Over at NaPP, Burt has a post up about an utterly horrifying phenomenon (of which I knew nothing until today) occuring in Russia as a consequence of decreased heroin supply.  He writes:

The war in Afghanistan (remember that one?) clearly is resulting in, at long last, a decrease in the opium poppy trade, and the concomitant decrease in the global supply of recreational heroin. Apparently, heroin has become next to impossible to obtain in Russia, not from law enforcement activity but rather because there just isn’t enough of the stuff making it out of Afghanistan.


The invisible hand works in the illegal drug market in Russia the same way it works in markets for legitimate products in Western nations. Supply and demand are the drivers, and when demand is high and supply is low, the market will find a way to return to equilibrium. In the case of Russia’s heroin market, the void left by heroin’s sudden unavailability has led chemists to manufactue substitutes. To meet the void left in the illegal narcotics market, some genius in Russia has concocted “Krokodil“.

You can learn more about Krokodil by clicking on the embedded link.  In short, it’s an injectable narcotic compound created by cooking codeine (available without a prescription in Russia) and such other ingredients as lighter fluid and gasoline.  The effects on the body are gruesome, as one might expect when one considers what’s being injected.  There are no pictures in the linked article, but the descriptions are vivid enough.  Reading the article reminded me of a particularly grisly scene in “Infinite Jest,” during which an addict shoots up heroin adulterated with drain cleaner.  Krokodil doesn’t work quite so fast, but the end results seem about the same.  From the article:

Injection sites turn flesh grey, green and scaly until gangrene skin peels away and bone is exposed; it can lead to amputated limbs.

Photographs of addicts are shocking, to say the least. Exposed bone from wrist to elbow, arms look more like the half-devoured limbs of a zombie than a living human.


Burt rightly notes that making heroin more difficult to obtain has had little effect on the use on injectable narcotics by addicts.  In fact, successful interdiction of the comparatively safe heroin has led addicts to melt their bodies and brains away with a terrible chemical substitute.  Unless Russia’s desired drug policy is for addicts to more rapidly kill themselves off (an outcome the cynic in me does not find totally implausible), making heroin unobtainable has been worse than a failure, and actually created medical problems that would not otherwise have existed for this patient population.

In my experience, the legality of a substance has been incidental to an addict’s use.  Certainly people willing to inject themselves with a street drug of any kind have already crossed a threshold, and are willing to disregard personal well-being in pursuit of a high, with the law being the faintest forgotten consideration.  I imagine that more people would be willing to try marijuana if it were legal (and probably also cocaine), but I also suspect that most people who avoid heroin or crystal meth do so because they are really, really bad for you, not because they’re illegal.

Conversely, most people who drink alcohol do so safely and responsibly.  Some drink irresponsibly and suffer legal or social consequences.  But the number of people who die of cirrhosis, or who go into delirium tremens when they stop drinking is very small compared to the vast number of people who consume the substance.  Perhaps some small number of the comparatively very small number of severe alcoholics would have been spared this fate had alcohol been illegal, but it makes no sense to prohibit the majority from consuming alcohol to prevent the suffering of the minority.  It’s obvious that there’s more to becoming an alcoholic than simply being able to take a drink without legal incumbrance. 

People who want to use a substance will find a way to do so, as our failed national experiment with Prohibition demonstrated.  People who want to do drugs recreationally find a way to obtain them.  Addicts will go to whatever extreme necessary to get their fix.  Were heroin to be decriminalized, I have a hard time believing that many more people would use it.  By continuing our benighted war on drugs, we fail in our goal of significantly reducing addiction, and simply make the addicted more desperate.

Russell Saunders

Russell Saunders is the ridiculously flimsy pseudonym of a pediatrician in New England. He has a husband, three sons, daughter, cat and dog, though not in that order. He enjoys reading, running and cooking. He can be contacted at blindeddoc using his Gmail account. Twitter types can follow him @russellsaunder1.


    • Can you clarify what this question refers to? I assume you mean 12-Step recovery programs, but want to be sure before I launch into a response.

        • I am broadly very supportive of 12-Step programs for people who want to stop drinking/using.

          People have to be at a point where they truly want to stop, and want help. For people who don’t really want to stop, I don’t think they do much good (nor do I believe they would claim to). I think 12-step programs present a very good framework for changing behavior patterns and seeking support, and have helped a lot of people.

          However (and as they readily will concede), they don’t have a monopoly on sobriety. Many people have found ways of getting clean or sober without them. People who have achieved long-term sobriety through AA tend to speak very specifically about how it has worked for them. But success does seem to require actually doing the 12 Steps and continuing to attend meetings, which seems a sticking point for a lot of people.

          • I think the issue is that some people are terrified of personal responsibility; terrified of making a choice, because what if you make the wrong choice?

            The program gives them the illusion of external authority; “I can’t take a drink now, it’s not part of The Program”. It’s still their choice, but they can pretend that it actually an instruction that they’re obeying rather than a choice that they made. The responsibility for the choice is assigned to another entity and they can be content with it.

          • People have to be at a point where they truly want to stop, and want help.

            Which is why I’m skeptical when people say “Instead of putting drug addicts in jail, we need to give them treatment.” Not that jail is a good idea, but unless they want to quit (and I’ll bet the vast majority do not), treatment is useless.

          • @ DD

            > The responsibility for the choice is assigned
            > to another entity and they can be content
            > with it.

            This is a good point. Addicts have control issues, and the imposition of external control (or the appearance thereof) can help them ignore their impulse issues temporarily while they build up enough self-reliance to walk on their own feet. At least functionally.

            No addict in my experience ever really stops being an addict. They just change what they’re addicted to (often moving from drugs or liquor to Jesus, in my own experience). The “trick”, from society’s standpoint, is to get them addicted to something that doesn’t lead to self-destruction when their impulse control fails.

  1. I still worry that crystal meth, etc, are more broadly addictive than alcohol (I say this as a suburban mom whose knowledge of hard drugs comes almost entirely from The Wire and Breaking Bad). So perhaps the majority of users would not be able to have a casual relationship with it. In which case, the Prohibition analogy would not hold up.

    I also worry that lifting laws would provide at least some ease as well as legitimacy for these drugs. Nothing may stop those poor souls who resorted to Krokodil from getting high one way or another (and indeed, better heroin than that). But perhaps laws stop someone who would be an addict, but is not yet, from initially trying.

    • I think we have to be very careful in our approach to certain drugs, particularly meth. However, in places where meth addiction is a widespread problem, clearly criminalization hasn’t helped much to curb its spread.

      Prohibition failed because a very large number of Americans wanted to drink, and knew they could do so safely. Conversely, I think criminalization of particularly dangerous drugs adds little disincentive for most people, who know they would never use it because of how horribly bad for you it is. Are there a few people who avoid addiction because the illegal nature of the drug keeps them from trying it? Sure. But I am skeptical that the number of people helped by our current drug policy aren’t vastly outnumbered by the people harmed.

    • Elizabeth, I agree. Not too long ago, they actually found a few bottles of beer dating back at least 5000 years. Now that must have been one helluva hangover!

      The point being, humans have a 10,000 year old history of drinking alcohol safely doing little or no harm to the body. The same can obviously not be said for crack, meth, benzedrine, dexedrine, glue sniffing, Drano drinking, LSD, STP, smack/heroin, etc. etc. etc,

      The question then becomes what to do with a segment of society that, regardless of the of any warnings about the dangers of these substances, will still use them no matter what? So, my solution–reopen Alcatraz (also Gitmo when available)–allow these parasitical leeches all the drugs they need or want. If their intent is for a slow peaceful death, well, that’s just going to happen. Strengthening the potency of these drugs should help speed up the process. I guess you could say, it’s just a different kind of rehab. A type of rehab that is, however, 100% effective. Plus, the scenery is quite beautiful overlooking the Pacific.

      • Since this comment is technically on topic, despite its being morally appalling and repulsive, I’m going to let it stand. Just remember how very thin the ice you’re on remains, Heidegger.

        • I’m sure it gets thinner and thinner with your presence, Dr. Saunders.

          On a serious note, have you made any progress in securing those tanks of N2O?

          Thanks, kind sir. Needless to say, you’re invited to the bash. William James, William Blake, Aldous Huxley, Beethoven, Mozart, Freddy Chopin and several other gods have RSPVed, so your appearance would be much appreciated and welcomed.

          Looking very much forward to meeting you Doc.

          Yours in Christ, MH

    • As I said on Burt’s post:

      “Change “(Drug) is a gateway drug” to “(Drug) is a barrier drug”.

      Beer keeps some people from smoking dope. Pot keeps some people from trying coke. Coke keeps some people away from smack. Smack keeps pretty much everybody away from shit like this, because smack will probably kill you before you graduate.

      People with addictive personalities slide down until they stop at whatever scratches their itch. If you take away the stop, they just slide farther down.”

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