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Safe injection sites in San Francisco could be first in the US

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Re: Safe injection sites in San Francisco could be first in the US

#101
post #77
post #7

Earlier quoted context omitted.

Sources for this would be very helpful. Always interested in alternative viewpoints!

Sources are very hidden : first result page on google (I'm talking for french people) http://www.bfmtv.com/police-justice/paris-emotion-apres-la-m... http://www.leparisien.fr/paris-75010/paris-le-cri-d-alarme-d... https://www.google.fr/search?q=riverains+salle+de+shoot&sour... to sum up : the neighbours are very unhappy about it. The area was already largely insecure, though (heaven of crack-heads). I don't think the…

I recommend the rue de Maubeuge. It's just miserable, always a few crackheads hanging around and dealing or whatever. In one article [0], I read that the police deliberately don't act there. The videosurveillance is broken atm anyways.

Maybe the nurses and the psychological aid they can freely ask for in the shooting room will save these poor souls so we don't need the police to intervene. But I go by everyday and there's no diminution.

[0] https://www.streetpress.com/sujet/1463153023-drogue-paris-cr...

Re: Safe injection sites in San Francisco could be first in the US

#102

Earlier quoted context omitted.

The point of medical heroin, or other harm reduction programs, is to allow people to get on with their actual life without the all consuming addiction being front and centre all the time. I'm currently on a methadone program in the UK (there aren't any heroin based programmes as far as I know here) and it lets me keep up my job as a software engineer without daily worries about having to make sure I can score and not…

I'm curious to hear about your program. Is the goal to get you clean? Slowly wean you off heroin?

Like 'skellera says in the sibling comment, heroin is an incredible time-sink. The methadone programme I am on (provided free by the UK NHS) is something that will let me gradually reduce the amount of heroin I'm taking, and eventually yes, get clean. After a couple on months in, I'm down to ~25% of what I was taking daily before, and that should reduce further to zero over time.

A methadone maintenance program will gradually increase the amount of methadone prescribed, while the user reduces the amount of heroin they take, until the user is 'stable' and no longer using heroin. After that I certainly would like to then stop taking methadone too, but in some cases the maintenance can continue indefinitely and it would still be considered a net positive outcome...

Re: Safe injection sites in San Francisco could be first in the US

#103

Earlier quoted context omitted.

Indeed, it's entirely possible for people to take heroin at the weekends or similar, and put it down without problems, and I know several friends who do it irregularly without getting addicted - although only smoking, I've never heard of anyone injecting IV heroin who wasn't an addict...

Injections are apparently much more potent than smoking, so it makes sense that people already addicted prefer that to keep the required amount lower. For recreational uses, smoking would just be much more practical.

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.

Re: Safe injection sites in San Francisco could be first in the US

#104
post #5

Here in Vancouver the safe injection sites have saved countless lives and drastically lowered needle sharing. There's a big misconception that safe injection sites somehow promote drug use. They save lives and give people a legitimate pathway to get clean if they choose to. Do the right thing, SF!

It might be a hard sell to use Vancouver as a model. It has an area which is perhaps the most public display of social decay I've ever encounted in a first-world city, principally from drug abuse.

SF's Tenderloin is the same though. If anything it seems worse.

Re: Safe injection sites in San Francisco could be first in the US

#105

Earlier quoted context omitted.

Injections are apparently much more potent than smoking, so it makes sense that people already addicted prefer that to keep the required amount lower. For recreational uses, smoking would just be much more practical.

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.

I’d like to take the opportunity and thank you for posting here. It’s hard enough to find reports of people that are going through a withdrawal, so being able to engage in a discussion is a rare opportunity. I wish you all the best in that process.

Re: Safe injection sites in San Francisco could be first in the US

#106
post #71

Earlier quoted context omitted.

The death grip of heroin is mostly unrelated to the actual medical properties of heroin (or most opioids). The worst health effects come from the impurities in the substance (Strychnine, a common additive, is generally speaking not a substance beneficial to your health), the conditions under which it's used (shared needles, lack of hygiene) and the treadmill of having to organize funds for the next shot. Medically sp…

Heroin wasn't historically a problem because the users died. Heroin's been a problem because of just how far people will go to get it, and how a massive amount of people will drop everything else in life just to get a steady supply of it. Opiates are the most addictive substances in the world. Once someone gets a taste of it, their life is forever changed. People can smoke a cigarette a couple times and decide it's n…

Only about 10% of people who try heroin go on to become addicted.

The first few tries just aren't pleasant.

Cocaine or methamphetamine are probably more psychologically addictive, although not as physically addictive.

And, for addicts, coming off heroin is unlikely to kill you. Coming off alcohol might.

Re: Safe injection sites in San Francisco could be first in the US

#107

Earlier quoted context omitted.

Make everything legal to obtain or manufacture with a license attainable though education and certification – something in between what it takes to get a driver's license and an AA degree. If you want to buy heroin you have to understand it's addictive qualities, how human biology is affected, and how to recognize the negative consequences. Attach liability to the licensee for anything purchased that resulted in harm…

Education will not stop people from getting caught in the death grip of heroin. Just as education does not stop people from smoking cigarettes today. And once an addict is born, as they say, that person will struggle with addiction for the rest of their lives even if they manage to abstain. I'm all for legalization of marijuana, but legalization of heroin is a very poor idea. Heroin must be kept out of the hands of t…

Like others have said, folks won't actually stop using the stuff. Keep it illegal and folks have a higher chance of getting bad stuff, not injecting cleanly or properly, and increases overdose deaths.

At least with legalization, you get some science based education before you even try it the first time. For most folks, this is way before they start to inject. You can more easily have physicians and/or pharmacists having frank talks with patients about signs of addiction and have science-based plans to help folks wean off of the prescription drugs. You can have injections done by a trained professional, who calculates your dosage. You can make sure it is the strength on the package. You can be referred to a clinic for addiction.

Maybe we can even use some of that money we saved on incarceration to let folks rest at home after injury/surgery without losing their house or their job so that we use less pain medication and reduce risk. We can offer medicine-based addiction services as well instead of AA and NA being the standard treatments.

And sure, it won't stop everyone, just like cigarettes. But no one currently starts cigarettes thinking they are completely safe - I surely didn't and I started 20 years ago, though I'm down to 3-4 a day now. We can also not use as many of the scare tactics we use today and be honest about the positive effects folks get from this stuff along with the bad. For some, we might have better alternatives (different ways for coping with boredom and stress might help with things like boredom, which is what actually got me to start around 18).

And just to state things: I don't know how it is with heroin addiction, but not all addicts for other drugs are alike. Not everyone is an addict for life. Some folks can be alcoholics but then be completely able to drink casually like everyone else, without re-developing a problem. Others cannot, and I think we do a great disservice to people when we lump them together like this.

Re: Safe injection sites in San Francisco could be first in the US

#108

Earlier quoted context omitted.

Make everything legal to obtain or manufacture with a license attainable though education and certification – something in between what it takes to get a driver's license and an AA degree. If you want to buy heroin you have to understand it's addictive qualities, how human biology is affected, and how to recognize the negative consequences. Attach liability to the licensee for anything purchased that resulted in harm…

Would have loved for this to work, but there might be a few problems. 1. Some people might pass the test and sell it to others who didn't. 2. I'm not sure how education helps here. Everyone who takes heroin/cocaine knows how bad it is. I think people actually think it's much worse than it is. After taking a "health" class in high school, my friends and I said "wow, I thought drugs are much worse". For example, they s…

1. So, it'd be like alcohol and tobacco, then? At least the product they are selling will have standards of purity and things like that.

2. Education that doesn't involve scare tactics provides things like proper expectations, safety on dosage, and things like that. MOst drug education in the US has scare tactics - like your reference to cocaine. Most healthy folks can do a little bit every once in a while and have few to no side effects. Same for MDMA, but folks should know that taking it too frequently can mess you and that you'll not be sober for a while. Folks get morphine and medical-grade heroin for pain without becoming instant addicts, so obviously it is safe in some situations. We can teach folks what to expect from pot edibles, mushrooms, and LSD. We can teach folks how to keep safe while doing a drug - how long before you should consider yourself no longer impaired, for example. Warning signs to seek medical attention are important to learn. Legalisation means folks aren't as likely to lie about it to cops and doctors.

Re: Safe injection sites in San Francisco could be first in the US

#109
post #13

In days gone by, heroin addicts knew how much heroin they needed to 'stay well'. A major factor in the escalation of deaths in the modern era is the contamination of the street pharmacy's heroin supply with more potent synthetic opioids (fentanyl, etc). Overdoses happen when street drugs are more potent than the user expects, or when the user's tolerance has changed. Two factors in my girlfriend's OD were having been…

> Until the politicians find courage to acknowledge that it was a mistake to trust organized crime to control the supply of addictive substances, [...] What would be a better solution in your opinion? Legalizing it, or allowing it with prescription? I see some problems with those alternatives as well; there's probably no magic bullet here.

There is a solution to the drug problem that is clear, simple, and wrong. As you put it, there is no magic bullet. However I hope we can all agree that the current war on drugs isn't working. We've been fighting it since (before) 1971, and prohibition isn't working. People are dying, and have been for decades.

Just like we admit that 100% uptime is impossible, and admit that there's no solution that will make that possible, we instead work to minimize 500s to an often respectable number of nine's. Similarly, there is just no solution to the evils of addiction.

What we can practice, however, is harm reduction, and injection sites have been one method that has been in use in Europe for decades.

Can we agree that the drug war is a failure, and work on supporting harm reduction techniques?

Re: Safe injection sites in San Francisco could be first in the US

#110
post #50
post #13

In days gone by, heroin addicts knew how much heroin they needed to 'stay well'. A major factor in the escalation of deaths in the modern era is the contamination of the street pharmacy's heroin supply with more potent synthetic opioids (fentanyl, etc). Overdoses happen when street drugs are more potent than the user expects, or when the user's tolerance has changed. Two factors in my girlfriend's OD were having been…

Not really entirely true. I was an IV drug user before the fentanyl analogs started being pumped out of China and "hot shots" were always a thing.

Thanks for commenting - as always, the devil is in the details.

Would any IV drug user risk getting a 'hot shot' if they had access to a supply of known potency?

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