Sarz Maxwell, psychiatrist

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Heroin addicts are the pleasantest, kindest people. There's an altruism that I've never seen in any other addiction. If I'm a crack addict, and I've just bought a rock, and I see you coming down the street, I'm going to duck in an alley so I don't have to share it. But if I've just spent my last ten bucks on heroin, I'll share it with you so you can get your sick off.

When I ask people how they got addicted to heroin, they tell me, "I always knew there was something missing, and I didn't know what it was until I used my first bag." They become addicted because at some point before they use the drug, their brain stops making enough endorphins. When kids at a party use heroin, they're trying to get high. When addicts use heroin, they're trying to get normal—the way you and I feel on an average day. That's why abstinence-based treatment for heroin addiction has such miserable results, and why substitution treatment with methadone or suboxone is so effective.

Methadone meets all the criteria for a wonder drug. But it can only be dispensed in a federally licensed methadone treatment program. When you start treatment, for the first 90 days, you're required to come to the clinic at least six days a week and receive your dose there. After 90 days, you're eligible to request the privilege of only coming five days a week. Imagine if you had to do that for your birth-control pill or your blood-pressure medicine. They talk about heroin addicts not being compliant. They're fucking heroic.

I have a good friend who said that when he was trying to get treatment, he walked into the police station with a needle hanging out of his arm and said, "Please arrest me; I've got to get off this." They tossed him out. So he started smashing the windshields on the police cars, and they finally arrested him. Heroin addicts are not in denial. They know there's something wrong. They just don't know how to make it right.

People think that shaming addicts is part of the treatment. There's all sorts of catchphrases in treatment, like "king baby"—the addict who supposedly thinks he's the center of the universe. In one treatment program, if a patient was acting like "king baby," they'd make him wear diapers. And if someone relapses, they're thrown out. Where else in medicine could you get away with throwing patients out of treatment because they showed symptoms?

When I was in medical school, I was told that addicts would try to steal my prescription pads, but what I learned on my own was that if I wrote them the prescriptions they needed, they didn't steal anything. Now, if you want someone to be violent, give them alcohol. Never has anyone done a bag of heroin, beaten their wife, and then gotten in their car and run over a kid on a bike. You need alcohol to do that.

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