Could legalising heroin end overdoses?

Fast Forward does not support or oppose the legalisation or use of any substances. Research and information are taken from the following peer-reviewed article:

Darke, S. & F. Michael (2013): Would legalizing illicit opioids reduce overdose fatalities? Implications from a natural experiment.

Could legalising heroin end overdoses? The answer is: It depends.

There’s little research on what would happen if heroin users had access to medically sanctioned (i.e. ‘safe’) heroin which they would take on the premises, monitored by healthcare staff – we’ll get to this later.

As for medically sanctioned heroin which users would be free to take in their own free time, an interesting ‘natural experiment’ that occurred in the Appalachian Mountains between 2002 and 2009 could give us some idea of exactly what might happen if heroin were legalised.

But before we get to that, let’s talk about overdosing.

Strength, Purity and Taking Too Much

There’s a common misconception that ‘overdosing’ on heroin is something that happens when you take more of it than your body can handle; that this is common when the strength of the heroin is higher than normal; and that dangerous substances that heroin is ‘cut’ with are often what is really responsible for causing fatalities.

Here’s the reality: Overdosing isn’t simply a matter of taking ‘too much’. If this were the case, it stands to reason that most heroin fatalities would happen with relatively inexperienced, younger users. But it doesn’t.

The hard facts show that in the vast majority of heroin related fatalities the deceased were older, long-term users who also had heady mixtures of alcohol and benzodiazepines in their systems. Meanwhile, studies show that unusually high purity and or dangerous concoctions of heroin available on the street generally has very little effect on the number of fatalities.

In other words, ‘overdosing’ is the word we conveniently (and erroneously) use instead of ‘dying from taking heroin while already under the influence of powerful depressants that slow down respiratory and cardiovascular functions.’

Welcome to Appalachia

Let’s return to the natural experiment mentioned above. Between 2002 and 2009, the legal sale and prescription of pharmaceutical opioids, especially a drug called Oxycodone, tripled in the USA. Though it was initially prescribed as a powerful medicinal painkiller, enough people soon discovered that you could use it illicitly.

Demand grew. You could buy it for much less than heroin, and in a lot of places it was far more readily available. You could probably get it from your doctor with a well-rehearsed script, then you could take it all yourself or sell it on for as much as $1,000 per pack.

With all this medically sanctioned, pre-packaged heroin substitute floating around, free from impurities and of known concentration, you’d have expected the number of deaths (from ‘overdoses’) to drop significantly. After all, Hillbilly Heroin – as it came to be known – was as safe as safe could get. You always knew how much you were taking (it was written on the packet/pill), and you knew there was nothing nasty in it (since the pharmaceutical companies had manufactured it).

Instead, deaths increased by a staggering 124%.

Why should this be the case? The Oxycodone-related deaths were more or less identical to those attributed to heroin; the vast number of fatalities were older, long-term users, who had been drinking heavily or taking other depressants, leading to cardio-vascular and/or respiratory failure. All that had changed in this case, arguably, was the availability and widespread use of the drug.

What does it all mean?

It means that arguing for the legalisation of heroin on the basis that it would bring down numbers of overdoses is based upon two false misconceptions: That overdoses are a result of variations in the purity (strength) of the heroin available on the street, and that overdoses occur when there are dangerous impurities in the substance. Neither of these assumptions stand up to much scrutiny.

So what if there were centres where users could legally inject heroin, supervised by medical staff? Two randomised trials from the UK and Switzerland have shown positive results, with fatalities being greatly reduced. The reason fatalities continued to occur at all could be due to facts about overdosing that the medical community still doesn’t understand; it’s also because heroin users can take alcohol and other depressants both before and after visiting the centres.

Bringing us to a final, short answer to the question ‘Would legalising heroin reduce overdoses’: If that meant that users were free to take it freely and in their own settings, then no.

 

For more information on heroin, visit Drugscope: http://www.drugscope.org.uk/resources/drugsearch/drugsearchpages/heroin