In speaking of “new drugs” one must avoid falling into a misunderstanding. The novelty may refer to the fact that these are new molecules, but it does not mean that these market innovations are destined to become the most popular drugs, nor that they have ever been. Conversely, the fact that a drug is now known does not mean that it is out of fashion, because the diffusion of substances does not depend on “fashions” and that’s it, but also on how much the substance is able to take hold.
The supply, in other words, is not accidental, because the induced demand is not the same for any tested substance: some substances are biologically destined to take hold. If anything, new markets can “change dress” to old drugs, with two effects: the first is to prevent consumers from being frightened by what they already know about that substance; the second is to create a novelty effect that always stimulates the first consumption .
Heroin is currently at this stage. The use of heroin has never decreased over the years, but in recent years in particular it has “returned” in disguise, that is, smoked heroin. Not that it didn’t exist before, but when it comes to heroin it automatically associates with the syringe, and vice versa. Nasal or inhaled use is actually almost always the first type of heroin consumption, also because the injection, as well as being more difficult, is also more risky.
Smoking and snorting are not the same: while snorting, absorption occurs from the nose, while inhalation carries the substance into the lungs. Since it is a small amount of substance, snorting and injecting the substance is often “all” introduced into the body, with the difference that by injecting the dose introduced corresponds to the one that actually reaches the blood (through the syringe), while for the nose a part goes lost. Nasal absorption is slower than the injection obviously.
In both cases, especially with the injection, you can have an overdose (immediate in the injection). Smoking heroin is a different practice. Heroin is vaporized by heating on a sheet of aluminum foil (easiest way) and consumed as it vaporizes. Absorption is rapid if inhalation is deep, but the quantity is not consumed “all at once”, so if the dose is excessive it is likely that the person will fall asleep while consuming it, and therefore stop in time, before the ‘overdose.
Another “trend” of heroin consumption is that which accompanies or derives from the consumption of stimulants (cocaine, amphetamines). Cocaine users can use heroin in combination, to end the effect of cocaine in a non-annoying way, or to counterbalance the anxious and paranoid effects of cocaine. The risk of these associations is also that, when the effect of cocaine wanes, that of heroin will prevail to the point of overdose.
The addictive potential is the same. It should be borne in mind that the addiction usually develops non-injected, and the passage to the syringe is only a way to have the effect with lower doses, so as to economize. Today perhaps this aspect matters less, because the price of heroin has dropped over the years, and therefore “maintaining” an addiction costs less as regards the price of the substance. It is therefore foreseeable that many will remain nasal consumers or smokers. The transition to the injection may be occasional, but it is not always a definitive step.
A particular case (which has been discussed for a while) was kobret, basic smoked heroin, obtained from the residues of the preparation process of normal heroin. In this case, a different preparation of heroin was used for the highly addicted drug addicts, who obtained a more concentrated effect. In unaccustomed subjects, this variant induced a rapidly aggressive addiction, not very functional to the creation of a pool of reliable customers able to maintain their dependence.
Finding foil, inhalation tools and lighters should suggest heroin use. This can also make it possible to identify a consumer in the pre-addiction phase or in a less severe stage of an addiction already in place, that is, before the syringes and holes appear. However, it must be repeated that drug addiction can be serious and overt even in people who smoke heroin.
The therapies for heroin addiction obviously do not depend on the route of intake, so they are the same (long-term therapies with agonists, in Italy oral methadone and sublingual buprenorphine), or, in some particular and less serious cases, antagonists (naltrexone oral).
Useful informative texts:
- Giancane S. Opioid disease in the digital age. EGA, 2014.
- M. Teresa Brugal, G. Barrio, L. De La Fuente, E. Regidor, L. Royuela, J. M. Suelves Factors associated with non-fatal heroin overdose: assessing the effect of frequency and route of heroin administration, Addiction, 2002; 97(3):319 – 327
- D. Werb, T. Kerr, B. Nosyk, S. Strathdee, J. Montaner, E. Wood, The temporal relationship between drug supply indicators: an audit of international government surveillance systems, in BMJ Open, 2013, n. 3
WHO guidelines on opioid addiction treatment: http://apps.who.int/iris/bitstream/10665/43948/2/9789241547543_eng.pdf
9 comments
# 1
Former user
11 December 2017
Good evening everyone ..
Yes, in fact, what I have read is more or less corresponding to reality … I the first time I sniffed it I was practically just of age and since then in the space of 4/5 months I had a quite devastating degradation but then over the course of little and by radically changing habits I was able to stop and get it out of my head at least for the first year and a half … then in the meantime I grew up and didn’t look for it too much until then at about 23 my first daughter was born and for the remaining other 10 years no longer thought of precisely even if strangely I used it about 2/3 times a year for special occasions (just to reduce the stress accumulated in particular periods) … and this is where everything falls but …so having the first daughter now 10 years old and the second now about 2 years old and frequenting certain friendships a bit by mistake a bit for other reasons I gradually increased the frequency of these few annual occasions until I came back more inane than before despite my wife and all the others did not think in the slightest about what was happening to me … I feel like a real m …. now even though I have recently talked to my wife and tried to explain everything to him (which I think she did not understand) I stopped .. I would like to say that in the last three years I have tried to quit several times with poor results because at the first chance of a fight I would start again and I gave myself the excuse of being able to give myself a smoke to forget ..what I want to tell you as an addict (even if I don’t think so) and stay away from this stuff because it doesn’t get out easily .. if you can’t get help from someone … physical addiction is easily overcome with first 5/6 days but the psychic one remains like a woodworm .. I know I can do it now but I will have to be strong as I have ever been and I don’t want substitutes like subuxone or methadone which are not needed by everyone because we are not all the same .. physical addiction is gone now but the psychological one will be hard ..I know I can do it now but I will have to be strong as I have ever been and I don’t want substitutes like subuxone or methadone which are not needed by everyone because we are not all the same .. the physical addiction is now gone but the psychological one will be hard ..I know I can do it now but I will have to be strong as I have ever been and I don’t want substitutes like subuxone or methadone which are not needed by everyone because we are not all the same .. the physical addiction is now gone but the psychological one will be hard ..
# 2
As before several other times, a series of errors on the subject are repeated here.
He describes a situation that corresponds to what he reads, after which the conclusion would be: but I don’t care because we are not all the same. So we are more or less in the symptoms of diseases, when it comes time to be treated as it happens each is a case in itself.
Now this is not a reasoning, it is a symptom too. Wanting to manage yourself, refuse therapy.
The problem is obviously not “physical” addiction as abstinence, it never was, that’s not why drug addiction is a disease. Psychic dependence, which is also physical (it concerns a piece of the brain, and indirectly other parts as well) is the problem.
And it is on this problem that anti-addiction drugs act.
The term “substitutes” was created by those who believed that the issue was the cure of abstinence, but even in this sense they do not replace anything, if ever they avoid abstinence. If that were the problem, one would use heroin directly. If he does not, there must be a reason, which is the relationship with heroin, not manageable according to his own purposes, but out of control.
Methadone and suboxone are anti-craving therapies, and they don’t replace anything. They restore normal control of their intentions, that is to say that function which is “broken” and does not return to equilibrium except temporarily. Since it is broken, and it is due to the effect of heroin, if you want to fix it there are these cures,
And if one uses them badly, and takes them to cure abstinence, it is clear that he does not stop and they are of little use. But this, I repeat, is not drug addiction therapy, and abstinence therapy, which is not a disease but a secondary passing state, unimportant in the dynamics of drug addiction.
Moral: those who fall back avoid wasting time taking offense, cursing themselves, if this then means “I don’t want to cure myself”. When one takes a closer look at this type of thought, it is evident that it is not a logical thought, but this is also a symptom of addiction, which keeps away from cures, makes them stop earlier, makes them do it incompletely, does not take the right doses , and so on.
When someone has appendicitis, he doesn’t say: I don’t have an operation because we are not all the same
When one has a cavity he does not say: the dentist no, we are not all
the same When one has pneumonia he does not say: antibiotics are not needed, we are not all the same
Therefore, it makes no sense to speak in a decidedly standardized and predictable disease, even in his cure, such as heroin addiction.
# 3
Former user
December 11, 2017
Dr. Pacini you are absolutely right but one thing that you cannot know is that none of you doctors can know unless you have been personally involved and that if you really want one can in many ways … then the treatment through sert is the most used but not necessarily the one that works 100% … if you don’t have the will you can do a lot but you don’t get out of it anyway …
# 4
No, she’s really wrong here. Will has nothing to do with it, and one of the altered functions. But sorry, but we are talking about drug addicts who have will and others who do not.
There is no such speech, and pure misunderstanding.
I am not talking about SerT treatments, I am talking about treatments that should be carried out at SerTs, and which for about 80% of patients are not carried out, as shown by statistics available everywhere. The treatments are there, as we know, patients often row against the nature of their disease (by rowing against I do not mean that they do not take will, but that they do not do the treatments), and then – this could be avoided – the cures are not applied by doctors and operators who think more or less like drug addicts caught in their illness, that is, as you have just done above.
That is: “I cure him, but if he has no will he will never stop”. In this way we end up doing bad treatments, and bad treatments do not work, as if one takes a quarter of the antiobiotic tablet they give him and takes it until the fever passes and then he stops. Then the infection returns, the symptoms, yet from the fever one “had come out” etc … the same absurd speech would be made.
Therefore, it is not that what I say is true BUT as you say it takes will and you can get out of it in a thousand ways then. No, I say exactly the opposite. It does not matter any phantom will that everyone has or does not have. One has a disease, one is cured. And he does it according to a technique, not according to how it seems right to do.
# 5
Former user
December 13, 2017
I happened to quit last year I was out for more or less two months and this without taking subuxone or methadone … by this I only say that this time I will be more stubborn and intelligent not to commit myself than if I can think of try again I will not have to fall into the trap of self-conviction that everyone does, that is: “oh well this time and then I don’t do it anymore” … I believe that if you are convinced not to touch it anymore and pass this phase you will lie to yourself you can go on for a year as well as two or ten … then the choice is always up to us .. obviously one thing that likes like it even after ten years and you can always come back to point and back .. but this can happen the same to who is being treated at the sert for three years maybe up to the final scaling and then when it ends he is back to point and head again …I hope I was clear and not misunderstood … anyway thank you very much for the advice because I will treasure it anyway in case I find myself in trouble again or for some other ..
# 6
No, he’s repeating the usual mistakes. She takes normality and flaunts it as if she knows what goal. There are people who pride themselves on detoxing on even days and relapse on odd ones.
Drug addiction is that disorder for which you stay out for a long time without methadone or subutex, you are strongly convinced that this time you will be more stubborn and intelligent etc, and that if you pass the first phase with the right push then it is almost done.
This is addiction and how an addict thinks. It is not part of the solution, much less the key to the solution.
No, the choice is not always up to us. If we are drug addicts, no. Even if we have a tumor or flu, it is not up to us to choose when and how it passes, when and how we relapse.
It is not a choice of pleasure, it is not a vice, it is not a habit. Era. This has nothing to do with drug addiction. It would also be obvious, we would not be here to explain it, if we are and because the brain of a drug addict, despite n times, indeed due to n relapses, reasons the opposite of how logic would have it, that is, that the course is predictable.
It is still expressed with respect to the cures with this idea that the cure ends with the definitive scaling etc. It does not work like that. The cure is not meant to be tested when it takes off. The cure must first of all ensure that, by taking it, the problem goes back and does not come back. Then, for some diseases, it can be removed. Then, for some, it can even be removed after a while. But the sequence of reasoning is this.
Not that you are treated, then you take the treatment off and you see if you relapse: if you don’t relapse, then the treatment is useless, so it is useless to take it back. This is how drug addicts generally think of methadone. Like it’s supposed to work when it’s not there, and not having been there for a while.
# 7
User 413XXX
June 25, 2019
Strange, an article by the “doctor” that still has user comments open. Usually he always closes them, even this is something that must make us reflect among other things. I’m just making this observation: no matter how hard he tries to make it sound, this “doctor” doesn’t have the truth in his pocket. Drug treatment is not an exact science. It is not even necessary to open a parenthesis on the pros and cons of a maintenance, or endless, methadone therapy. The cons are there and there are many and just ask and inquire with other doctors. However, methadone is also a way. There are various treatments and various strategies, and certainly the will to get out of them is an important prerequisite. Unfortunately, it lasts, very hard, and it is very easy for relapses during the course of treatment. It is also important not to throw in the towel, and trust only those we feel we can trust. I end up saying, indeed repeating, that it is not all gold that some “doctors” make gleam. Also take a look at the other articles or consultations to understand how “some” deal with patients and any opposing voice, however respectful and moderate.
# 8
First don’t allow yourself to write doctor in quotes, which is defamatory, let’s see what the staff say. It is for people like you that sometimes it is better to close the consultations, and let everyone think about the article.
Trivia like “drug addiction is not an exact science” etc don’t help anyone understand. Not even you, who don’t know certain things and don’t want to learn them at the moment.
Data processing uses the so-called “exact sciences” so to speak, ie mathematics and statistics. Methadone is not “a road”, it is one of the possible treatments, all three of which are pharmacological.
The pros and cons he discusses them as much as he wants. The pros are that and care. The cons as in any cure there will be. Then there are the “cons” of those who do not do therapies or nonsense propaganda or pretend that the treatments are “opinions”, and continue to wallow with joy in the idea that there is no precise cure because they are ideologically convinced that they should not be a medical cure.
This is the danger and the greatest limitation, that instead of sticking to partial data one always keeps science at the level of political debate, in which it is a question of how one sees it.
Meanwhile, let him clarify what he means by “doctor” in quotes.
# 9
The user’s account is deleted for violation of the guidelines
Best regards
staff @ medicitalia.
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