actually.

Jul. 07 2014 11:48 AM
Steve

I was surprised that one of your guests said that people use heroin to treat pain and anxiety. There may be some people who start using these drugs for these reasons but addiction is a very different thing. We know from studies of Vietnam War vets that only a small percentage of those who used heroin when they were in Vietnam became addicted to it or even used it again once they came home. Generally those who are addicted to any drugs who give reasons why, apart from their addictions, they use the drugs are making excuses as to why they do so.

As to Peg's comment. There was a time in the U.S. into the first decade of the 20th century when heroin, morphine, and cocaine were readily available without legal sanctions. Addiction was still a major problem; that's why law restricting their use were instituted. And as to those diabetics using insulin, addiction requires that the drug use markedly interferes with the users ability to function. Does she really believe that insulin interferes with diabetics' ability to function?

Jul. 07 2014 11:44 AM
Mr. Bad from NYC

@ gene from NYC

I think you just illustrated my point, perfectly. People who don't want to destroy their lives with drugs/booze... don't. If you have/had so little self control that more than a single hit of smack would derail your life you made the choice most people would make i.e. to no do it again. Some of us can and did/do party without completely derailing their lives or ever letting it destroy what is truly important to them. It's just for fun. I think that most people who destroy themselves and others with drugs/booze are people in need of help, people who typically have horrible families, histories of sexual abuse (very common) or dark traumatic episodes in their lives but they do NOT have a "disease", they have a messed up life for which, unfortunately, there is no cure. They self treat with drugs and maybe they're entitled to IMO. When "cleaning up" means returning to a loveless life of aimless drudgery, sadness, bad memories and a hopeless future is it really surprising that some people choose to chase a high until it kills them or puts them in jail? It doesn't take a "disease" to explain it...

Jul. 07 2014 11:38 AM

All these harms are a result of prohibition.
If opiates were available without prescription from a drug store, the price of opium and heroin would be less than for alcohol.
Few people rob to support a booze habit.
Before the first opium ban, addicts could & did support a normal or even successful lifestyle.
Just end the war on drugs. Make it all legal.

Jul. 07 2014 11:27 AM
gene from NYC

I tried heroin once. And it was so thrillingly _good_, that I remember thinking,

"O.M.G., I'd better never, ever do this again in my entire life. Because if I do--then that's all my life will be about."

I've been there (or almost), and those who dismiss the very concept of addiction are full of it, imo.

Jul. 07 2014 11:13 AM
Truth & Beauty from Brooklyn

I disagree with your guest's assessment of why young people use drugs. Most of them start as a means of rebellion against parental and school authority and/or just to get high. Some of them try heroin or other opiates once, don't like the effects and don't use again. Some are genetically prone to habituation to opiates and have a great deal of difficulty stopping use after the first two or three times. Only the rare teenager begins using because s/he is in emotional or psychic pain, although some may continue for that reason.

The people who have the most difficulty stopping their use of opiates and any other physiologically habituating substance (meth, alcohol, etc.) are generally those with this genetic predisposition toward habituation. As with any drug or medication, effects differ among different individuals, and whether a person is going to be able to kick this habit is based on physiological and psychological factors.

To the mother who called in about her son: He may be a criminal due to activities he engaged in in an attempt to purchase illegal drugs to satisfy his habit, but I'm certain that if he ever gets the treatment he needs - possibly methadone, at this point - he may have a chance to revert back to his pre-drug-use self. He'll require therapy and monitoring for most of the rest of his life, but there is an opportunity to rehabilitate him, if you want to pursue it. You, however, must go to support groups, as well, to learn how not to inadvertently enable his drug use, but only to support his ongoing treatment and re-integration into society.

Jul. 07 2014 11:10 AM
fuva from harlemworld

@its_me23 from NJ: Word. As usual.

Jul. 07 2014 11:03 AM
Mr. Bad from NYC

There is no "addiction" disease, it's not defensible in any logical way and there is no scientific basis for the disease model. Full stop.

http://lifeprocessprogram.com/the-truth-about-addiction-and-recovery-why-it-doesnt-make-sense-to-call-addiction-a-disease/

Jul. 07 2014 11:01 AM
Peg

About the mother whose son has been through all sorts of treatment programs and is still needing to support his habit by doing terrible things. How about having a doctor prescribe what he needs for his chronic health issue rather than having him turn to the street?

Doesn't Switzerland have a program to supply herion to addicts so that they are capable of holding jobs and becoming contributing members of society?

Jul. 07 2014 10:58 AM
john from office

The sellers of these poisons are the problem. They have no souls.

Jul. 07 2014 10:57 AM
David from the North East Bronx from Bronx

To the self-medicating caller, your self-medication is putting billons of dollars in the pockets of the Taliban and other violent terrorist/gangs around the world who are responsible fro destroying the lives of millions

Jul. 07 2014 10:53 AM
Mr. Bad from NYC

@ msmith from south bronx

Exactly. This is just another way to crank up the "Drug War" $$$ machine for law enforcement now that it's obvious weed is going to be effectively decriminalized nation wide with the next decade even if it never becomes fully "legal" in every state. The kids in Jersey are using recreational amounts and in that fashion, everyone knows it's possible to use all weekend and still get up for work/school, we used to do it all the time. Self destructive people will find a drug and use it to destroy themselves, that is what they seek, "addiction" does not take over anyone's life, it simply describes a chosen lifestyle, the disease model is and always has been bullsh*t.

Jul. 07 2014 10:50 AM
Peg

Are diabetics addicted to insulin? Are hypothyroid persons addicted to synthroid? If we stop calling opioid users addicts, just call them patients with pain issues and allow doctors to prescribe to them, won't their health outcomes be better?

Jul. 07 2014 10:49 AM
jc

Oh goody - let's step up the "war on drugs". An oldie but a goodie come election time.

Jul. 07 2014 10:48 AM
Nick from Manahattan

I really wish these conversations would include a discussion about ibogaine treatment and how beneficial it can be vs. methadone.

Jul. 07 2014 10:48 AM
its_me23 from NJ

Heroin reached suburbs, and politicians react....

Jul. 07 2014 10:45 AM
Mary Janey from New Jersey

Thank you Governor, for informing me that high-quality heroin can be had for $10 a bag. Marijuana, non-addictive, medically beneficial marijuana, is 5X that cost but keep twisting yourself into knots to keep that illegal for responsible adults. And quit acting like you've never tried it. You're a child of privilege who was married to a Kennedy. That's some serious partying creds right there.

Jul. 07 2014 10:43 AM
msmith from south bronx

ask any user. it is not stronger, it is not cheaper their stats are bogus

Jul. 07 2014 10:40 AM

And how many tax dollars are chasing the cannabis market instead of heroin?

Jul. 07 2014 10:40 AM
Larry from Brooklyn

I do sense that there is a little hysteria which can, I think, undermine the seriousness of the problem (which is real). Case in point: neuroscientists will tell you that there is no such thing as a drug that is "instantly addictive." This kind of hyperbole has been used by politicians in the past when it comes to drug use.

Jul. 07 2014 10:40 AM
Sheldon from Brooklyn

It's refreshing that the powers that be - finally acknowledging that this problem is about addiction.

However, I wonder if this "epidemic" was predominantly in Bed Stuy or Harlem, as opposed to Staten Island, Upstate, or Long Island; would politicians, law enforcement, and the media have been as sympathetic.

Jul. 07 2014 10:37 AM

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