Theodore Dalrymple

[Fluoro]

Before I go into my reason for making this post, if people take the time to look back at my previous posts they will know I am a supporter of methadone maintenance as being an option for opiate addiction.

I just want to clarify that I am not a supporter of the deluded Dr Dalrymple, but after browsing through one of his books the other day (Junk Medicine), there were (I've got to be honest) a couple of points that he makes that I agree with. I havn't read the full book and I'm sure there will be many things that he says in the book that would make my blood boil, but one of the points I agree with (although this doesn't personally apply to myself, because I have never been a heroin addict). My introduction to opiates started with taking 3 30mg df's occassionly when I was 17-18 when I could'nt get any weed, then I was given methadone by my mum starting at 5-10ml, then gradually increasing to 45-50ml a day as my tolerence increased. It was given to help keep me calm, so that I could go to work, when I was going through a manic episode and be able to sit at my desk, without constantly going wandering around the office (at the time my bipolar was undiagnosed, although both me and my mum both knew that I had it, but my gp would'nt refer me to a psychiatrist and just diagnosed me as having depression). Please don't think my Mum was a bad Mum, she did this as a last resort, anyone who knows about bipolar disorder will know that an anti-depressent alone to someone with bipolar disorder is about as much use as baby aspirin. Your main medication should consist of a mood stabiliser.

Anyway, back to my original point. In his book he says that heroin withdrawal is like having a bad case of the flu, with the most painful part over after 3-5 days (he admittadly ommitts to mention the fact that you also suffer insomnia, therefore providing you with no respite during the withdrawal process. He also forgets to mention the period of depression following detox). However, the point I am in agreeance with is that addicts universally agree that heroin in comparison to methadone is far easier to withdraw from. I have heard comments like coming of the gear can be done standing on your head, or compared to methadone withdrawal, heroin withdrawal is like a holiday. My point is, when an individual approaches a clinic for opiate addiction treatment-and in the vast, vast majority of cases the addiction is usually to heroin, why offer a drug that is far more physically addictive? I know methadone has its benefits, in that it stabilises the person (when adaquetelly dosed, and when the person is using it as prescribed), nobody has to sell me the reasons for why methadone should have it's place in addiction medicine, and I know that whilst it is more difficult to get of physically, it is less psychollogically addictive than heroin (especially if the person has been injecting, because you don't get that 'rush' that you get with heroin), but I think there should also be another option for clients as well as methadone, e.g morphine sulphate tablets. I'm not suggesting getting rid if methadone, just making the individual aware that its physically harder to get off than heroin, and offering morphine (orally as another option).

[wastedyouth]

You are right when you say that Heroin is easier to come off of than methadone(alot), and you get all the things like it gets right into your bones, which as far as im aware is totally wrong.  When i had my addiction to heroin alone my drug workers tryed for three yrs to get me to go onto methadone but i continually said no for the reason that i knew that i would use on top.  My plan was when i was ready to detox i would go to the doctor say im ready now stabilize me, then start a rapid detox,my thinking was 1. i didn't want to have two habbits(as i saw it) running along side each other at the same time 2. I wanted to get on and off methadone as quickly as i could.  I think in theory my plan would have worked, but i fell pregnant and was basically forced onto methadone to reduce my drug intake, which i did.

I would like to know why the withdrawls are so seveire from methadone, i think the only good thing is you are getting the same purity every time, the same amount and to reduce to make up a detox plan is easier eg. you bring yourself down to a bag a day but the purity of the heroin will never be the same, so how can you possiblily judge it.  Your right i was never made awear of what the withdrawls would be like from methadone, but to your doctor and drug worker i think getting you stabble is their main concern(thev'e done their job)


I thank methadone for what it did for me but i also hate the controll that it has over me, i know it's no more of a controll than heroin, but all the same.  The only good thing i could say is that it is easier to set up a detox plan because everything is the same, but if some one had offered me a drug that the withdrawls did not last so long it would have chosen the other opption.  The thought of withdrawls sends me into a panic at the best of times.  I think that there are people that need maintanence programms but i do feel that the doctors just asume that more people fall into that catagory than accually do.  With a bit of support i think alot less people would be on maintanence programms.

[mac15]

Hi all,

Totally agre with both points above when i was put on methadone i think i started at 40 ml but ended up on 160ml as the doctor said i was using that much smack,about a quarter a day there was a very high risk i would overdose,so the Meth would stopin at a time so maybe i didnt notice the withdrawls from Meth,i still have Morphine but not enought to try and detox from and substitute for Methadone me getting the same "Dunt" off the smack but at no point was i informed of the withdrawls from Methadone and i often wonder if there is a legal case to be answered here as Wy said if i knew what the withdrawls from Meth where like i "might?" not have taken it.
I am now on a 100 ml dispensed twice weekly on a Mon and Fri which is a hell of a lot better than going everyday in the small place i live and standing about waiting to go into the strategically placed "Tardus in the corner"
When i tried to come down to 95ml i felt i hit a brick wall and ever since my doctor has never mentioned coming down as i have spoke about on here before.

I was in hospital recently and was on Morphine and i had no craving for Methadone at all,this could be a couple of factors,i was in a lot of pain and the brain can only focus on one pain at a time so maybe i didnt notice the Meth withdrawl and from what i have heard there are very very few doctors who will give you Morphine as a  substitute for Methadone withdrawl.

I hate being addicted to Methadone although my life is good and im not using,my life is manageable again but i still hate having to go and pick it up and the stigma attached to Methadone,you are still clased as a second class citizen or still a Junkie as there is still a lot of people who use on top of there script.

Until this countrys drug laws and policies remain the same,the treatment will be the same and peoples attitudes will never change,we have the highest rate of alcoholism in Europe and the Government wouldnt agree to minimum pricing as they would lose to much money and the Portman Group who are a collective of drink companies who advise the Government are funded by guess who.....THE GOVERNMENT,that says it all,alcohol kills thousands and destroys families but thats okay as its legal,is the man or woman buying a case of beer and a bottle of wine or vodka stigmatised the same way at a checkout the way we are in a Chemist,its all fkn wrong,excuse the language but it makes me angry.

Best wishes with whatever journey you are on.Best wishes Stevie

[mcdermott]

I'm always a bit embarrassed to admit this, but I'm a secret fan of Theodore Dalrymple. And actually have been for many years now -- long before he wrote that book. He used to do a column in a very conservative journal called 'City Journal', in which he wrote about the trials and tribulations of being a doctor in the inner city, and even though I disgree with his politics, and think he's completely wrong about drug treatment, I also think that there's a compassionate and rational core to a lot of his writing, and I think he often does confront a lot of myths that we take for granted.

So yeah, withdrawing from heroin isn't the worst thing in the world and it isn't going to kill anybody -- that much is true. But he neglects the fact that people will go to extraordinary lengths to avoid it -- and that can include robbing strangers, mistreating their nearest and dearest, risking long prison sentences, etc. Also, withdrawal doesn't mean stopping using. If it did, you wouldn't have any addicts. Everyone would just do a single detox and everything would be hunky dory. Compared with staying stopped, stopping really is easy.

So the damage isn't done by withdrawal -- it's done by the continued engagement in an addict lifestyle. Harm reduction initiatives like methadone maintenance are supposed to reduce that long-term damage. And as with any other medical treatment, its effects are uneven. Most people improve in the short term. Some people do extremely well. Others improve greatly, but use street drugs in a controlled, recreational manner, spending only what they can afford, while some people don't appear to make much improvement at all and continue to smoke crack and drink alcoholically while still on methadone. And for a long time, some services were almost collusive with this group -- I think largely because they had no idea how to deal with them. We're not an awful lot better at it at the moment, and still vacillate between being punitive and being overly accomodating.

So, while I think he's wrong about lots of stuff, I also think he raises some interesting issues. And I think some of the issues that he does raise are issues that the recovery lobby/new abstentionists have been seizing on. Sadly, some of these go in for the same sort of black and white, all or nothing thinking that Dalrymple leans towards. According to them, everyone on methadone is a workshy, feckless bastard glugging down two litres of White Lightning for breakfast.

If there is a rational core to what they say, in my opinion, it's this: few of the people in drug treatment who aren't working and who are using chaotically on top of their scripts are very happy. The life that they currently live isn't actually the life that they aspire to -- they're making the best of a lot that they can see no way out of. Those with large amounts of 'recovery capital' have always managed to move on in one way or another -- whether that be through what we now refer to as 'medication assisted recovery', through a stay in rehab, or attending meetings, or through just picking a different life for themselves and getting on with it.

There's another group though, that seems much larger because they don't generally move on, so they come into treatment and they stay there, they don't appear to make much progress, they take up much more staff time because their problems are more numerous and more entrenched. Consequently, they're much more visible, and so they tend to be what people think of when we think about people in methadone treatment. They're the reason why some people claim that 'methadone doesn't work'. Unfortunately, when you send them to detox or rehab, they either don't stay, or they relapse as soon as they get out. Their problems are difficult, many, and not easily solved.

Dalrymple believes we should just throw these people to the wolves. The 'new abstentionists' pretend to believe that they'd be sorted out by a quick dose of rehab -- generally because they either work in that sector of the drugs field, or because that's what worked for them, so they've still got the glazed eye of the convert. Harm reductionists have traditionally -- not colluded exactly, but some have looked at the chaos as a personal choice. All of us have failed to provide enough in terms of hope -- that a different, better life is out there, and is achievable if you want it badly enough.

Cliffs notes: Dalrymple -- he's a bit of a dick and wrong about a lot of stuff, but he's often very funny, quite insightful and actually genuinely concerned about the lot of the working classes and the poor.

[derek d j]

  Yep, its starting to sound like True Confessions but I've a soft spot for some of Theodore's stuff too.  The points he raises are often valid, as Mac says.  

I was at the counter at Waterstones last week as a huntin', shootin' fishin' type was buying his latest in hardback.  We talked, and found, to our mutual surprise, we rather agreed.  

  On what did we agree?  That the whole 'clinic system' had delivered little but methadone and gibberish since its incipiency, that the past 40 years of 'drug treatment'[policy had failed singularly and so terminally that it was time to throw away the rule book and try something new.  We talked about the new 'time limits' for new users and making diamorphine available as the user so chose, and found little dispute with either.

  Dalrymple's doing what he's supposed to, open up debate.  I've a sneaking hope he'd correct himself if he knew more about where he wanders.

[skunkworks]

Hmm.
I can forgive pretty much anyone's insults, bigotry, ignorance and talk that marginalizes & divides IF they are funny with it.
A classic example of an author whose politics and beliefs are polar-opposites to mine would be PJ O’Rourke. He is a rightwing asshole, Republican and all round disrespecter of the alternative, the downtrodden and the just plain different.
BUT.
He is fucking face slappingly funny. He could say everything Dalrymple says and I’d be lol-ing my head off the whole way through
My opinion, and I have read more than Romancing Opiates, is that Dalrymple is a nasty little man who delights in the misery of others.
And to me he is about as funny as root-canal work.
We are all different I guess and we all find humour in places other folks don’t. Reading Dalrymple I want to reactivate the Kalashnikovs and shoot the mothefucker right through his sanctimonious, big head.
Don’t get me wrong though, I’d probably cap O’Rourke too but it would only come after an hilarious, drunken argument with the guy that I’d make sure lasted at least 6 or 7 years.
Peace,
SW 

[MethDeth]

As far as I can see this man is an opinionated bigot, who has his head way too far up his own fundament to be of use to anyone.
Just like Popeye Doyle in 'The French Connection', I'd like to see this idiot abducted and forcibly injected with large amounts of good-quality heroin, three times a day for a period of no less than one year, after which the drug should be abruptly withdrawn.  Then we'll see who feels like they have the 'flu and who doesn't.  Meanwhile I'll be out at the chemist's, getting him a couple of packets of Lem-sip and a bottle of Night Nurse, which should adequately suffice for the duration of his illness, yes? 

[Flip]

Whenever anyone gives me the "withdrawal is just like having the flu" line. I just ask them whether they mean like the cold they had last year or the flu  in 1918 that killed more people than the first world war.  Yeah it's taking things to absurdity  but it's usually enough to demonstrate that the person knows as much about withdrawal as they do about the flu.

Flip

[skunkworks]

......
.....Then we'll see who feels like they have the 'flu and who doesn't.  Meanwhile I'll be out at the chemist's, getting him a couple of packets of Lem-sip and a bottle of Night Nurse, which should adequately suffice for the duration of his illness, yes? 

Nope!!





Lemsip and NightNurse both have paracetamol in them so the pharmacist wouldn't sell you 'em at the same time

Hehe - just being silly
Ill get me coat

[simon]

Don't forget your hat 

[steve]

Mr Theodore needs to know unless you have walkied in the shoes Iv walked in can you really be 100% sure about what your writing or mabye he reserves his statement just for heroin and not methadone. As when two are likei believe like black and white, a person  mantained on a script lives a totally different life to a person still using heroin.

[Lindyloo]

Love that idea bout injecting Mr (Dr?) Dalrymple for a year and letting him withdraw.

I read a lot but I've obv missed somehing cos I don't know who Theodore Dalrymple is.  'Scuse my ignorance, and if anyone wd like to give me a potted bio of the dude I'd be v grateful.

[steve]

throw it into google I only found out about him yesterday

[skunkworks]

Love that idea bout injecting Mr (Dr?) Dalrymple for a year and letting him withdraw.

I read a lot but I've obv missed somehing cos I don't know who Theodore Dalrymple is.  'Scuse my ignorance, and if anyone wd like to give me a potted bio of the dude I'd be v grateful.

Ill do better if it's of any use - PM me your address and I'll mail you 'Romancing Opiates' which is the book that caused all the consternation in the 1st place!

Of course I'd not want anything for it, and every-time I see it on my bookshelf it annoys me so you'd be doing me a favour!

SW.

[KikiMarooni]

There are so many people in positions of authority that can affect the lives of others in respect to addiction, who it seems are uneducated in any other way than the official bureaucratic school of thought. It seems sensible GP's who have fair and rational opinions of addicts are the exception and Mr Dalrymple is definatly not alone. Half the fear when attempting to withdraw from heroin or any other addictive drug is seeing what type of doctor you will be sent too!!!.

Go to the below link and read the absolute nonsence another GP from the Mr. Dalrymple school of thought has written

http://www.newstatesman.com/199904090021

(P.S. this isnt Kiki this is her partner Craig)