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Can I keep my friend from becoming a junkie?
June 4, 2012 8:19 AM   Subscribe

A close friend recently revealed to me that she's been using heroin on occasion. She is unconcerned; I am freaking out. I need advice on how to handle this, or if I can.

She has experimented with various drugs over the years, as have I, but heroin always seemed like a "hard drug" which we would never touch. I didn't know she had tried it, let alone used it on a regular basis and I was honestly shocked and at a loss about what to say.

She thinks it is no big deal as it has had no real effect on her life (she is 27, owns her apartment, has a good job) and she only uses on weekends. She has only been using for a few months. She smokes or snorts it, never any needles, because it is "safer". She considers it a recreational pursuit much like we used to take ecstasy or acid in college, and points out that back then I took Oxycontin, Vicodin, etc. which are opiates too.

I beg to differ...I am not into drugs anymore and I believe anything beyond cannabis/psychedelics is bad news in the long run. But I think heroin is one of the scariest drugs except for meth or crack. More importantly I think heroin is a much greater risk than borrowing someone's prescription pain pills because who knows what you're getting on the street? I am scared shitless that she will screw up her life, OD, or end up with something like toxic leukoencephalopathy. I'm afraid of losing her.

1. Am I overreacting here? Just how much danger is she in?

2. Is there anything I CAN do to convince her to stop? Is it even worth trying? I feel like I have to make a move now before this progresses into full-blown addiction.

3. Beyond that, is there any "harm reduction" type advice I can give her on how to do it in the safest way possible?
posted by anonymous to Human Relations (38 answers total) 4 users marked this as a favorite
 
The harm is real. It is a dangerous drug.

You and her are having the "But you used XYZ so I can use ABC" argument. That's the wrong argument. If you smoked crack her smoking heroin would not become "healthier"

You can of course attempt to intervene in her choices, and it is always worth it. Even if it doesn't work. Full blown addiction is a very real possibility with occasional heroin use. So take the steps to help your friend. This is an Intervention level drug in my book, as someone who has had to be a part of stage several interventions I know this can be tough. People may hate you for doing so but they will be alive to hate you.

Memail me if you want to discuss off the record.
posted by French Fry at 8:27 AM on June 4, 2012


You're not really overreacting. Everyone I know who has dabbled with heroin has ended up doing it for years. The idea that someone old enough to know better would voluntarily begin using is pretty appalling.

Don't instruct her on how to do heroin safely. She won't listen, and anyhow it sends the wrong message -- that there is a way to enjoy this drug that isn't harmful. Let her know one last time that it's an insanely risky habit to adopt (and yes, even doing it "just on the weekends" is a habit) and that while you love her, you refuse to accept this as harmless recreational drug use. Don't let yourself get drawn into a debate about the relative safety of other drugs and activities. This is straight-up stupidity on her part.

And after that, there's precious little you can actually do if you want to keep the friendship.
posted by hermitosis at 8:30 AM on June 4, 2012 [4 favorites]


1. Am I overreacting here? Just how much danger is she in?

You have reason to be worried. She could OD or get hooked.

2. Is there anything I CAN do to convince her to stop? Is it even worth trying? I feel like I have to make a move now before this progresses into full-blown addiction.

You can't help. People make their own decisions.

3. Beyond that, is there any "harm reduction" type advice I can give her on how to do it in the safest way possible?

Worry about you, not her. You can't keep her from harm. You can, however, start putting some distance in between yourself and your friend. She's making some bad decisions that you can't change. What you can do is start drawing some firm boundaries. Keep your friend at arm's length. That may seem harsh, but if her experiment with smack becomes something more then you're going to need to have an exit strategy because there's no worse feeling in the world than seeing someone you care about fall apart and knowing you can't do anything about it.
posted by dortmunder at 8:32 AM on June 4, 2012 [1 favorite]


I'm pretty sure every junkie has at one point said "It's no big deal, it hasn't effected my life".

I knew someone who didn't start until his 40s, but ended up losing his until-then successful business, house, vehicles, etc.
posted by backwards guitar at 8:50 AM on June 4, 2012 [3 favorites]


Unlike other drugs, there is no such thing as casual, regular use of opiates. She will get addicted. It is a biological law. This is not a matter of will power or self control like pot or alcohol or cocaine or speed or ecstasy. She will be unable to live without it.
posted by empath at 8:51 AM on June 4, 2012 [2 favorites]


You can of course attempt to intervene in her choices, and it is always worth it.

Didn't you mean never?

I guess you can try an intervention, but since there are (as of yet) no real world consequences here and she is convinced it's just casual, I see little hope of success and don't even think it's your right to do so. You can't make someone's choices for them, which is generally a good thing, but you can let your friend know you'll be there if she needs help quitting or has quit.

"Friend, I'm very concerned about this. I just can't watch you do this, and it's a medical fact that you will get addicted to this drug no matter how casually you believe you're using it. If you want help quitting, I will do whatever I can for you, but I can't be a part of your life while you're using heroin."

I know this is a shitty situation, I'm sorry. Then again, maybe I'm wrong about cutting yourself out because you could be a support system.. but until she wants help, there is no help you could provide. Since you can help yourself by not watching your friend do a bad thing, I would do that.
posted by OnTheLastCastle at 8:57 AM on June 4, 2012 [3 favorites]


I have a friend who's a cocaine addict and has been for years. They feel that their use is purely recreational. I feel that their use is habitual and that they would not be able to stop without serious medical intervention. We do not currently discuss it, as the one conversation I broached on the subject years ago ended in a pretty nasty fight. In spite of my concern for them and my distaste for their habit, I love them and want them in my life.

What I do is strictly limit my interaction with this friend. I can't make them quit by giving them some kind of impassioned plea about the dangers of cocaine. I can't make them quit by reinforcing to them how much I care about them and want for them only the best; they know this and it makes little difference to their rational brain because their addictive brain is the brain that's in the driver's seat and has been for some time. Still, they're highly intelligent, functional, gainfully employed in an industry where "recreational" drug use is no biggie, and still relatively young, so their addiction is not costing them all that much, according to their own logic. I, being several years older, know that aging and genetics alone will take a noticeable toll in a few years but, again, none of us can be told this. We just have to experience it for ourselves. All I can do is have consistent limits. Here is what they are:

- They are never a guest in my home because the one time I had them over for a holiday dinner they got very drunk and snorted up in my bathroom. So, no more invitations to my house. This has never been explicitly stated; I just don't invite them over anymore. They know why.

- Before we go out for dinner, I determine when I'm going to be in a cab or on the train home. Again, I don't discuss this with them, I just say, "I'd like to meet early so I can be home by X time." Then, I adhere to that. I limit my alcohol intake; I've found that this makes them less apt to go completely hog wild because I'm not a fun "playmate" in this way. They rarely push me and, if they do, I laugh it off, take a little teasing for being "an old lady" and then leave.

- I don't go out to social gatherings with them. I only ever see them one on one. This is easy, actually, because I'm a homebody and not much fun, say, at a huge loft party.

- We see each other perhaps a two or three times a year rather than the several times a month we used to see each other.

It's up to you to set limits with your friend. If you have a moral or philosophical issue with their drug use, and you have no wish for further contact with them, I personally wouldn't give them a big speech about it. I'd try to be compassionate but mostly unavailable when they wish to hang out. They'll know why. Speeches aren't going to help, anyway. They'll stop when it starts costing them, or they won't. You really don't have much say, I'm afraid.
posted by TryTheTilapia at 8:57 AM on June 4, 2012 [13 favorites]


I'm sorry. I don't think you're overreacting, either. Hard drugs are scary and dangerous. I don't think there is much you can do to change her behavior, though; just tell her one last time you care about her and are worried and try not to bring it up again. Lecturing her about things she certainly already knows is only going to drive her away.

I think the real decision you need to make at this point is how supportive you want to be of her while she's living this lifestyle. It can be really hard to watch someone actively making terrible, life-ruining decisions. I've had to cut someone very dear to me out of my life completely because it was too painful for me to watch him kill himself with substance abuse.
posted by something something at 8:59 AM on June 4, 2012


Yikes. I agree with dortmunder.

Does she know the medical research on heroin use? If not, perhaps send some of that her way, especially if you can find any that compares heroin use to "milder" drugs like marijuana or LSD. Otherwise... well, I'm generally not a fan of ultimatums, but in this case I think it's warranted.

Maybe the standard Intervention-esque speech: "I really care about you, and I'm very very worried that you've started using heroin. I know that you truly believe that your usage is safe and within your control, and I know that you're a smart, capable, mature person. But I've seen too many lives fall apart due to drug use, and I know too much about how bad and addictive heroin is, and I don't want that to happen to you. Obviously you're a grown up and I can't tell you what to do. But I do need to tell you that, if you continue your usage, I cannot be your friend anymore. I can't, and won't, have this drug in my life.

I love you, and I really want our friendship to continue. I hope you understand that this comes from a place of caring and concern, and that it's difficult for me to say. But I can't be a part of this."

Good luck to you, I hope your friend smartens up.
posted by miss_kitty_fantastico at 9:00 AM on June 4, 2012 [3 favorites]


Adding to the echo chambers that your concerns are very real about heroin vs. other opiates - one of my friends started out doing Oxycontin on the weekends, and later graduated to heroin. His wake-up call came when he had a heart attack (at 28) as a result of impurities from the cheap street stuff he was getting building up in his arteries. He was incredibly lucky to survive, and would have died if his neighbor hadn't found him immediately. This is just one anecdote among many, and I don't know if you can convince your friend, but it's probably worth it to not stop trying... Heroin is bad news.
posted by permiechickie at 9:06 AM on June 4, 2012


I don't think very many heroin addicts start out planning to get hooked. I think most of them figure they'll just do it on the weekends. One morning they realize they don't want the drug to feel high, they need the drug not to feel terrible. That's addiction.

I would urge her to go visit a drug abuse 12-step program. Maybe go with her, if you can get her to go along with you. Just to check it out. Just to hear the stories. Because I bet a lot of them start with weekend recreational use.

My own experience with opiates is limited to Fentanyl I was prescribed for excruciating shoulder pain. (I tore my rotator cuff.) What I learned: it is very, very hard to get off opiates. It takes a lot of willpower, and you have to be willing to spend a lot of time feeling really crappy.

You might check out a 12-step program for partners of substance abusers. You're not her partner, but you might want to hear the stories, so you know what patterns to look for in your own relationship as your friend almost inevitable spirals downwards.
posted by musofire at 9:18 AM on June 4, 2012


To clarify my first post: I don't believe it is always a good idea to intervene in other people's lives.

I believe it is a Good Idea to intervene in the lives of people you love who start using heroin.

Here's why: With heroin there is often not a rock bottom, there is often not a later, there is very rarely even a long drawn out trainspotting-esque decay. It can just kill you. At least that is my experience going through high school and college during local heroin booms.

I think both camps of suggestions "do something now" or "get the heck out" up-thread are really valid. It's all about how this person fits into your life. I've been in both camps, seeing this happen to family and also to friends who I knew well but not intimately.
posted by French Fry at 9:19 AM on June 4, 2012 [1 favorite]


Heroin is bad news indeed and your concern is warranted. Most heroin addicts begin by "chipping" (casual use) like your friend. I was once close to someone who became addicted this way. He became sick with flu-like symptoms one day, and assumed he just had a virus, but it was actually heroin withdrawal. That was the turning point. He ended up using daily just to not stay sick. He pawned all his guitars (he was a pro musician) and lost the respect and support of his parents. He dropped out of college at 19 and to this day, 11 years later, has not returned. His junkie period was late teens-early 20s, and he missed out on an incredible musical opportunity then that he still regrets. He developed dishonest personality characteristics and a short temper that remain to this day. He's now 30, and had to take methadone for years which made him sleepy all the time, messed with his testosterone level, and caused hypothyroidism. They don't tell you these risks at the clinic. Now he's off all opiates and trying to rebuild his life and it's hard.

I helped this person recover, and the emotional and financial costs to me weren't worth it. Tread carefully and memail me if you like.
posted by xenophile at 9:23 AM on June 4, 2012


Sorry to hear about your friend, and I've been in your shoes of caring about friends in these tought spots. Not to get into semantics or an arguement, but oxys and other strong opiates can be just as "hard" as heroin. I've seen the path those can lead.
Full disclosure, I do dabble time to time with opiates that are not scripted to me. I recognize the dangers, i only send this message as you made a line of heroin, a street drug being hard when those other opiates can be just as dangerous. Difference being one is at least pure, and calculated doses and the other being who the hell knows.

I had one of my childhood friends go down this road. I had to cut them off. Another friend I made during undergrad started the H train, and lost everything. It was quite sad. He always wondered why his stuff was stolen (he hung out with junkies, and was found OD'd in a car in a McDonalds parking lot in Detroit). I have always been fine with people making their own decisions, and am generally very liberal towards drug/chemical use, but I've seen what happens when people loose control. Its hard, sad, and like your friend, wouldnt see the direct, very immediate danger they are putting themselves in. I generally cut ties as I dont want to be collateral damage.

Offer help, express your concern, but that is about all you can do.
posted by handbanana at 9:37 AM on June 4, 2012 [1 favorite]


Ask her if there's a point at which it makes sense to bring it up again with her. What WOULD be the warning signs if she started having problems, and get her to agree that you are allowed to bring it up with her if any of those things happen.

And then do it. And when she changes the warning signs, you tell her that her use is affecting your relationship with her. THAT is one of the signs, by the way -- if it affects her relationships.
posted by vitabellosi at 9:40 AM on June 4, 2012 [4 favorites]


Unlike other drugs, there is no such thing as casual, regular use of opiates. She will get addicted. It is a biological law.

This is not true. The "biological" factors that couple with heroin addiction are high, but they're in the same ballpark as alcohol and nicotine. You're saying there's "no such thing" as a drinker or smoker who kept the habit under control. It's hard, maybe unlikely, and usage usually increases (particularly since there's no reliability in dosage or supply), but the demon-drug version of the story is just not true.

(Same with the other current demon drugs, crack and meth, for what it's worth. You almost certainly know several people who have used them and not turned into helpless drug fiends.)

Nobody knows exactly how addiction works. We have a lot of peripheral data and huge multi-dimensional predictive models, but nothing iron-clad. Your friend is, however, toying with a drug with a well-worn addiction path, and running serious risks of impurity, unknown dose, use off the record (so nobody to monitor her increasing dependence and no support for withdrawal), high costs and severe legal penalties. It will be much harder to kick than ecstasy or acid. Ask her if she's tried going off for a couple months to test it. Ask her what she knows about the drug! Lots of people have no idea what they're getting into, when they start using a drug.

I'd recommend approaching this with a cool head and a lot of facts. Like, from actual drug and addiction researchers, who can put it in context and help your friend realize exactly what she's doing, rather than come across as a state propagandist or scare-monger.
posted by ead at 9:49 AM on June 4, 2012 [18 favorites]


The only thing you can do is not enabler her.
Never lie for her. Never cover up her drug use. Never make excuses.
Don't give her money. Don't give her a place to sleep.

Beyond not being an enabler - there is not much you can do.
posted by Flood at 10:07 AM on June 4, 2012


[A couple comments removed; this needs to not turn into a side-argument.]
posted by cortex at 10:21 AM on June 4, 2012


Given the large amount of non-fact-based anti-drug hysteria in the world, many drug users tend (rightly or wrongly) to dismiss condemnations of their drug of choice that seem overly black-and-white or based in anecdote. I suggest that you approach your friend with as evidence-based arguments whenever possible. This will hopefully help her see that your concerns are well-founded and not dismiss them as propaganda.

Here are some government statistics on heroin use and addiction (from 2003, but I'm sure there are newer ones out there somewhere). This states that 57% of people who used within the last year meet criteria for dependence, but of the 3.7 million people who have used at some point in their lives, only 119,000 of them used in the month prior to the survey. My interpretation of these numbers is that the risk for addiction is substantial and your concern is justified, but the idea that everyone who uses heroin is inevitably destined to become an addict is not accurate.

I disagree with the idea that you shouldn't give her harm reduction advice because it gives a false perception that heroin is safe. I don't have time to dig for the research right now, but when I was last reading about this there wasn't much evidence for that claim, and there's a lot of evidence that harm reduction programs don't increase drug use rates and succeed in reducing overdoses etc. Plus, you can explicitly guard against that possibility by telling her that less dangerous != safe.

As far as specific harm reduction advice, I'm speculating here, but maybe suggest that she try to buy from a single source that she trusts rather than sketchy strangers on the street, and that she always tries a small dose from each new batch first so that she'll know if it's unexpectedly potent? Or encourage her not to use alone, if possible?

vitabellosi's suggestion is also really good, I think.
posted by introcosm at 10:42 AM on June 4, 2012 [3 favorites]


never any needles, because it is "safer". She considers it a recreational pursuit much like we used to take ecstasy or acid in college, and points out that back then I took Oxycontin, Vicodin, etc. which are opiates too.

If you can make it at all plausible -- I'd be tempted to tell her that those were drugs you stopped because they were causing problems for you, even if it's not entirely true. And the problems you had giving them up. That would model the kinds of decision making she could engage in.

"actually, I stopped those drugs because they were interfering with my life. I couldn't get to work on time, I wasted whole days being on them or recovering from them."

Get her to be really specific about what it looks like to have a problem with it, so there's a chance she'll recognize it.
posted by vitabellosi at 11:00 AM on June 4, 2012


A few suggestions/observations. There are things you can do if you choose to try to help. The usual caveat, I work in a substance abuse treatment center blah blah blah.

The recognition that drug use is causing problems and that drug use is out of control are usually the two things that usually drive people to want to stop and to get help.

It does not sound like she's there yet because right now her drug use may not be causing problems and she can control her use. This is the internal view. The external view is everyone standing on the outside who can see the train wreck coming and wanting to stop it. This is skipping to the end. It's usually not very effective for others to do this. Keep in mind that it is possible she'll do this for herself. It does happen.

My best suggestion is to not skip to the end but try to plant seeds now that may help nudge her towards an earlier understanding of her own threshold for loosing control over her use and losing control over the problems it's causing.

One way to do this is to go along with her claims that her use isn't problematic right now and that she's still in control. Something like: okay friend, tell me how you will know if this starts to get out of hand, tell me your flags? Would it be you use in the middle of the week, spend more than x amount of money on the drug, can't wait for the weekend to start etc. What signs might I see? Try to encourage really specific answers. Ask: what do you want me to do if I see these signs? If the flags emerge, reinforce them and remind her that she gave you permission to do whatever.

Most substance abusers make lots of elaborate contracts with themselves about their use and most start moving the line of those contracts up and up as an addiction progresses. The idea is to make those contracts explicit, spoken out loud and to get some buy in from the person that it's okay to point out the discrepancies between what they promised themselves and what they're doing.

The other idea is to start planing seeds now that define problematic use internally. It is really common to define addiction comparatively - i.e. someone is truly addicted when they use more than I do, have lost more than I have and their life is far worse than mine. This is part of what drives the functional addict myth and the well, at I'm using pills and not heroin or I'm smoking but I don't shoot minimization.

This is harm reduction. It is not insisting she stop now, it's helping cultivate and reinforce her own definition of a problem. It's not inundating her with facts and data and science or convincing her that a train wreck is inevitable. All the facts, science and data can't convince someone they aren't the exception to the rule. Only experience and attention can do that.

As for you, I would do the same thing. Ask yourself now how you will know if/when you're getting in too deep with her. Ask yourself now who you can turn to to give you a self-check on trying to come to her rescue at your own expense.

Good luck.
posted by space_cookie at 11:13 AM on June 4, 2012 [11 favorites]


Or. what vitabellosi said with fewer words.
posted by space_cookie at 11:14 AM on June 4, 2012


Maybe the standard Intervention-esque speech: "I really care about you, and I'm very very worried that you've started using heroin. I know that you truly believe that your usage is safe and within your control, and I know that you're a smart, capable, mature person. But I've seen too many lives fall apart due to drug use, and I know too much about how bad and addictive heroin is, and I don't want that to happen to you. O

Unless, you know, you haven't seen a bunch of lives ruined by heroin and you're making it all up in which case she will ignore you. A lot of people get all dramatic about drug use. In reality a persons problems are generally deeper than that. A vanishingly small number of people with totea awesome lives up and start shooting dope for fun, then throw it all away and end up on the street. Most have significant issues that are apparent long beforehand. I suggest you focus on these issues if you want to help your friend. Did she just have a breakup, or hook up with a bad guy? Does she have problems with depression or chronic pain? Is she a crazy risk taker? These are all things you can discuss that are going to help a lot more than a Just Say No lecture. Also can you provide some alternative activities a few weekends? A lot of people just get high because they're bored.

I just had a Come To Jesus talk with a friend about her use of prescription medication but I didn't focus on the meds. I told her we were all real concerned about that but mostly we were real concerned that she was so unhappy she was starting to abuse them. She's had very significant life stresses and we brainstormes better ways to deal and to help her cope with loneliness and stress. Then I roped a bunch of people in and she's pretty much too busy to wallow at this point.
posted by fshgrl at 11:49 AM on June 4, 2012


As a recovering addict, the scenario you describe sets off a lot of alarm bells. My main question would be what are her motives in telling you she has this 'hobby'? In active addition, my motive would have been to encourage someone to join me. Sounds sick, but it is the truth. And of course I would say its no big deal, because I wanted something from you like money, and if you came along it made me feel like I wasn't doing something so bad.

There are plenty of places she can get help. Save yourself and run.
posted by heatherly at 11:53 AM on June 4, 2012 [1 favorite]


There are a couple of theories about addiction that might be useful for you consider. Stages of Change is a model that recognizes that people who are using substances are in different places in terms of addressing it. The first stage, where it sounds like your friend is at, is called Precontemplation. These folks do not see that there is a problem, so interventions about the urgent need to stop are inappropriate and will be dismissed.

The interventions that are helpful with Precontemplators are aimed at moving the person to the next stage, that of Contemplation, considering that indeed there *might* be a problem. Such interventions are usually things like helping the person notice the problems that their use might be creating for them, e.g., that they are spending more money than they thought, that they are using more than they thought, that they are using different avenues to get high (going from snorting to smoking to shooting), that they were late to work x number of times, that they had a really scary run in with their dealer, that they are losing friends, etc.

If a person starts to consider that there might indeed be a problem, they are much more amenable to considering making changes, which is the next stage, called Preparation. After that the stages are Taking Action and Maintenence.

Research and practice suggests that it's ineffective to try to get people to take action if they don't even consider that they have a problem.

The other theory that you might want to know about is Harm Reduction. It's tricky to talk about, as some people consider that it looks a lot like enabling. The basic idea is that people are going to use, so they might benefit from using safely. This movement gives rise to needle exchanges, for example. Harm reduction focuses on things like not driving while high, avoiding unprotected sex while intoxicated, etc.

It's a very touchy subject - people have *VERY* strong feelings about substance use and the best way to deal with it. But harm reduction as a policy is is aimed at trying to keep users safe, rather than promoting an idea that users should necessarily suffer consequences because they use.
posted by jasper411 at 12:11 PM on June 4, 2012 [2 favorites]


How long has she been doing this? And how often? And how does she talk about it? And where does she get it? Is she the kind of person who is impulsive or takes needless risks in other areas of her life? Does she understand the risks? And is she the kind of person that you could imagine becoming addicted? Does she smoke cigarettes? If she can't use any drugs for a month, would this be a major catastrophe in her life?

First of all, you can get addicted without ever using needles, I know of such people. But not everyone who dabbles with heroin will be such a person. I know because I once was one. Yes, it's possible, though they don't make movies about such people. Most users of opiates for pain relief never become addicted. It's not inherently more addictive than the other drugs you and she took and cultural factors and what is going on with her life are relevant. It may not be a big deal. It wasn't for me. If she's been doing it occasionally for a long time and not increasing her amounts or frequency and it's not interfering with her life otherwise, she might be fine.
posted by Obscure Reference at 12:39 PM on June 4, 2012 [1 favorite]


Or. what vitabellosi said with fewer words.

It's interesting that we arrive at the same advice from slightly different perspectives. I hadn't thought of it as harm reduction. I've seen it used as a way for people with mental illness to give "advance directives" to peer supporters for how they want to be treated if they have an episode or a return of symptoms like delusions. They give permission to be approached and express their preferences. Sometimes these are peer-led locations as an alternative to hospitalization, often with volunteer nurses and clinicians.

I like the idea of advance directives (can be things like -- don't touch me, or you're allowed to touch my hands but don't grab me by the shoulder). Especially because it engages the person in identifying what would be a problem -- when is it okay to intervene? What can the intervention look like?
posted by vitabellosi at 1:37 PM on June 4, 2012


Is there a significant other in the picture that is pushing her down this path?
posted by gjc at 2:12 PM on June 4, 2012


I'm not saying whether you should be concerned or not; that's your call. I probably would be in your shoes.

However, evidence (As opposed to rich anecdote) suggests that the large majority of people who try heroin do not become addicted in the sense that most people think of it. Additionally, research suggests that heroin is certainly addictive, but not uniquely so - further, I know credible people working in drug policy who have asserted that cigarettes are as or more addictive than heroin, to give you an idea of things.

These numbers are hard to track, especially because govt and society has encouraged us to demonise drug users and particular drugs, which makes self-reporting and other figures difficult to ascertain. I am not trying to minimise the risks that heroin may represent to your friend, but I am saying that the risks you perceive of heroin have been shaped more by social and political forces, than medical epidemiological evidence. In some cases the gulf between the two is large, in some cases small, but I would recommend doing some more research yourself. If nothing else, the knowledge will comfort you I think, and also give you a more nuanced understanding and armory of facts with which you can help your friend should she need it.
posted by smoke at 3:54 PM on June 4, 2012


I'm pretty sure every junkie has at one point said "It's no big deal, it hasn't effected my life".

So has every alcoholic, though. Obviously most people don't intend to get hooked to whatever substance they start enjoying. Logically, the fact that every junkie starts as a casual user does not necessitate that every casual user becomes a junkie.

Unlike other drugs, there is no such thing as casual, regular use of opiates. She will get addicted. It is a biological law.

That's a bit of an exaggeration. At very least there are definitely people who use heroin for a while and stop without the intervention/ 12-step / life-falling-apart part. Maybe they are "functioning addicts" who are good at going through the withdrawal on their own, or maybe they are casual users who decide to stop using, but either way, heroin does not have to be seen as mythically omnipotent. It is dangerous, like cocaine, and like the various opiates you mention, but it doesn't need to be romanticized as an inescapable abyss.

You could always advise her to make sure she can go without for a few weeks so that she can check that withdrawal isn't becoming painful. Or you can just make it clear you think she is making a mistake, and if you see signs it is affecting her life, intervene. But it is possible she will stop on her own. A lot depends on her personality and attitude and specific dna and what else is going on in her life, just as with any other drug.
posted by mdn at 4:29 PM on June 4, 2012 [1 favorite]


I also strongly recommend the Stages of Change model. It asks a lot of you, the friend, because at this point, it's asking you *not* to give advice, *not* to try and change behavior, just to listen. However, listening coupled with the kind of conversation space_cookie suggests, where you ask her to define how she'd know if she had a problem, could get her actively involved in thinking about her use and ways to reduce possible harm.
posted by epj at 5:07 PM on June 4, 2012


It sounds like you really care about your friend and you're freaked out about her behavior. It also sounds like she trusts you enough to share this information with you.

I want to address your harm reduction question. Good for your friend for smoking or snorting. That does reduce some of the potential harms that can come from sharing injecting equipment. One of the most significant dangers from opiate use, whether vicodin or heroin, is overdose. Please make sure that you and your friend know how to identify the signs of overdose and how to respond. If at all possible, get her to get a prescription for naloxone and make sure that people who may be around when she is using heroin know how to use it. Get one for yourself if you can.

Naloxone is very safe and very effective at reversing opiate overdoses. It unfortunately is sometimes hard to get a prescription for, depending on what state you're in.

I want to add that I do in fact know quite a few people who have used heroin a handful of times and no longer do. The majority of people who try heroin do not become addicted. That doesn't mean that you're wrong to be concerned about your friend, but just that there's no inexorable slide from one smoke into a life of addiction.
posted by gingerbeer at 6:33 PM on June 4, 2012 [1 favorite]


Some anecdata, which may or may not be of use: there was a flood of cheap heroin in Sydney in the 1990s, and living in the inner city as I do, I've known a fair number of people who've used the drug. To be more specific, I'm speaking of maybe around a few dozen; those kinds of numbers.

On the downside, 3 are now dead from overdoses, that I know of. They weren't part of some hardcore junkie clique, and I doubt they even knew each other: one was an ex- housemate, another a casual acquaintance from clubbing circles, and the third a friend-of-a-friend muso who reportedly committed suicide rather than facing gaol after being caught stealing too many times.

On the upside, everybody else who I still have any idea about seems to be living a normal life with a regular job. Whether they still use or not I wouldn't know. Those were student days, and circles move & change; I don't have much contact with more than a small handful of people from those times, but occasionally you see on facebook etc that somebody's still alive & kicking.

For the most part, the casual users would generally do so on the same kind of pattern as your friend, eg every weekend or two. The 'wisdom', commonly held, was that they could avoid physical addiction as long as they never used more than 2-3 days in a row, and then had a decent break in between to "clear it out of their system". WARNING: I am not saying this is true; just reporting what people believed.

You'd hear from time to time about somebody who was sliding out of control, but to their credit they generally pulled themselves out of it again, maybe to relapse later & repeat the pattern. People pawned a lot of their stuff, but (other than the muso guy mentioned earlier) I'm not aware of anybody descending into petty crime or prostitution etc.

So yeah, it's not necessarily all doom & gloom, but it's not a lot of fun watching people walking a tightrope like that. Keep an eye on your possessions, and try to advise your friend never to use when drinking or on any other kinds of depressants.
posted by UbuRoivas at 7:20 PM on June 4, 2012


Correction: on afterthought, a couple of the girls worked as dominatrices. Obviously, if any others did any kind of sex work to support their habits, it's not the kind of thing they would've necessarily shared with everybody. Ditto for any petty crime. So, my anecdata may be biased from lack of complete evidence.
posted by UbuRoivas at 7:26 PM on June 4, 2012


However, evidence (As opposed to rich anecdote) suggests that the large majority of people who try heroin do not become addicted in the sense that most people think of it. Additionally, research suggests that heroin is certainly addictive, but not uniquely so - further, I know credible people working in drug policy who have asserted that cigarettes are as or more addictive than heroin, to give you an idea of things.

This doesn't really have the intended effect, because cigarettes are HIGHLY addictive, so anything else that is even nearby on the addictiveness spectrum is also highly addictive. It's just that cigarettes are way less likely to kill you in the short term. Plus, cigarettes don't have the addictiveness add-on of the flu-like symptoms and nausea during withdrawal.

Anyway, this isn't the case of someone just trying it once and giving it up. This is someone with a full blown habit. It just isn't a daily habit. Yet.

These numbers are hard to track, especially because govt and society has encouraged us to demonise drug users and particular drugs, which makes self-reporting and other figures difficult to ascertain. I am not trying to minimise the risks that heroin may represent to your friend, but I am saying that the risks you perceive of heroin have been shaped more by social and political forces, than medical epidemiological evidence. In some cases the gulf between the two is large, in some cases small, but I would recommend doing some more research yourself. If nothing else, the knowledge will comfort you I think, and also give you a more nuanced understanding and armory of facts with which you can help your friend should she need it.


No, you ARE trying to minimize the risks. You are saying the risks aren't as bad as everyone says. This may be true, but it is not helpful here. Heroin might not be the worst thing out there, but it is still pretty goddamned bad. And any implication that it isn't is basically long-distance codependence.
posted by gjc at 7:31 PM on June 4, 2012 [1 favorite]


All I'm saying is that public perception of heroin use, and heroin users, is different to actual heroin use, and heroin users - and such perceptions are often built more around highly visible examples, or cliches from popular media. There is overlap, naturally, but the perception is inaccurate. This is not controversial.

Recognising that there's more to heroin use than Requiem For Dream will be helpful for the OP in understanding what his friend is likely experiencing, and in assessing the risks she is exposed to, and how to help reduce them, or offer assistance.
posted by smoke at 9:08 PM on June 4, 2012 [1 favorite]


This doesn't really have the intended effect, because cigarettes are HIGHLY addictive, so anything else that is even nearby on the addictiveness spectrum is also highly addictive. It's just that cigarettes are way less likely to kill you in the short term.

They're also ubiquitously available, at a price affordable to just about anybody, without people having to associate with criminal types or risk police attention, or indulge in crime themselves to feed their habit. Also, there's vanishingly close to zero risk that a single cigarette will kill you instantly because it's stronger than your regular brand, or adulterated with something nastier than usual.

You can't really compare the addictiveness of the two unless you raise the bar significantly for participation in the cigarette habit.
posted by UbuRoivas at 9:24 PM on June 4, 2012


[Let's not become sidetracked with the cigarettes vs heroin relative addictiveness question, please -- and everyone needs to just generally avoid debating other posters' comments. This needs to be a thread of answers addressing the OP's questions, and not a discussion among commenters. Thanks.]
posted by taz at 1:53 AM on June 5, 2012


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