Written by Dr Dave Ores - NYC. updated AUG 2023.
Prescription heroin for people dependent on heroin.
A Rational Argument for Prescription Heroin
The economic costs of the prohibition of heroin are staggering; in lives (100,000 + last year alone) and medical / social interventions. American medical doctors prescribe huge amounts of morphine to surgical patients, hospice patients, cardiac patients and chronic pain patients everyday. We are not, however, allowed to prescribe morphine or morphine derivatives to persons who are heroin dependent / users. That makes little or no sense. Allow me to present an alternate world where clean, pure and safe prescription heroin would be provided three times a day, for free, at drug control centers.
First, let us redefine two common and misused terms: “Street heroin” (aka smack, horse, dope, etc) and “overdose”. Street heroin is actually mystery street powder (MSP) since street heroin consists of many unknown, toxic and often deadly components other than heroin. Ranging from talcum powder and cleaning powders to deadly car-fentanyl or deadly Xylazine (aka “tranc”). Also included are traces of urine, saliva, hepatitis-C, infectious bacteria and HIV viral particles to name only a few. Neither the buyer or the seller has any idea as to the actual ingredients or toxins included in the common street MSP. Hence the mystery (MSP).
“Regarding Overdose.” Of the 100,000 plus reported deaths due to “overdose” due to impure street opiates / heroin, only a very small fraction were actually and truly overdoses. In truth, the overwhelming majority of these deaths are poisonings. Allow me to explain. If John eats a sandwich and falls over dead due to cyanide ingestion, John did not “overdose” on sandwiches. John did not eat 250 sandwiches. John ate one sandwich and subsequently died. John did not “overdose”. John was poisoned. If John injected himself with a normal and customary amount of MSP and then was suddenly dead, John did not overdose. John was a victim of poisoning. Possibly from fentanyl and / or a concentrated amount of opium, since the purity or potency of the dose was unknown to John. No one knows what is in any given amount of MSP. If John ingested 90 prescription pills, drank half a bottle of vodka and left a suicide note, that would be an overdose.
An aside. What if your doctor or nurse injected your hospital IV with a blue liquid and told you it was penicillin purchased in a local park from a guy named “Ritchie”. Additionally, the health care professional assured you that Ritchie is a good guy, can be trusted and always sells good product. Would that be OK with you? Or anyone? There is no universe where that would be allowed or OK. Well, that is exactly what we are forcing drug dependent people to do three times a day. And at a staggering financial and social cost.
Moving on to tax payer dollars, prohibition of heroin leads directly to a well documented cascade of enormous and varied expenses. These expenses include: medical, surgical, judicial, police, prostitution, human trafficking, ER visits, ambulance rides, fire dept responses, prison costs, trial and court costs, hospital costs and outpatient care costs to name a few. All these costs are carried by Federal and State taxpayers as well as insurance corporations. At multiple billions of dollars per week.
--Violence. Gun shot wounds and stabbings connected with street drugs are costly and involve police time, ambulance / EMT time, medical staff, medications, hospital resources, trauma surgery, ICU care, post op care, hospital days with a low average of $150,000 per event. When added together, at 500,000 per year, these injuries are extremely expensive in the neighborhood of 10 billion to 20 billion per week.
--The Law. Chasing, arresting, detaining and prosecuting heroin users involves court time and all sorts of peripheral costs.
--Prison: There are approximately three million incarcerated persons in the USA and around 85% of these are from drug related infractions At $60,000 dollars a year for each person, that adds up to around 120 billion dollars a year.
--Free usable time: A heroin user needs to procure $10.00 cash three times a day to satisfy their perceived need. This is true 7 days a week, 365 days a year. There are no days off and this activity takes up a lot of their time. They are “too busy” to take advantage of available programs or to deal with few (or any) of their many issues and problems. Unfettered access to safe supply would allow SUD persons to take advantage of a myriad of social and legal services.
--The rehab industry: A revolving door. Most rehab programs are an endless wheel of discomfort, meetings with mixed results and common relapse. Both inpatient and outpatient programs are highly subsidized with taxpayer dollars. Also, active users do not have the free time to take advantage of such programs.
--Petty crime: With few other available options, the heroin users, as a cohort, commit many millions of low level and more serious crimes to obtain their required $30 dollars a day. This also includes prostitution, theft and being sex trafficked to get their daily MSP.
-- Sales force: Many drug users are incentivised to bring in new customers to the dealer to get their drugs for free. This is a very large and effective dark market sales force.
--Cartels and War: All the daily collected cash from nationwide MSP street sales goes to highly organized and well popularized drug cartels and this may also be connected to global weapons sales which feed many global, tragic violent conflicts. Billions of dollars are collected weekly. In turn, local governments, and therefore USA tax dollars, are consumed to respond to these political global kill zones. Afghanistan is an example of such activity, and Afghanistan produces 85% of the global opium supply.
There is an alternate universe. Legal prescription heroin (Rx Heroin). If the heroin user had access to free, medically safe, pure, sterile Rx Heroin many or all of these enormous expenses would evaporate.
Imagine a drug control center (DCC) inside a medical hospital setting with all sorts of resources to assist and treat persons dependent on street MSP if they choose that option. In this DCC the client would receive three daily doses of injectable Rx Heroin at an appropriate dose under medical supervision with no strings attached. Imagine the benefits to one such individual:
--They would have the entire day off to take advantage of any programs or opportunities made available to them. Including food and other types of self care.
--They would no longer need to commit petty theft (or worse) crimes or prostitution to get $30 each day.
--They would not get arrested.
--They would no longer infect their bloodstream with HIV, Hepatitis C, bacteria and other poisons from the toxic components of injected MSP. These are often very costly, life long systemic infections, amputation and frequent use of public medical services.
--They would not be killed by added fentanyl or Xylazine / “tranc”.
--The DCC would provide sterile, clean, safer pharmaceutical Rx heroin at known, consistent, medically supervised mg amounts.
--They would not become chronically ill, crippled, amputated, weak, infected or damaged from the injecting adulterated, uncontrolled MSP.
--They will not get shot or stabbed as often which is a huge medical expense.
--They will more likely live long enough to enter a recovery process and improve their lives if they choose that avenue.
-- Safe supply would also serve as an excellent gateway into recovery programs if and when the SUD person chooses the recovery option.
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What about treatment? How will these people get better? How will clean, free and safer Rx Heroin help them instead of keeping them addicted and dependent on daily heroin? For the reasons noted above, pharmaceutical heroin is 1000 times less expensive and much safer than MSP on multiple levels.
A useful metaphor: One needs to understand that there is no known treatment for abdominal pain. The cause of the pain needs to be established before an appropriate treatment. Some possibilities are: ectopic pregnancy, pancreatitis, hepatitis, cancer, infected bowel, trauma, infection and dozens of other possibilities. The same is true for drug dependency. There is no single fantasy, effective treatment for addiction. No such magic bullet treatment exists. Also, a 23 year old schizophrenic is not the same medically as a 63 year old jazz pianist. Heroin addiction is a Venn diagram of mental emotional health, financial status, genetics, psychiatry, family history, childhood experiences, PTSD, medical illnesses, alcohol dependence and many other elements. Each individual person will need a unique and bespoke care and recovery plan if it is meant to be effective. No two people will necessarily have the same conditions, obstacles or problems. Exactly like abdominal pain.
The philosophy of a safe supply Rx Heroin program: The stated goal of a safe supply Rx heroin is paradoxically not to help anyone. The single and sole purpose of a Rx Heroin plan is to “put out the fire”. Like when the top three stories of an apartment building is in flames, the initial and primary objective is to put out the fire. We generally do not allow the entire block of building to burn to the ground while we discuss the future plans for the site. Such as insurance issues, securing an architect and a contractor to initiate all the repair and reclamation work. No. Step one is to put the fire out.
The same is true for a safe supply Rx Heroin program. Offer the person dependent on MSP a clean and safe and cost-free alternative free of the violence, desperation, crime, incarceration, disease and all the dozens of other ancillary expenses. All the chaos, social costs, health dollar costs, law enforcement expenses, etc. is the fire. We need to put out the “fire” and then deal with the problems in a safe, considered, rational, controlled and calm professional manner.
After weeks, months or even years of safe supply Rx H, some clients may choose to opt for recovery and treatment is made available for that individual. Perhaps a third of clients will eventually wean off the need for thrice daily heroin with all sorts of programs and modalities. Another third will continue injecting Rx Heroin three times a day until the natural end of their life. The last third may wean off Rx heroin only to begin using again weeks, months or years later. Critically, in all cases, these clients are no longer consuming billions of taxpayer dollars. Needle exchange / Rx heroin sites would be incredibly less costly in many dimensions. And the fire will be out.
Also, critical to the success of safe supply Rx Heroin is never to ask or require an adult user to stop injecting Rx Heroin three times a day. That choice is entirely up to them and the DCC will assist them in every way possible if they make the recovery choice. But, recovery is not the primary goal of a “middle space” Rx Heroin program. The primary goal is to put an end to the outrageous waste of lives, social dollars and many billions of health care and police costs every week. Maintaining a person on injectable heroin is relatively very low cost and completely less harmful and costly when compared to the decades long MSP disaster.
In closing, the rational economic and medically correct solution to reduce the “heroin problem” and the crime problem and the mass incarceration problem and the out of control health care costs problem (and many other ancillary social costs) is, paradoxically, clean, safer, controlled and free prescription heroin.
Thank you.
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I AM SEEKING OPINIONS ABOUT PRESCRIPTION HEROIN / SAFE SUPPLY. PLEASE EMAIL ME WITH ANY COMMENTS OR OPINIONS YOU MAY HAVE, ONE WAY OR THE OTHER.
ALSO, I AM SEEKING PEOPLE IN THE KNOW TO VIDEO INTERVIEW FOR A FUTURE DOCUMENTARY PROJECT. MY CONTACT: DRDAVE.LESM@GMAIL.COM.
THANK YOU.
David J. Ores, MD - NYC updated August 2023
General Practitioner and Social Health Programs
189 East 2nd Street NYC 10009 text or cell: 917 723 4206 Projects can be viewed at: www.drdaveores.org
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