[robbiep]

As someone in the medical field, this article does a very good up job of restoring the balance and correcting some preconceptions regarding substance dependence and addiction - ie. that not all substances are going to lead to lifelong dependence and addiction, and in fact it only occurs to a small percentage. This is established medical fact and is taught in all medical schools now. However I worry that it might make people consider heroin as something that will be okay to have a crack at... There are very real psychosocial dangers of heroin should you end up being dependent and addicted - and the depths of despair that users end up in should not be ignored. No-one can predict ahead of time if you will be okay on it, or if you will follow the stereotypical pattern with which we are familiar with from popular culture.

The article also fails to mention that once addicted, and then having returned their lives to some base level where they are able to seek help (assuming they have not died of an overdose), 90% of patients that start on the methadone program are still on it 10 years later- in Australia the methadone program grows at about 4-6% per year, representing new people coming on and no-one really leaving. Not cool, and not a good lifestyle!

[shousper]

This is really good to hear from someone in the field, thank you.

Those numbers for the methadone program could be purely from population growth, but then considering the state of the world its probably not entirely either. (Not that I'd know)

[robbiep]

yes you are right about the population growth, I thought this too - but think of it like a school year or something like that (i.e. there are, in most industrialised countries, pretty much the same number of people going into a year of school as the year before - we have a rectangular (as opposed to pyramidal) population tree. Most people experiment with drugs in the same age groups, and In australia over the last 15 years heroin use has been falling (although slight bump last year or 2) - thus the 'cohort' or number of people trying heroin is not increasing, certainly not at the rate of population growth. cheers!

[refurb]

A couple comments:

1. Is chronic methadone usage really that bad? It's never great to be dependent on a substance to function, but if all it takes is a trip to the methadone clinic for your daily dose, but the rest of your life is relatively normal, is that so bad considering the alternative?

2. I've heard methadone withdrawal is much worse than withdrawal from heroin. Heroin WD symptoms are very intense, but last about a week. Methadone WD symptoms aren't that intense, but they last for months. It take an impressive amount of willpower to put up with being tired, weak and "sick" for months.

[robbiep]

Chronic methadone usage has a number of problems associated with it, the ones I am most familiar with (From my experience working with D&A specialists) is poor teeth - easily chipped and broken, cavities etc (? related to bone mineral density changes? I am not entirely sure) as well as the significant hassle of going to a methadone clinic and having to deal with the social crowd and second hand drug market that usually exists just outside a hospital dispensary (In aust many pharmacies don't dispense methadone because of the crowd they think it attracts, and those that do charge for it, which can be a couple hundred a week, vs. free from a govt-provided system) However I did meet some people during my time at the methadone clinic that had what you are saying - a steady job, etc - but if you have a job and have to be at a clinic every day, which opens only from 8-1, and only serves 1 at a time, you better have an understanding boss...

with regard to 2, I don't know about methadone withdrawal being worse than heroin; worse here is perhaps relative; you are exactly spot-on regarding the aspects of both of them in terms of length - heroin withdrawal only lasts around a week, and incredibly you can't die from it, although it may feel like you will! - as an aside, the only drug you can withdraw from that can kill you is Alcohol (Delirium Tremens causing convulsions and death)

-- EDIT -- This image http://img546.imageshack.us/img546/9791/422a.jpg shows the biochemical effect of opiate withdrawal. This image shows enzyme activity levels in a specific part of the brain associated with perception of pain - Pain relief is correlated with the initial decrease in cAMP formation. However within a short period AC increases leading to cAMP returning to normal levels, and thus the return of pain; amplified by sudden withdrawal of the opiate - now AC acts uninhibited, there is a massive increase in cAMP and thus the 'pain' of withdrawal is experienced as physical pain, as real as being cut open

[andrewfelix]

Russell Brandt has an interesting take http://www.guardian.co.uk/culture/2012/aug/12/russell-brand-...

[pkulak]

I just listened to this, which made it sound like there's something out there substantially better than methadone:

http://www.npr.org/blogs/money/2012/07/31/157665908/episode-...