I know my own problems, way back when, really got going at around the 5 year mark, and turned from weekend fun to every day need. If I hadn't have met my partner who helped pull me out I'm not sure where I would be right now. Knowing what I know from personal experience, this book seems reckless to me.

Imagine being in the nursing home with the heroin addict who thinks he has everything under control.

Everything is about risk. Bad shit happens in life and people have to deal with it. Bad shit can happen unexpectedly. And it’s difficult to know how it will feel when it happens. Look at how many people will “hit the bottle” because someone dies. Or a relationship ends. Imagine if that becomes something 100x more risky.

We see all the disastrous effects from legal drugs and now he wants to add more to the mix.

The difficulty in obtaining drugs reduces their use. That is the bottom line. Everyone wants to argue against it but it’s the clear reality.

This guy just lives in a bubble.

While I am now pro-decriminalization, I don't believe marijuana is as harmless as its proponents contend, mostly because I detect the same signature addiction rationalizations and defense mechanisms in the discussions and messages.

But I guess I am pro-decriminalization primarily due to me wanting to alleviate the economic basis of smuggling destroying the cultural vitality of Mexico, Central America, and Latin America, converting them into zombie narco states.

I still believe decriminalization will vastly increase use/abuse of drugs (the most heavily used ones are the legal ones) and treat our own people and problems.

But truly addressing that would be addressing the depression, loneliness, and lack of fulfillment the modern capitalist media consumer state creates.

If I could pick something, it would probably be legalization + social support for people dealing with addiction, along with actual consequences for people who do bad things while on drugs, as opposed to what the police do now, which is basically throw up their hands and say "we cant put every heroin addict in prison".

I think the biggest issue I have with Heroin personally is how it seems to totally consume so many peoples lives and how completely unable they are to recover. There is a reason people say heroin addicts never really recover, they just take breaks.

Heroin and opioids may be slow and gradual, but then it’s an insta kill.

Maybe food for thought though about how society views direct vs indirect causes of death.

(Alcohol) prohibition ended, not because people changed their minds about alcohol being problematic, but because it failed, basically, and I think such an arrangement is politically unpalatable in today's world.

I think that Dr Hart makes a lot of good points, but he also makes some dubious ones. For example, his point about the "normal range" of height. Its a fine thing to point out, but it is such an incomplete picture that its borderline preposterous.

Lets say you are 6'5". If I take a chainsaw and cut off 7 inches of your feet/shins, does that mean you are just fine? You would still be within the normal height range, after all! In fact, theoretically you might be better off, because before you were outside of the normal range!

This is intentionally absurd, so no need to point it out, but that is my point; the way some points in this article are made, it really makes me worry how many people who are on the border of being sure they have a problem are going to keep going down their destructive paths.

To be honest, I bet my brother in law would have said the same thing about himself -- he is "fulfilling all of his obligations", after all! He did work, aside from periods when he was homeless/unable to hold down steady work/keep himself from spending literally all of his income on drugs. But, the last few years, he has been working and had an apartment, all while using.

No. The worst that can happen to him is that he is pulled over by a cop in the parking lot. Gets charged with possession of heroin. Goes to jail for a couple nights, then looses his job/pension/car/house/wife/kids (in whatever order) and winds up on the street. Regardless of the biological realities of heroin, the realworld criminal consequences of regular heroin possession can be worse.

And I have yet to meet any longterm drug user who hasn't on occasion sold some to a friend. Get caught "dealing" and you will face an entirely different legal regime.

It's been 45 years since it was first established that heroin CAN be used safely when accompanied by a social ritual. Part of the problem IS the mindset and stigma around addiction, and that "insanely addictive drugs" have full power over people, and there is no ability to moderate their use, which is false. People are either 100% sober or a social pariah. The response in these comments mostly confirms this sort of black or white thinking. Maybe somebody should ask if its the lack of social ritual / social controls causing the problem, not the drug. Maybe society is failing otherwise responsible drug use by making all users outcasts. Or is a spectrum and complex interaction of multiple issues, and not just drugs. "This is too dangerous of a conversation to have" puts us in danger of not having productive conversations.

https://web.archive.org/web/20201111183716/https://www.harva...

Edit for more context:

Depending on the drug, substances consumed outside of working hours would still show up in a drug test. Firing someone for something they do outside of work shouldn't be acceptable.

If you can prove they consumed drugs that would impair their ability to perform their job during working hours, that'd be a valid cause for dismissal. Drug tests don't measure that precisely enough though.

Not to mention, drug tests are not infallible. They can come back positive for morphine if you eat a poppy seed bagel in the morning [1].

[1] https://www.snopes.com/fact-check/poppy-seeds-alter-drug-tes...

Years ago I was an office manager at a battery supply warehouse (car batteries not AA’s). We had an employee that had started working for us for about 6 months when it became vary apparent that he had a drug problem. Because his brother also worked there we knew that he had suffered a major car accident, was in crippling debt from the medical bills, and developed a pain pill habit as a result. He was only 19 at the time.

The issues that involved the work place were things like being consistently late, taking 2-3 hour lunch breaks and coming back high. So high, that he could not perform basic job tasks like counting a pallet of battery cores. My biggest concern was that he was licensed to use our fork lifts and so I had our warehouse manager do his best to keep him off the forklifts.

At this point I recommended to my boss that we fire him for the repeated offenses, as well as recommend that he seek drug consoling. I felt bad for him. He had a problem. He needed help. But he did not need to be working at that job for his and others safety. My boss and my boss’ boss, on the other hand, decided it was best to send to him to a “random” drug test, so that when the fired him they could do so with indisputable cause. This did not work, he disappeared for many hours, despite the drug testing facility being just down the street, and the results came back clean. I know that people have many ways of faking drug tests. I suggested again that he be fired for the offenses and not the drug test. Again my bosses disagreed and sent him to two more “random” tests each week after that.

The employee in question got wise to this. He knew what they were trying to do. So he went to a therapist and got a declaration of temporary disability. My company then had to pay him his full wages for 6 months with out him needed to come to work.

And I sat back and laughed at my bosses, as the unemployment claim would have be nominal by comparison.

edit: not sure why this would be down-voted. It is just a real story, relevant to the thread. I was only suggested that waiting for test results when possible danger lurks was not the right course of action. i forgot to add the employee did come back after his psychological disability ran out. And of course they sent him to take a drug test again. He failed that one and was fired.

The funny thing I've been reading the article and the tone of it reminded me of heroin addicts who was not hit by their addiction heavily yet. I mean, Carl Hart thinks he is a responsible user, that he have an ability to decide for himself. It doesn't seem so for me. It is hard to tell, having as a data only one interview with him. But... you know, I'm an addict also, a nicotine one. I know how it is. First ten years of my addiction I though that there is nothing wrong with that, it costs some money and gives an urge to smoke sometimes, but it brings some benefits too. A few years ago I stopped smoking, after a month of abstinence I saw no benefits in smoking at all. My abstinence lasted for a couple of years, now I'm smoking again. Seeing no benefits at all.

I know what I'm speaking about, I know the signs, I see the signs, and I see Carl Hart as a fellow addict, though with a different substance.

I drink alcohol sometimes, and I know that I'm not an addict. Even despite the fact that sometimes I want to drink. A wish to drink is a warning sign of course, but I see no other signs. Like a despair coming with the thought that now it is not the good time to drink for some reasons. I have no ideas about benefits of being drunk: it is a funny state of mind, but mostly annoying, I'm really stupid when drunk, I see my stupidity and can do nothing to it. An addiction is a special state of mind, I believe one (i.e. me) could feel it as distinct from other states. Though it takes some learning, one needs to become an addict and to stop using an addictive substance of his choice. If Carl Hart wanted to prove that he is not an addict, he should stop using heroin for a couple of years, and then try to state his freedom from an addiction with a straight face. While he is using heroin for just five years and didn't tried to stop, I'd never believe his words that he is not an addict. When it would be 10-15 years or 5 years of abstinence, I'll probably believe his word on it.

Anecdata and broad brush strokes of course - In my experience anyway, the actually responsible and heathy adults I know haven’t felt the need to use heroin. The people who somehow are able to delude themselves into thinking they are responsible and healthy while obviously in crippling mental and/or physical pain, have - and it’s been devastating to them.

I’ve had prescription opioids before (hydrocodone, codeine, morphine) during medical emergencies. The feeling of peace and calm is amazing - which is exactly why it attracts people in pain and suffering, destructively so in many cases. It is difficult to know if that feeling is going to be magnetic or repulsive to you until you try it. It happens to be repulsive in my case (I know it’s a trap), thankfully.

It’s a complicated story of course, and bad outcomes tend to get the press. Better treatment (including in many cases mental health treatment) is definitely needed.

It is not the only substance like this - alcohol, tobacco, amphetamines, and others have track records of similar problems.

Pretending that anyone and everyone could self evaluate and go for it without a decent percent of them having major problems for them and those around them is unfortunately just not a good idea.

That coupled with the fact of how heroin is treated in society makes it worse. On top of that, add that not everyone that uses it is healthy and responsible, makes it even worse providing some bad validation. And then, not everyone is capable of making the distinction between fun or addiction early on when an addiction is starting.

I too think it's dangerous.

This not a very helpful observation, as we all know that this is far from what happens and is not going to become the norm.

Furthermore, quite a lot of people became addicted to opiates through acting seemingly responsibly (at least initially taking the drugs under the supervision of a doctor whom they could reasonably assume was looking out for their best interests) and in the persuit of better health.

I should add that Hart himself punted on this issue when the interviewer touched on it. In the interview, he does this a lot - for example, when the interviewer raised the question of physical addiction, Hart merely discussed the physiological basis, without touching the obvious issues it raises for the concept of responsible use. It may be telling that, in his description of himself as a responsible user, he avoided saying anything about this particular issue.

> Then you can also argue that you might not have lost your friends only because of Heroin the substance, but also how people with heroin addiction is "treated" and frowned upon in society.

This is also rather beside the point, as, while the way addiction is treated is also a problem, it is not an issue except where there is already a problem with addiction.

That aside, there is such a thing as responsible addictive-drug use (including, but not necessarily limited to, people with chronic pain that only responds to such drugs) and the way we respond to addiction today is in many ways ineffective and in some ways very harmful. One cannot make a very good argument for reform, however, on the basis that some people can use some of these drugs responsibly.

Exposing oneself to developing a heroin addiction seems a somewhat irresponsible and unhealthy thing to do.

The impact of failure to somehow prevent yourself from being addicted can be catastrophic ... even if you are successful in getting them out of the cycle of addition. And that impact can extend WAY beyond the individual.

I'm open to the possibility that some drugs really can't be used responsibly by enough people that they absolutely should not be legal.

'All substances of abuse self-administered by humans that can result in addiction are believed to exert their reinforcing effects by increasing DA in the nucleus accumbens (NAc)'

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3050051/

So if you create an accomodating and encouraging area for taking heroin you will find it surges in population when heroin is freely available and detox discouraged. Everybody points to the European model but they must have done something different than just harm reduction, like proactive policing breaking up open air drug markets and shutting down slums teeming with addicts forcing them into detox.

Even more so, _nobody_ wants to hear about responsible drug users, because that'll contradict the general discourse.

This seems to me to be a excessively myopic way of thinking about it. To the point of amounting to rationalization.

On the WHO lists, alcohol ranks below heroin and the like, but not far below, and certainly not as low as cannabis.

Harmfulness seems largely irrelevant for legislation.

I know grandpa quit cold turkey after my dad (newly invested as a medical doctor) came home and said "You will die of lung cancer almost surely if you keep this up". And an uncle quit after his 8-year-old daughter (my cousin) said "Papa please. I don't want you to die" plaintively or something like that.

I guess some things just change the game for people.

Back during one of the big buyouts of ca. 1980, an executive of KKR explained why it was buying some cigarette company: You make it for a dime, you sell it for a dollar, and people are addicted to it.

So I guess I had a pretty good hold on what the population of smokers was, and so I know most struggled to quit.

As for the other drugs, yeah, I'm open to thinking otherwise. I have lots of friends who recreationally use cocaine, MDMA, LSD, mushrooms, and whatever else. Personally I've tried all of those and really just use shrooms now occasionally¹. No particular addictions there among my group of friends, so I'm open to your school of thought there.

¹ Cocaine is boring. MDMA is great. LSD is cool. Shrooms has massive therapeutic effects for me. I can skip my Adderall for two weeks after a trip. I feel so motivated to work and find it trivial to focus.

People are very very different in their drug tolerances and really shouldn't give advice to other people, because they are not the same.

And no, I don't really even 'want' a cigarette. I know what addiction is, in that I feel this strong pull towards sweet stuff. I must have any kind of dessert, and if I see a novel food, I must eat it. I just must. It's like a fugue state. Try as I might I fall. Also with online validation for comments I write or stories I tell. The dopamine hit from an upvote has a debilitating hold on me.

But with no drugs have I felt this desire. Not even shrooms which I enjoy or MDMA which has been my all time favourite. I have some shrooms and some LSD in my fridge so I can partake any time. I just don't.

I'm amenable to the Rat Park hypothesis too. Maybe it's all Rat Park stuff.

That's interesting, though.

I've smoked opium a handful of times. It smells wonderfully.

And yet, if I take any drug regularly, I'm using something with THC in it (hash or pot, in general). I currently do not, however, and tend to have a few drinks and get high on the weekends. Not a big deal if I don't, though.

I've had medical grade heroin in the hospital (morphine didn't take care of the pain). No withdrawal, though I was wonderfully high. Haven't gone to a morphine habit.

The prudent thing to do is not to say, "opioids are instantly addictive", but to give folks safe ways to detox from them and give folks information on signs of addiction - because not everyone has such experiences.

Do you have a source for this assertion? I'm just a physician with a particular specialty in medically managed (as opposed to procedurally managed) pain, and I've never seen a "I took it once and was instantly addicted." I don't mean to undercut your subjective experience, but I've seen a few folks on pain killers, and if what you described was more common than "very rare", I would have by now.

They may be instantly addictive for you, but they are not for everyone.

After I had a pleurodesis, the nurse sat me down in the chair next to the hospital bed and gave me a little controller I could use to release morphine into my saline solution if the pain became unbearable (and it did). It was the strangest sensation—I could 'feel' the pain, in a sense, but it was like I was on a different plane, and it didn't quite bother me.

But to say it was instantly addictive—nope. Not at all. Have had no desire to try anything like that again outside of a hospital setting. Maybe some people are just not prone to it.

FWIW, good on you for recognizing that you're one of the third group and getting off of it entirely before the addiction gets even worse.

This is the kind of FUD that TFA is specifically addressing. Namely, that this is not always a true statement.

Of course, for many people, it is, which is why people make such sweeping (and incorrect) statements. Your warning is valid, your claimed facts are not.

And I say this as someone who's plenty happy with drugs legalization, who likes the occasional MDMA, and who drinks plenty of alcohol. I guess I'm lucky I never run the risk of opiates addiction, because despite all that I have no desire to every touch the stuff again.

Edit: Just to clarify, she was not prescribed any opioids/drugs to be taken post surgery, it was purely the anesthetics.

Is that true generally, or just for a subset of people who have some predisposition to addiction?

While it could just be Purdue Pharma propaganda, I vaguely recall hearing that the "instant addiction" was a myth. However, people like you have experiences like yours, so there must be some truth to the "instant addiction" idea.

Edit for downvoters: I think it totally makes sense for everyone treat opioids like a loaded gun, like another poster said, if some people are vulnerable to an instant addiction effect. I just want to clarify what the actual situation is (for me and all the other people who were told it was a myth).

I've been through plenty of addictions, but quitting Oxy after surgery is the closest thing to hell I've experienced so far.

But I love cocaine, psychedelics, and weed though, and I have been somewhat addicted to all three at different times in my life. I specifically wouldn't ever get drunk if I didn't have weed to go with it, as that's the only way to make alcohol any fun for me.

Most relevantly, coffee contains a relatively large amount of Harmala alkaloids, which are a family of beta-carboline monoamine oxidase inhibitors commonly found in Ayahuasca brews (and named after one of its ingredients, Penganum harmala).

Try caffeine pills, they have a cleaner effect with no stomach/intestine troubles. Somewhat easier to quit, too.

On my worst weeks when I think "i need to cut back" I might average ~3 drinks a day, maybe 5 on a holiday bender.

Maybe we're getting a very different view of the US from the UK, but despite all of America's flaws and how weak the beer is, it seems so unexpected to me that 1/10 of people are opening a new drink every 90 minutes and somehow managing to hold down a job to be able to afford such a habit.

The first Wednesday of every month at 10am he shot himself heroin.

It's one of his extremely methodical routines. It can be seen as an habit, but you can't truly call him an addict.

If you reframe your happiness around your drug use you're already addicted. The question about my original post was more like: Are there people who have a drug habit without the addiction? If yes, how many of them are there?

I'm not a drug addict either, but I can relate with some of it about my cigarette smoking habit (it's actually an addiction, I know).

As for the metaphor, "every weekend" looks already like an enormous amount of debt to me.

Every single person in group homes and foster system had same sort of tale.

8 hours for getting your $80 for the day to get high

4 hours to get high

4 hours for...I don't know, working on a novel or something

Design work though? There was many a time I awoke the next morning and had a dread-chill panic thinking I'd need to get some project done, only to find I'd not only done it the night before, but I'd actually not hate it. Which, as a designer at the time, was high praise. Sure, there might be some rough edges or stupid typos, but the overall work would be Great, by my standards at least, so after a quick review, would be ready to go. I used to refer to it as 'free work'.

I guess letting go is more of a useful trait in design.

I'd not recommend it for doing work in critically-important fields, obviously!

- ed last line

The statistics for alcohol consumption in the Nordic countries in the 19th century are staggering, adult males were basically drinking hard liquor all day every day as they went about their work. Alcohol definitely has its effects on the body and is a huge safety risk, but apparently men were still able regardless to run their farms, build the buildings they needed, chop wood, etc.

  I get up around seven
  Get out of bed around nine
  ...
  I used to do a little but a little wouldn't do it
  So the little got more and more
  I just keep tryin' to get a little better
  Said a little better than before
  ...
  Now I get up around whenever
  I used to get up on time