The point I made originally is that effective prohibition (as opposed to straight-out repression) hasn’t been tried in many countries, and when prohibition is actually conducted as one might expect it to be when one says “let’s ban drugs!”, it can work. Obviously not perfectly, but enough to prevent a lot of people getting easy or cheap access to a drug we don’t want them to.

Once we’re there, admitting this basic fact, we can examine the various different legal frameworks we can impose over the drug-filled society we’re going to have anyway, eh?

If it took a constitutional amendment to enforce prohibition of alcohol, why do we not require a constitutional amendment to prohibit other commonly available drugs?

After all, marijuana is a common weed, it grows nearly everywhere…

Jer

“We should just make Belle world dictator. The world would be more sensible, intelligent, stylish, and wacky.”

Throw in Tyler Cowen as your finance/culture/figuring out the pesky implementational details minister and hell, everyone would have a pony. Maybe everyone would BE a pony. I’d be happy.

In the former case (prescription heroin) rational health care systems will introduce it on the basis of its cost effectiveness – methadone for the majority of users, heroin for those whom methadone fails. The need to inject heroin 3 times a day means it is essentially impossible to hold down a job on a heroin prescription program (you can’t do your job if you’re on the nod). So in this regard it is only a treatment for addiction, not for all the lifestyle problems that go with it.

In the latter case (heroin legally available like alcohol) the need to prescribe treatment heroin 3 times a day should give you a hint – addicted users of this legally available heroin won’t be able to work. Also, the prices you gave are for prices the NHS paid, not retail prices, so it’s likely to go up in price considerably (especially if demand rises!) This latter situation – treating all recreational drugs like alcohol – tends to be the argument I have seen from libertarians*, which is what I was talking about in the last post. You won’t find any objections here about prescription heroin, which is an entirely different kettle of fish. But we need to get our terms right, because “heroin prescription” and “legalised heroin” (which is what your swivel-eyed mates want) are very different.

*since we’re doing this footnote thing now, I’ll try it too. It’s worth pondering under this scheme (legal heroin that is, not footnotes) exactly who will be selling this heroin. It won’t be your corner dope dealer, that’s for sure. You will be buying it from some kind of pharmaceutical conglomerate. I imagine the kind of company which sells a known deadly and highly addictive drug that kills nearly 1000 young Australians a year is likely to be quite a nasty company. I would think we are looking at a kind of bastard offspring of Big Tobacco and Big Pharmaceuticals, with a good moral contribution from the alcohol sector. I can’t imagine that such a company is going to be a force for social good. But it’s funny how libertarian policies always seem to point to the biggest, nastiest corporation on the block isn’t it?

Here’s one thing.

http://www.sid.u-net.com/monkey/i7a11.htm

” Diamorphine lasts about eight hours in the body, while methadone is effective for twenty-four hours. As they are both of similar potency, this means you have to prescribe about three times as much diamorphine per day as methadone. However, I usually find that someone on 100mg IV methadone is likely to require about 400mg diamorphine to be comfortable. This much diamorphine costs about £18 per day, or about £6,500 per year. Two 50mg methadone amps cost £4 per day, or about £1,500 per year. In both cases dispensing charges have to be added, which comes to about £500 a year (for daily dispensing). In other words, the diamorphine would cost the NHS £5000 per year more than the methadone amps. This kind of figure is not calculated to cause delight in our finance departments.

You are right that diamorphine is much cheaper if it is dispensed in the form of powder. 400mg costs £2.60 per day, or £950 a year; not much difference from methadone mixture. We cannot prescribe it in this form for two reasons. Firstly, it is not guaranteed to be sterile. Therefore if you injected it and acquired an infection, you could rightly complain of poor medical practice. Secondly, the Home Office does not allow it. They argue that powder is more easily sold on than ampoules, because it can be readily cut down with other substances. I’m not sure they are right about this, because there is a ready market for diamorphine ampoules. Nonetheless, they are the ones who are in charge.”

And in the prices the NHS paid in 2001:

http://www.publications.doh.gov.uk/generics/index.htm

Diamorphine HCl Injection 100mg 5 Ampoules, £22.49

Diamorphine HCl Tablets 10mg 100 pieces £12.30.

Those two sets of prices seem to be comparable, 18 and 22 pounds a day for ampoules. It also seems that for directly injectable I was wrong about heroin being cheaper than the cost of a prescription: it’s about 3 times it.

From a purely pragmitic point of view, from the cost to the taxpayers, it looks as if it would be much cheaper to provide it for free to addicts rather than continue with this War on Drugs nonsense.

Of course, it’s not just slighly left wing governments which would bring in heroin prescription. I and my muckers at the Adam Smith Institute are usually regarded as swivel eyed loonies from the far Thatcherite right (slightly unfairly I feel, but that is how many regard us) and we’d do it too. Be the second thing on the list, right after hounding Polly Toynbee out of the country :-)*

*No, that is not the official policy of the ASI. Don’t be absurd.

But yes, I’d certainly prefer state funded heroin bars to the mess that is the current War on Drugs.

One point I should make: I’m from UK, you’re in Australia, so the details of the systems currently in place are different. My real scorn is for the (as I regard them) insane US laws on the subject, where doctors get jailed for “over prescribing” opiates.

Or if heroin bars goes to far for it actually to be practicable, why not registered addicts get it on prescription? Not, to my mind, quite the perfect solution but even then vastly better than what we have in either the US or UK.

I’d certainly prefer that to the current War on Drugs, yes. Perfectly happy to put the high falutin’ rhetoric aside for prgamatic solutions in the face of such absurdity.

“(Hint: think of a controversial study of a war zone).”

Ouch, don’t, I’m still stinging from the slapping I got around here over that.

As for the Dr. Marks experiment, you are presenting an age-old defense of substitution therapy. No-one (well, no-one in civilised countries) disputes the importance of substitution therapy, and in Australia substitution therapy is the first line of treatment for heroin addiction. As I mentioned above, we wanted to introduce heroin prescription as part of our approach to heroin addiction. The debate amongst professionals in this field concerns whether or not heroin or methadone are equally effective, so as to determine the best way to target each treatment, not whether or not we should not use heroin substitution. The problem with the Marks experiment is that he was the only source of prescription heroin in England, a lot of his clients had been on his program for a very long time, and it is likely that he had a highly self-selected group. The reality of substitution therapy is that the more widely you make it available, the less effective it becomes (as the self-selection effects are reduced). This is why no modern methadone program outside the US can reproduce the results of the 70s studies in the US - the progams have been extended beyond the highly committed treatment participants of those early trials, and suffer very high drop out (from memory of the data I saw, many programs in New South Wales, Australia, had woeful retention compared to those early US studies, which were the “gold standard”). All the effects described by Marks happen as a consequence of methadone substitution therapy, just not as dramatically – it is not unique to heroin. The heroin prescription he did does not serve in and of itself as an argument for legalisation, either, because he was running a treatment program, not a heroin bar. In order to believe that no-one would die using legalised heroin – similar to Marks’ unique results – you would need to be able to guarantee that they could take their drugs in a medically supervised environment. As a libertarian I’m sure you would object to government subsidised free heroin-injecting facilities just so dole-bludgers can have more fun, right? You’d want people to be able to pick their shot up and go home to have it with a beer, if that is the road they want to take to perdition, right? As soon as you allow this you are back to the naked truth – in 1999 in Australia, 980 people died of heroin overdose, from a suspected population of 74000. That’s 13 deaths per 1000, and we have some evidence that the death rate follows the price. Can you think of any other situations in recent memory where a population had an excess death rate anywhere near that high? (Hint: think of a controversial study of a war zone).