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No cut for you today - Tactical Ninja

Feb. 4th, 2014

11:21 am - No cut for you today

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So Philip Seymour Hoffman died, apparently of a heroin overdose.

"Yes yes we know, Tats. That's yesterday's news." I hear you say.

I just have a few things to say about it, in response to the various opinions I've been reading over the last day or so.

For a start, drugs are not evil. Good luck even defining exactly what a drug is, never mind ascribing human characteristics or value judgements to them. Heroin is not inherently evil either. People who use heroin are not evil. I think poor dead Philip is a case in point, eh?

Using drugs does not inevitably lead to addiction or death. In fact, depending on who you read (and believe me, I've read as many studies on this as I could find), between 85 and 97 percent of people who use illegal drugs* never have any problems. So let's not be saying he died from drug use. He died from an overdose of a drug that he had used many times without dying. He died, if you insist, from drug MISuse - he got the dosage wrong, took too much. Just like, you know, if you use a car it's not harmful. If you misuse one you can kill yourself and others. It's an important distinction in the field of drug study. I suggest you learn and use it.

Did you know that heroin-assisted maintenance programs are improving outcomes for even the most entrenched cases of heroin addiction in Europe nowadays? The programs aren't getting people off the drugs directly. What they are doing is allowing people to extract themselves from the 'junkie' lifestyle by removing the harms associated with the black market - dirty needles, impure heroin, dealing with the criminal underworld, paying exorbitant prices - by providing measured doses of pure heroin free of charge, under supervision. What they have found is that when people are no longer having to deal with all that crap, they can improve their lives to the point where many heroin addicts are functioning within normal society - holding down jobs, paying taxes, raising families. And often, when people are experiencing these trappings of 'success', they then choose to slowly reduce their dose and come off heroin. Not all, but it's telling that heroin maintenance has been significantly more successful over a number of outcomes than just about every other intervention available.

Why am I telling you this? Because I'm tired of hearing about how it was the drugs that did this, that or the other to a person. In the case of heroin, while it is addictive, does have high overdose potential, and is objectively one of the most harmful drugs, it still does not have the power to make a person do anything. Even people who have previously been considered hopelessly addicted are showing that given the ability to take control of other aspects of their lives, they can use heroin regularly and will not inevitably die or be criminals.

So if heroin is not the culprit, then what happened to Philip Seymour Hoffman? It says in the article I linked to above, that he is quoted as saying:

"I don't know, I was young, I drank too much, you know, so I stopped. It's not really complicated. I had no interest in drinking in moderation. And I still don't. Just because all that time's passed doesn't mean maybe it was just a phase.

"That's you know, that's who I am."


This was in reference to his previous stint with addiction, that time to alcohol. Those lines were spoken in 2011, when as far as the world knows, he was free from addictions. He said about himself that moderation was not in his nature. He was a pusher of boundaries. It seems to me that addiction maintenance was not likely to be an option for him - it was either completely clean/sober, or 'drinking too much'. It's not hard to see how this would translate to heroin use turning into misuse, followed by overdose. "How high can I get?" Especially with increasing tolerance levels**.

So maybe he should have just stayed away from drugs then. Well, he did say that himself, after a fashion. But it's ignorant to make blanket statements about the nature of drugs because the occasional boundary-pusher goes too far and dies.

Dan Osman was a boundary-pusher too.



Known mostly for his freeclimbing exploits, he died, ironically, while using a rope. It broke and he fell to his death.

I doubt there are many eulogies that mention how evil ropes are, or even how evil climbing is. Nobody will say he died from climbing. They will say he died in a fall. They might talk about the unwise decision to jump that day after exposure of his gear to the elements, or about how he was always a risk-taker. But they won't talk about climbing as if it has agency, and nobody has called for it to be banned because of what happened to Osman.

He was looking for the edge. He found it. End of story.

Why do we make different assertions about someone's death when it involves an illegal drug? People who do that, please stop and think about what you are doing.


* I am assuming here that in this context when people say 'drugs' what they actually mean is 'illegal drugs'.
** It's a recorded phenomenon that people who've been clean for a while are at higher risk of overdose if they start using again, because their tolerance has decreased and they then hit at the dose they stopped at, which is too high for their current state. Either scenario sounds possible.

Comments:

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From:fbhjr
Date:February 3rd, 2014 10:37 pm (UTC)
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You know this:
"I don't know, I was young, I drank too much, you know, so I stopped. It's not really complicated. I had no interest in drinking in moderation. And I still don't. Just because all that time's passed doesn't mean maybe it was just a phase."
is exactly why I don't drink.
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From:tatjna
Date:February 3rd, 2014 10:47 pm (UTC)
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Yeah. I think a lot of people have something like that with particular substances or activities. For me it's ice cream. I'm lucky, it's relatively harmless in that I'm unlikely to OD on it.

As a wonk, my mind immediately turns to the question of agency. Some people are unwilling or unable to make the decision not to touch their nemesis substance. The vast majority of other people will be fine with it (even heroin only has an addiction rate of 25% of regular users).

So, what interventions are a) effective and b) respectful of human rights in terms of someone's inability to use X in moderation? And I keep coming back to 'pretty much none'. So, what to do?

[edit] I'm increasingly of the view that folks should be allowed to make these decisions for themselves, and that the supposed support systems of society are what needs looking at in terms of how they are failing these people when there is a problem. But even if they were perfect, some people will still die of bad decision makin, and maybe we just need to accept that.

Edited at 2014-02-03 10:49 pm (UTC)
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From:springheel_jack
Date:February 3rd, 2014 11:33 pm (UTC)
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"The Edge... there is no honest way to explain it because the only people who really know where it is are the ones who have gone over."
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From:tatjna
Date:February 4th, 2014 12:36 am (UTC)
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Hahaha so true.
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From:richaarde
Date:February 4th, 2014 12:30 am (UTC)
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I really wish they had heroin maintenance programs here. Heroin is nasty stuff but at least you know that you're getting a consistent product from a maintenance program.

The worst part is that bloated government egos are the reason for not starting maintenance programs. It basically comes down to governments not wanting to change their ways because changing would force them to admit they were wrong. And governments are never, ever wrong.
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From:tatjna
Date:February 4th, 2014 12:35 am (UTC)
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There is this bizarre perception among policymakers and governments that providing heroin maintenance programs means condoning drug use - and they are afraid of being seen to condone drug use.

It's a bit of a worry when those who are responsible for a country's wellbeing will sacrifice that wellbeing for the sake of face-saving even when confronted with irrefutable evidence. Never mind that harm minimisation is a million miles from condoning..
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From:crazedturkey
Date:February 4th, 2014 01:04 am (UTC)
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Heroin management program's is interesting,

The prevailing thought process when I did addiction medicine (and it wasnt that long ago!) was that opiod substitution was a better idea I.e bupe/methadone, because heroin is too short acting - the fast onset/offset makes for easier addiction and harder management in terms of withdrawals. Whereas methadone and bupe are slow up and down. The problem with that though is of course you don't get the rush (unless you divert and inject hence the need for supervision because that's a fast way to get an abcess).

Edited at 2014-02-04 01:08 am (UTC)
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From:tatjna
Date:February 4th, 2014 01:20 am (UTC)
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I think (but am not certain) that there's recently been a shift in terms of understanding addiction from the point of view of the person experiencing it. So while methadone etc are convenient in terms of their slower redose compulsion, it's also harder to come off than heroin (being one of the few substances from which withdrawal can kill you). So if the endgoal is to help a person get off drugs altogether, methadone is not so helpful.

Also, heroin addicts tend to spend a very large proportion of their time seeking their next hit, and this often involves complex, dangerous and difficult tasks. So to go to a clinic twice a day for their dose is orders of magnitude simpler than finding it for themselves.

These reasons make heroin substitution a much better deal for the person being treated IMO, especially given that by the time a person is seeking treatment or a maintenance program, they aren't really after the hit any more, they're simply trying to avoid dopesickness.
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From:brynhilda
Date:February 4th, 2014 02:44 pm (UTC)
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Yes, we have heroin-assisted maintainance programs overhere in Germany. Mostly it's substitution via methadone. I do know some folks who went through it.
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From:tatjna
Date:February 4th, 2014 07:31 pm (UTC)
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Yep, here it's methadone and bupe. I've known a few people who've used it (heroin isn't really big here, I suspect because our society is relatively equal), and was kind of shocked to find one person who had quit heroin 10 years previously, still on the methadone because now she was addicted to that.

Doesn't really seem like the best option, eh?
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From:danjite
Date:February 4th, 2014 05:28 pm (UTC)
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Dude had more than 50 baggies in his flat.

Junkies I have known (thanks to life in the music industry) wouldn't keep more then TWO around, as not having the stuff right there was part of not overdosing. Having five- much less fifty- in one place seems like willfully creating a condition so one can die.

Depression- like addiction- is an expression of mental illness. The two together can be a spectacularly bad combination, as was likely the case with PSH.

When I was young, depression was badly underdiagnosed, incorrectly treated, and too shameful to discuss. Same with addiction. Yes, things are still really bad with addiction treatment in much of the world, but I am glad to have seen the start of humane treatments for both during my lifetime.

Edited at 2014-02-04 06:19 pm (UTC)
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From:tatjna
Date:February 4th, 2014 06:29 pm (UTC)
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The addiction-as-a-disease model is definitely a step in the right direction from the previous view of addiction-as-a-personal-failing-that-deserves-punishment. However, it also fails to recognise the social factors that can greatly increase the chances of addiction - you know how problematic drug use tends to be a lot more common among marginalised groups? This implies not only that there's something happening socially in much of addiction, but also that in some cases, drug use can be a rational choice.

So while considering addiction as a product of mental illness is a more humane view, I'm not convinced it's accurate - and it can lead as much to removal of agency and violations of the rights of the addict ("We know what's best for you") as the previously-held model.

Julian Buchanan has more on this view if you're interested.

Having said that, my first thought on reading about PSH was "Needle in arm? Loads of heroin around? This is very convenient - was it set up to look like an accidental OD or what?"
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From:helianthas
Date:February 4th, 2014 06:30 pm (UTC)
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And if that's the case, I'll put my 2 cents in and say that I really wish more celebrities would talk openly about suicidality before actually dying either intentionally or unintentionally. I believe a real open discourse led by some people in the public eye could be so helpful.
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From:wildilocks
Date:February 8th, 2014 08:12 am (UTC)
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When you take the word "drug" out of the equation, I think it simply boils down to the fact that in our society in general, we purportedly admire and reward restraint, control of the self, mastery over desire or indulgence. This is a common thread in most major religions and philosophies. Mastery over the self instead of giving in to our base urges. So with that framework I do understand the mindset of "drugs are bad, mmmkay" and that those who choose to let their desires rule them are "getting what they deserve" when it all goes wrong. However, thanks to the new God, money, I personally feel that we live in such a dysfunctional society now that it is something of a rational choice to want to escape it (hence notably higher drug use in lower socio economic strata).

I do believe self-restraint is something to be celebrated. It is one of the few things that can give us all genuine satisfaction, no matter where you sit in terms of wealth. But it is hard. Maybe harder than it ever has been in history. Human desire for mind-state alteration is universal, but we have lost the community, the ceremony, the structure and the attribution of meaning to it, thanks I think largely to the rampant run of the Century of the Self (see Adam Curtis' excellent documentary). Of course, we have in some circumstances been able to create new rituals (and this is why Burns are the only festivals I think I *really* enjoy now, though the Self still dominates there is at least some structure, some community and some ritual and this doesn't require drugs to appreciate and be fulfilled by) but because we are more Self - focused (and also -aware, thanks to Science), we can't (in general Western society at least) easily make ritual as integral in our lives as it used to be.

"That's you know, that's who I am."

Is chasing the edge, the all-or-nothing response to desire, a valid response to a lack of meaningful community, ritual and purpose in life, in a society obsessed with the Self?
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