Withdrawal from heroin is a trivial matter

Theodore Dalrymple is outraged by the mollycoddling of drug addicts coming off heroin and the notion that their predicament is a matter of human rights

7 January 2009

We live in Keynesian times: the answer to the economic problems created by a mountain of debt frittered away on trifles is clearly a whole mountain range of debt frittered away on trifles. In the circumstances it is good to know that a judge has done his bit to stimulate the general improvidence — sorry, the British economy. He has awarded £11,000 each to three prisoners in Winchester Prison who underwent withdrawal from heroin without benefit of further doses of heroin or of methadone and other heroin substitutes. It was against their human rights, he said.

This is indeed odd. It is doubtful whether anyone ever dies from withdrawal of opiates alone. In reviewing the medical literature between 1875 and 1968, the doctors and researchers Glaser and Ball were unable to find a single case of death from withdrawal of opiates, despite the fact that the literature covered many thousands of cases.

Indeed, such withdrawal is medically triv-ial, unlike that from alcohol and barbiturates (and sometimes even benzodiazepines such as valium). Let me quote Niesink, Jaspers, Kornet and van Ree’s book, Drugs of Abuse and Addiction: Neurobehavioral Toxicology: ‘[Withdrawal] is time limited… and not life-threatening, thus can be easily controlled by reassurance, personal attention and general nursing care without any need for pharmacotherapy.’

By contrast, 2,845 people died of methadone poisoning in Great Britain between 1996 and 2005. In 2006, 241 died of methadone, and 713 of heroin or morphine poisoning. In 2007, the figures were 325 and 829 respectively. In Dublin, more people die of methadone poisoning than of heroin poisoning.

I repeat, no one dies of opiate withdrawal. I might add also that doctors have a very long history of treating the trivial condition of withdrawal from opiates in a dangerous, indeed fatal fashion.

It goes without saying that we are all furious at Mr Putin’s treatment of Georgia, but few of us realise that the drug addicts of the country whose president brokered a ceasefire between Russia and Georgia — France — have caused far more harm to the population of that country than Mr Putin’s Russia.

They have systematically diverted the drug with which their heroin addiction is ‘treated’, buprenorphine, to Georgia (as well as to Finland, incidentally), where scores of thousands of Georgians have addicted themselves to it. The fact that the French addicts have diverted it in this fashion is eloquent testimony to how much they needed it in the first place, and how easily they were able to deceive doctors.


It might, I suppose, be argued that such drugs as heroin, methadone and buprenorphine are potentially safe when given under strict medical supervision; but such supervision is extremely difficult to enforce, given the levels of duplicity, deviousness and dishonesty among the population for whom they are prescribed. In one Canadian case, for example, a woman in a prison prescribed methadone for her withdrawal symptoms vomited it to sell it to another prisoner, who then died of an overdose. Guess whom the relatives of the dead woman sued?

The evidence is pretty conclusive that the great majority, though not quite all, of the suffering caused by withdrawal from opiates, insofar as it is real and not feigned, is psychological in origin and caused by the mythology surrounding it. In the 1930s, experiments were done demonstrating that morphine addicts could not reliably distinguish between injections of water and morphine: when they received water thinking it was morphine, their symptoms abated, but when they received morphine thinking it was water, they grew worse.

It has also been established that the distress of withdrawal is not correlated with the physical severity of withdrawal symptoms, and is often at its worst before, not during, withdrawal.

Even accepting the ludicrous, corrupt and corrupting doctrine of human rights, it is difficult to see how it can be a human right to have a non-life-threatening condition transformed into a life-threatening one by supposed (and ineffectual) treatment. The old medical adage, first do no harm, ought to take precedence, and therefore the presumption must always be against, not for, treatment for withdrawal. That so evident and unassailable a point did not prevail in court, instead landing the British taxpayer with a total bill that no doubt ran into hundreds of thousands of pounds, is deeply emblematic of the moral and intellectual decadence into which we have fallen.

This is not an isolated instance of it, either, even in the relatively small question of how we conceive of heroin addiction. The Sentencing Guidelines Council last week suggested that first-time offenders who steal from the vulnerable should be given stiffer sentences than they currently receive, but that courts should not send drug addicts who steal to ‘feed their habits’ to prison, but should consider instead drug or alcohol treatment programmes.

The Sentencing Guidelines Council was attempting, as it has so often done in the past, to mislead the British public into thinking that the law has become harder on criminals when in fact it is becoming more lenient. The class of the former type of offender — the first-timers who target the vulnerable — is of course very much smaller than the second class, the addicted thief, robber or burglar.

Thus, despite the impression given by headlines that say ‘Stiffer sentences for first-time offenders’, what is being proposed is a reduction in severity of sentencing.

Now it does not follow from the fact that many thieves and burglars are drug-addicted that they are thieves and burglars because they are addicted. In fact, the evidence suggests that the relationship is the other way round: that whatever causes them to become criminals causes them to become addicts.

In a survey in the prison in which I worked, I found that the great majority of heroin addicts sentenced to imprisonment had been imprisoned for the first time well before they ever took heroin. Since most people are convicted about ten times before they are sent to prison, and the clear-up rate of crimes is about 5 per cent (and even that, thanks to police dishonesty, is an exaggeration), it is likely that many of them had committed dozens, perhaps hundreds, of crimes before they ever took heroin. Therefore, it cannot be that they are criminals because they are addicted.

Heroin addicts are not ‘hooked’ by heroin, as fishermen take fish; they ‘hook’ heroin. Most of them take it intermittently for quite a time before they take it regularly and become physiologically addicted to it. Moreover, taking opiates by injection is not incompatible with normal working. In the 1930s, the majority of morphine addicts in America went to work normally.

Moreover, the Sentencing Guidelines Council must know that the Audit Commission recently found that 75 per cent of addicts did not even comply with the kind of community sentences that they recommend, and that Home Office research found that the re-conviction rate within two years of people given such sentences was 90 per cent, i.e. the re-offending rate must be close to 100 per cent.

The Sentencing Guidelines Council is therefore aiding and abetting crime on a huge scale, and ought to be disbanded forthwith. Addiction should be treated as an aggravating circumstance, and an automatic additional five or ten years ought to be added to addicts’ sentences: that is, if the peace of the poor, who are the primary victims of crime, is to be protected by the government and the criminal justice system.

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  • Anonymous

    I’d like to read a similar article on cocaine, that I admit is a totally different substance. Cocaine addicts seem to be more dangerous than heroin addicts.

  • James currin

    Theodore Dalrymple has done an excellent job here, and in a recent book of debunking the persistent myth of the unspeakable horrors of opiate withdrawal. I would like to see him undertake a more demanding task…to study and report on the effectiveness of so-called drug treatment programs. One never finds such data in the press—effectiveness is merely assumed. Over here, in the US, “treatment” has assumed the status of a mantra that is the solution to all problems arising from drug addiction. A popular TV reality show called “Intervention” brings together the addict and his friends/family in which he is to be persuaded to do something about his addiction. The happy ending, which makes everyone breathe a sigh of relief, occurs when he agrees to enter treatment. What I would most like to know is, for a reasonably large sample of those treatment centers which have trained therapists under a director with professional qualifications, what fraction of entrants complete the treatment program, and of those how many do not become recidivists. Most important of all, what is the average cost to the public of each successfully rehabilitated addict. Given the numbers and industry of researchers in the Social Sciences, it would surprise me if such data did not already exist. I also expect that their conclusions will be discouraging—if it were otherwise they would not have been such a well-kept secret.

  • Robert Jenkins

    I am a little confused by this article.

    Does Mr. Dalrymple sustain this view ONLY for those addicted illegally to heroin?

    How does Mr. Dalrymple feel about the multitude of those addicted to prescription opioids? It is true that some people actively choose to abuse these medications with no legitimate medical need – yet it is also true that many of those addicted to these opioids started using them as prescribed by a doctor for very real medical problems.

    Are those people “in the same boat” according to Mr. Dalrymple?

    Before coming to any conclusions on his assessment of heroin addicts and their perception/role in society, I feel it is important to know how Mr. Dalrymple feels about the people I have mentioned above.

  • Frank Pulley

    This article effectively nails a persistent and insidious lie that has become ingrained in the social folklore of dopery in the West: that “cold turkey” is horryfying and life threatening. The very opposite, i.e. continued supply of narcotics and derivatives – modified or otherwise – is horrifying and life threatening. The crazy cult of pandering to slobs who insist on inflicting the varied results of illegal drug peddling, injecting and imbibing on themselves and the law abiding taxpayer has now reached industrial proportions. I applaud the good doctor’s article and remember one particularly excellent police surgeon who worked the West End of London and Notting Hill in the 1960s, Dr Shanahan, who always refused to prescribe any medication other than a couple of aspirins to anyone who was arrested for drugs and demanded ‘a fix’ and who insisted that they would die without it. “No, you won’t!” he would aver, “You’ll be much better after a week’s lay down in Brixton, I can guarantee, it.” He was always right. He blamed Frank Sinatra and the 1955 film noir “The Man with the Golden Arm” as the origin of the myth and insisted that in all cases it was merely a ploy to get free junk and that he would not be complicit in any circumstances. The fact that as soon as Dr Shanahan loomed in the door of the cell where a melodramatic cold turkey was gobbling away, the experienced “victim” stopped the play-acting when he saw the doctor appear, was sufficient to convince me that it was true. One notorious pusher/addict a Canadian ex-serviceman who operated in the West End in the 1950s also peddled the excuse that he had become ‘hooked’ on heroine because he had once been given morphine for war wounds. Once I got to know ‘Danny’ well, he coughed that it was bullshit but that it worked on most quacks. “Except that c*** Shanahan!” he once expostulated, “You can’t bullshit an old pro like him. How about calling Dr [he shall be nameless] instead?!” Needless the say, the latter doctor was more accommodating. Of course in those days Brixton Prison was not a source of junk itself, so after a week when the remand prisoners came back to court for the results of the forensic lab reports, they were always (comparatively) bright eyed and bushy tailed in order to try to con the magistrate that they had turned over a new leaf. I wonder how many Dr Shanahans there are left in police duties these days? None I guess, as they would all have been sued into extinction. Hence the problems we have today. I must buy the book you mention, Mr Currin – can you give me the details, or perhaps Dr Daniels will?

  • Gerry Nelson

    Mr Pulley, the book is called “Romancing Opiates”.

  • Adam Morris

    As an opiate addict myself I am willing to confess that Mr Dalrymple is telling the truth. Addiction is not a disease in the sense we commonly understand disease; diabetes or cancer for example. Many of us say or think, “goodness, I hope I dont catch diabetes or cancer”, but how many people EVER say ” I hope I dont catch heroin addiction”. None; and of the tiny percentage who willfully “experiment” with “being a junkie”, they are usually the ones that are able to terminate the experience when they wish. Addiction is, as it always has been, a personal choice. The addict chooses to remain using drugs, just as the smoker chooses to continue puffing noxious fumes into his lungs. The fact that I am here replying to his article, prior to cooking dinner for my daughter who I raise alone, is because I am one of the tiny minority of heroin addicts in this country given my drug of choice on prescription, & thus removed from all criminal behaviour. Instead I work & raise my family.

    However, what I dislike about Mr Dalrymple’s position is he offers no explanation whatsoever for how we arrived in this absurd position of medicalising intoxication. To briefly summarise, it began in 1926 with a government committee chaired by Sir Humphrey Rolleston, to examine the impact of the [then] four year old Dangerous Drugs Act which had introduced an American style prohibition regime by criminalising drug possesion.

    Mr Dalrymple always avoids this period of history when discussing his views on addiction, since the statistics do not support his authoritarian views. The fact is, between 1924 & 1962, the numbers of heroin addicts remained at around a stable 500, whereas New York State alone estimated itself as having over 250,000 addicts.

    The fact of the matter is, that we have seen over the last 30 years the introduction of US style War on Drugs, with law enforcement & prison being the primary response to drug addiction. Its shameful legacy is that today in Holland, where their policy of separating hard & soft drug markets by de facto decriminalisation of cannabis has resulted in them being the only country in Europe to have an aging heroin addict population, with an average age of 35+. Whereas here in the UK, the reliance on the police & criminal law to stamp out a personal vice means we must face the shameful fact that our heroin addict population is getting younger; currently averaging 19.

    So far, the only country that seems to have arrived at a reasonable balance is Switzerland; whereby hardened heroin addicts can receive heroin in special clinics. The heroin is never allowed to be taken home, the ensuring there is zero diversion, & the clients are offered help with reintegration into society through help with housing, employment etc. No doubt Mr Dalrymplye would expect to find addicts merely scooping up the free heroin, & making no changes to their lives whatsoever. In fact the opposite has been the case. Quite apart from the 80% drop in crime rates in some areas of Zurich & Geneva, it was found after 2 years that the majority of clients were no longer homeless, many had found employemnt for the first time ever, & most significantly approximately half had voluntarily reduced their dosage.

    This proves that Mr Dalrymple’s assertion that addiction should be an aggravating factor in crime deserving of extra punishment will only ensure that addicts become further marginalised, their crimes more violent without making the slightest dent in addict numbers. After all, the USA has some of the world’s harshest drug laws, yet the highest rates of addiction, & even Singapore & Malaysia, which have used the death penalty for certain drug offences still have significant drug problems. One begins to wonder if, behind his rhetoric, Mr Dalrymple really believes in the Maoist solution of, “One addict, one bullet”.

    It is not impossible for society to curb the use of an intoxicant without resorting to the criminal law. Tobacco is the perfect example. Highly addictive, even advertised at one time; by raising awareness that smoking a dying habit, we have seen the death of smoking as socially acceptable & a decline in tobacco use. How much easier would that be to achieve with a drug like heroin, which is not socially acceptable to begin with.

    My final words are to say this; that everyone should ponder on the fact that the time of Britain’s greatest prosperity, the Victorian & Edwardian era’s, were times when any adult was free to choose their poison, but answerable for the actions regardless; “The drugs made me do it cut no ice in a Victorian court”. Nor should they today; but the only way to return to that is to repeal the insane laws that prevent an adult who desire’s it, from entering a pharmacy & buying “A pound’s worth of opium”, & instead sends him up to the local drug dealer for a “Twenty quid bag of smack”

  • John Wilson

    Frank Pulley. Dr William Shanahan was head of the Chelsea & Westminster hospital’s experimental heroin prescribing clinic during the 1990’s -where injectable heroin was, [and still is] given to a minority of recidivist addicts to see if it resulted in lower criminal behaviour. So it appears that Dr Shanahan learnt an awful lot in thirty years, as he was a staunch advocate of substitute prescribing to minimise the harm of addiction.

    Oh yes, the trial. You can Google the results. By searching “Prescription Heroin + Nicky Metrebian”, [the reports author]. I was also informed that though the cost of the trial was expensive, it was actually *cheaper* to the NHS than deling with all required medical interventions, from draining abscesses, to HiV, Hepatitis C, endocarditis, overdose & every other medical problem found in an equivalent number of untreated heroin addicts using street drugs.

    Moralising about “slobs who insist on….injecting and imbibing on themselves” Is really nothing more than irrelevant intolerance. After all when was the last time you came home to find a heroin addict injecting in your living room? However, the words I removed from your quote are extremely significant: “the varied results of illegal drug peddling”. It is precisely the illegality of these drugs which ensures their impurity, the associated harms & rampant criminality.

    With respect, I suggest you take a look at the website of Transform, [tdpf.org.uk], who explain these matters with far greater clarity than I can manage.

  • Ray Taylor

    I am a practising Consultant Psychiatrist in Australia. I agree entirely with this article. We have an addiction industry in the health sector and many jobs depend on the maintenance of a pool of the addicted people to whom we dole out methadone etc. over long periods – far longer than required to achieve relatively comfortable withdrawal.

  • Frank Pulley

    Gerry Nelson

    Thank you for the information – very helpful. I shall acquire it today. A perfect title btw. But then over the years “T Dalrymple” has always resonanted with my experience of the streets of London with his vignettes of life as a GP and prison doctor.

    John Wilson

    You assume it is the same Dr Shanahan – I doubt it very much; the age would preclude it I guess. And the Dr Shanahan I knew was far too wise to get involved in the sort of experimentation you suggest. There were disastrous results in the 1960s with clinics. There were also the examples of the egregious quacks Petro and Swann and other venal medics and chemists who cashed in and caused so much proliferation of this particular menace.

    The remaining assumptions in your post are probably just as far off the mark as your Dr Shanahan assumption. The Swiss experiment was largely disastrous. As for ‘Transform’ -pshaw! You make my point for me.

    Ray Taylor

    Exactly! Another breath of fresh air. The law abiding public have been gulled for far too long as taxpayers have been ripped off by crackpot experimentation. In the UK and the US the engineering of a drug cult that began from the 1950s was part of the counter culture war that has become more and more complex as the years have passed. From the point of view of the disciples of Antonio Gramsci et al it has been a very successful strategy. The new counter-culture hegemony is rampant. I understand from many posters on various blogs, particularly Melanie Phillips’ blog in this magazine that your country is similarly afflicted.

  • Grateful for Methadone

    Dalrymple once again reinforces the majority of the medical community’s opinion of him as a dishonest, attention-seeking, fraudulent, and even dangerous quack of a “doctor”.

    I’m a recovering heroin/opioid addict, and I can tell you that withdrawal, a process that can be so excruciating that it’s led many to suicide, is no ‘trivial’ matter. It’s not imagined or exaggerated. I didn’t imagine myself going sleepless for days/weeks at time, all the while experiencing nonstop nausea/vomiting, diarrhea, cold sweats, dehydration, limb-spasms, fever, uncontrollable yawning and tearing in the eyes, rhinorrhea, chills, hypertension, painful priapism and spontaneous orgasm (in males, and not as fun as it sounds) due to extremely ‘raw’ nerves, severe cramps and bone aches which become so bad it feels like your back is slowing breaking, restless leg syndrome, and an inability to get comfortable no matter what position you’re in. And that’s not to mention the devastating psychological symptoms – the severe depression, anxiety, panic, hopelessness, desperation, feelings of raw guilt over the lifestyle you’ve led and things you’ve done, and a torturous craving for the drugs that you know can reverse all of these symptoms in a matter of seconds.

    If Dalrymple’s arguments made any sense at all, he should prove it and shoot himself up with 40mg of morphine 2-3x daily for the next six months, then stop all of a sudden, and show us all just how ‘trivial’ the things are that follow.

    Sorry Teddy, but it’s a scientific fact that these symptoms are all the result of the brain’s inability to produce the vital neurotransmitters known as endorphins, which happens when prolonged opioid use effectively shuts down the brain’s production as it becomes accustomed to getting them from outside sources. CT scans of the addicted brain prove this.

    So “Doctor”, what are you waiting for? Put your money where your mouth is, start spiking a vein, and show all of us whining morons just how right you really are. Remember, you need to fix up every day, no cheating!

  • E.J. Dabbs

    It’s a goddamned shame this big mouth could not experience opiate withdrawal first hand.I can guarantee that within seconds,he would be begging for relief.
    He might want to inform the American state of Florida that according to him,they are mistakenly paying millions of dollars in settlements to the families of two young women who recently died of,guess what?OPIATE WITHDRAWAL in Florida prisons.
    Darlrymples research skills need a lot of work.

  • Violet

    I have never touched opiates, but I have nursed heroin addicts through withdrawal. Whilst I agree completely that no one has ever died from the withdrawal itself, I must assert that the degree of suffering in not uniform. Some manage it better than others, depending on factors such as length of time of addiction, dosages, and individual variations of bio-chemistry. However, I have witnessed horrific suffering, physical and psychological which is not- IMO- well-represented in this article. Also, not mentioned is that medically and technically the addict is considered ‘clean and detoxed’ after 5-7 days. I have seen addicts still suffering a year later from severe physical problems related to withdrawal and psychological problems longer than that. This is partly why so many relapse. Treatment is inadequate (although I ensured it wasn’t for my addicts and they kicked it). Do not underestimate the suffering of withdrawal It is not the same for everyone and can be extraordinarily severe.

  • Verity

    E.J. Drabbs – How interesting. The state of FL. Do you understand that this is a British blog and our interest in Florida is limited to the fact that Princess Diana’s (RIP) gossipy ex-butler has a condo there?

  • Verity

    Grateful for Methadone: “Dalrymple once again reinforces the majority of the medical community’s opinion of him as a dishonest, attention-seeking, fraudulent, and even dangerous quack of a “doctor”.”

    Which “medical community”, darling? And not just “a dangerous quack”, but a “dangerous quack OF A DOCTOR”? That is serious! Could we have some figures from the “medical community”? As in, which country? As in “prison doctors”? As in “paramedics in Paraguay?” Or is it worldwide? In every language? How do the Chinese judge Dr Darlrymple, for example? Could you offer us their comments?

    Tighten it up.

    Frank P – I’m happy to see you thundering away with your normal lucidity and strength of expression. Your experience is much appreciated.

    I’m an ex-smoker – 60 to 80 a day, and I quit overnight without any medical intervention. I just decided, “I’m not a smoker any more.” And I wasn’t.

  • Verity

    Violet – Who gives a crap? It’s a manufactured industry.

  • Verity

    Violet – Who cares? They brought it on themselves. If someone chooses to walk across live electric cables, something may happen that they hadn’t planned on – although conventional wisdom would have militated against this impulse.

    It’s not the problem of the taxpayer.

    When we, personally, make stupid choices in my life -“society” is not to blame.

  • Frank Pulley

    Infants often get distressed when you take their toys away. Which doesn’t mean that you should indulge them when it’s time for bed. You don’t think that your ‘patients’ may have noted your sympathetic trait and put on a full am-dram performance for you, perhaps? After several decades of interface with drug addicts various, I found those addicted to horse the most cunning and dissembling of all – tipplers came second.

    I also, as I indicated earlier, always found that once they knew you were not credulous, the ‘monkey on the back’ suddenly darted off into the nearest tree. I see no excuse whatsoever for feeding their habit through the public purse, either with H or expensive substitutes. One thing is certain, whether or not there is genuine physical distress among some addicts upon withdrawal; they sure as hell won’t withdraw if you keep supplying the shit. Diamorphine is a very useful drug as a painkiller for patients who are in severe pain from post-operative trauma, or after severe trauma from accidental injuries of some kinds even before treatment. It is also an excellent drug to ease the pain of certain terminal illnesses and lubricate the exit from this mortal coil. It’s use by trendy or venal quacks to ‘wean off’ hedonistic idiots, or weaklings who can’t face up to life’s vicissitudes without the aid of a chemical cosh, should be illegal, as it once was. As for the poster who accused me of irrelevant intolerance; the intolerance of the intolerable is not only relevant, it is essential in any society that wishes to function with any sort of fairness and order. Ostracism of people who behave extremely antisocially has always been a useful deterrent to bad behaviour, even though it isn’t always successful. These days’ serial offenders are turned into celebrities. Peer group pressure can also be used for good as well as evil intent. One of the main drivers of the proliferation of drug abuse is the increasing tolerance of society towards its practice. And that has been engineered culturally by the counter culture mechanics that have infiltrated our legal, political and academic institutions since the 1950s – a few even before that. As for Dr Daniel’s reputation among his fellow practitioners, whether he is writing in his real name or his sobriquet: I always found that the sin of envy was as rife in the medical profession as it was among authors.

    I am told by Amazon that my copy of his book is on way; eat your hearts out you quacks who can’t match his success. I hope it becomes a best seller.

  • Dr Raymond Seidler

    As an addiction specilist in Sydney, i have seen countless drug users withdraw over 30 years of practice. itis not the horror of withdrawal but the perception of it that causes users to avoid withdrawal like the plague. They certainly have a lowered pain and discomfort threshold. Many incarcerated will not divulge their addiction to police for fear of retribution or targeting in prison.

    Five days of bupreonorphine effectively stops all heroin withdrawal. It can be given with naloxone to stop diversion described in Dalrymple’s article.

    As for gainful employment while using heroin, there is no way to generate enough money to satisfy even a moderate illicit drug habit, without sixteen hours of scamming per day.

    Drug treatment programs have been studied and have been successful. I have a number of addicts in treatment for nearly thirty years whose entire cohort has died through continuing drug use.

    The Netherlands is now opening specialised nursing homes for aging drug users. This was never the case in the past. They perished mostly by age 40.

    Methadone and buprenorphine are not the panacea but they certainly beat the alternatives, of rampant street use and escalating gaol populations.

    Perhaps Dalrymple should send a message out to the taliban who fund their war with the westthrough narco dollars.

  • Chris Weston

    Absolutely correct, the idea that ‘cold turkey’ is inhumane is preposterous. It is unpleasant, but not as unpleasant of dying of a smack overdose. If an addict goes through the full process of withdrawal without medical assistance that might act as a deterrent from getting into the same stupid situation again.

  • GC

    Absolutely so. Withdrawal from alcohol indeed dangerous, even potentially fatal, but not so heroin withdrawal.

    And just as pernicious yet the idea that tobacco addiction is harder to overcome than heroin addiction. Entire industries are devoted to helping you overcome the addiction.

    In fact stopping smoking is no more troublesome than stopping coffee. Tobacco addiction is essentially an addiction to an addiction (ie it’s only real pleasure and benefit as Oscar Wilde essentially observed consists in feeding the addiction)and the only real difficulty smokers have in giving up is willing themselves to do so and has nothing to do with withdrawal symptoms.

  • Violet

    Verity-My ‘patients’ were no drain on the taxpayer for reasons I won’t go into (but could if you insist). They did not all bring it on themselves as is commonly believed in the manner you suggest. I wonder what provides you with specialist knowledge or is it just the usual emotional reaction to a complex problem which is not easily solved. In fact, it is my experience that some problems have no solution…ever found one of those? I never used opiates, methadone etc to help them get clean And they have stayed clean. In fact, I think Methadone is not a good thing as it is harder to come off than heroin.

    Frank Pulley- You refer to infants. I have raised many-don’t know how many you have raised. It is not a good metaphor IMO. Children need training,limits, and an authority figure and are much easier to deal with than addicts. You think I don’t know all their tricks? Think again.

    I am only interested in good results whilst the rest of the world exercises its emotions. So far ‘society’ hasn’t found a good way to deal with this. And when an effective way emerges, as it occasionally does, it is quickly squashed. There are too many vested interests in keeping a segment (growing unfortunately) of the population addicted.

    You have several decades experience? I have a lifetime’s experience. I was born to and brought up amongst addicts and am old now..still treating though…also have specialist training so please don’t dismiss me discourteously.

  • ian skidmore

    I wish you would take over the country

  • Frank Pulley


    Hypocritical ‘courtesy’ is one of the weakening factors of our civilisation; another name for it is political correctness; blogs are for cutting through bullshit and speaking the truth, even if it offends the tender sensibilities of those who disagree. However, I will not be so rude to ask you the age of your ‘lifetime’ as you are a lady, or swap statistics about how many children we have produced or dope heads we have known, let’s each accept that we have both been around many blocks many times, but differ on tactics when it comes to dealing with self-destructive or hedonistic criminals who give the old ‘numero uno’ to society at large, regardless of the consequences for themselves, their families and their law-abiding, hard-working compatriots and I refer in particular to those who expect society to fund their stupid and reckless behaviour so that they may continue it. I suggest that those like myself who express this point of view are being practical and objective, not emotional or impolite. I respect “Dr Dalrymple’s” experience, he has written about it length in a perceptive and amusing way for many years. As one who has trod a parallel path through the same undergrowth, albeit with slightly different responsibilities, I recognise both his description of recidivist modern Britain and share his contempt for those who shrink from the solutions that are necessary. It’s your own experience and thinking about the subject that appears to me to be an emotional one based on early experiences with loved ones. I sympathise with that but refute that it makes you any more proficient in suggesting remedies. Tough love can be a very good factor in diverting the weak or wicked from bad behaviour. Removing them from society for long periods should be the last resort but a very useful one when all else fails. The demand side of the illicit drug trade drives the whole filthy business; the drug cartels could be wiped out overnight if the demand dried up, just as with any other business, so who’s fault is it?. If the law goes soft on the demand side of the market, the illegal trade will proliferate. Which is exactly what has happened for the past half-century or so. And feel free to be as impolite to me as you wish, if you think that it might help to adjust my implacable resistance to spending more public money on feeding the habits of drug addicts and virtually building a corrupt industry of quack medicine and phoney research. Refer back to my anecdote about Doc Shanahan (the one I knew – not the other one): his research was cheap and very revealing. Question: what is causing the problem? Answer consumption of opiates by people who are not seriously physically ill or injured. Question: how should that be addressed? Answer: Cut the supply and see what happens. Result – nobody died and health improved. QED.

    Simplistic? You bet, but the convoluted bleeding hearts approach (with other people’s money) takes on the sort of baggage that exacerbates the problems. Simple really. Life can be – if you refuse to swallow the huckster’s spiel.

  • Violet

    ‘Hypocritical’ anything is no good at all. I was talking about something genuine-perhaps respect is too antiquated and far removed a concept in UK today. And even that was secondary to the fact of dismissing empirical knowledge.

    I haven’t advocated any government spending…I don’t disagree with the tough love concept and I am fairly emotionally detached , otherwise I would never have been able to resist becoming an addict myself and remain able to extend help-I would have been caught up in it all and a victim. So, I think it is incorrect to say I have the emotional reaction. I still think it is you who have the knee-jerk anger which is what prevents people from finding solutions. Today in the Times there was an article about a generic (hence cheap) remedy that works for many alcoholics, but clinics were actually quoted as saying things like ‘how will we make money that way?’. Addiction is, aside from many other things, big business. For many. Rehabs and treatment centres have extremely high failure rates, but are promoted as the only way.And they are the tip of the iceberg.

    WIpe out the demand side? Why not just wipe out the whole population then you won’t have to be bothered or spend govt money to figure out exactly who is tomorrow’s (or tonight’s) newest addict. Is it the boy getting straight A’s at the local comp or his mum? Or his sister? Or his cousin or his mate? Or even his doctor? (I have known a few) Or none of those? Or all of those? How will you kill nascent demand? If you find a way, I’m sure every govt in the world from the beginning of governments would like to know. Mankind has always loved his intoxicants.You will not stop it by destroying or locking up every addict you catch. Especially if they are locked up in prisons where drug use is common. If anything, I think attitudes like yours are part of the problem rather than part of the solution. You obviously think the same about me.

    I am sorry if you have been damaged by your ‘trod through the undergrowth’. It is indeed a challenge not to be after years of exposure to the havoc which invariably results from close contact with the insanity inflicted by addicts.

    I would not claim it is my ‘decades of experience’ nor my personal background, nor even my training that qualifies me to speak of treatments, but the fact that I have seen what works and what doesn’t and that I am oriented to ‘good results only’.

    I also do not deny other peoples’ experiences. Mine are different. And I have not dealt with the lowest criminal elements of society perhaps like Dr Dalrymple and you. But addiction recidivism or relapse is universal and if there is a way to prevent it, then that shouldn’t matter.

    I think somehow my point is not getting through, which is not surprising at all to me.
    In the end, you and I are on the same side for sure. Why don’t we just agree to disagree?

  • Frank Pulley


    Agreed; particularly as we do agree about the most salient issues about abuse and its effects on society at large. Moreover I wish you luck in your efforts to ameliorate the lives of those who have strayed into deep waters through whatever motivation or misfortune, particularly the young and innocent. As you probably realise by now, my main concern is the guile of those who exploit the weakness or naivity of others and pretend to have answers when they know full well that they haven’t, whether for political kudos or for research funding that could be diverted to more worthy causes. And a little anger is good for the soul, sometimes; I’m not seeking sainthood; Heaven could do without my earthy pragmatism, I’m sure.

  • jimi

    Dear Theo.

    I do a little facilitating now and the for the RCGP at training events
    to enable practitioners to treat substance misuse in the community
    and in secure environments (HMP) and I have to say I am somewhat
    disturbed by your article. Never fear my good man because I know
    some excellent trainers who can drag you kicking and screaming
    into the twenty first century. Sounds like you need a little refresher.




  • jimi

    Dear Theo.

    I do a little facilitating now and then for the RCGP at training events
    to enable practitioners to treat substance misuse in the community
    and in secure environments (HMP) and I have to say I am somewhat
    disturbed by your article. Never fear my good man because I know
    some excellent trainers who can drag you kicking and screaming
    into the twenty first century. Sounds like you need a little refresher.



  • Baggo Brown

    I’m a fan of Dalrymple — and also a long-term heroin addict. He correctly identifies much that is wrong about the addiction treatment system, and it’s self-serving nature. However, he’s mistake if he believes that the purpose of prescribing methadone is simply to alleviate withdrawal. As he correctly points out, stopping isn’t the hardest thing in the world — the really hard thing is staying stopped.

    Without methadone, many thousands of us were doomed to an interminable cycle of using, quitting and relapsing, using, quitting and relapsing. With the quitting thing generally imposed upon us by the criminal justice system, and the relapsing thing occurring on the very day we get discharged from prison.

    What methadone does — for those of us that it works for, and I’ll grant that it doesn’t work for everybody — is provides a means of escaping that cycle, allowing us to normalize our lives. After years of compulsive use, we’re finally able to stop spending every last penny on heroin, finally able to stop shoplifting of cheque kiting to pay gangsters through the nose for a product that is often less than 10% pure.

    Now, it’s all very well for people like Theodore to tell us that what we *really* need is to get a bit of backbone, bite the bullet and start behaving ourselves. It’s not like we haven’t tried. People tend to try pretty hard to do things when the alternative is losing their job, their family, their home and their liberty, so we do try — and repeatedly fail.

    But for some of us, methadone provides a solution that works. A solution that provides that little bit of additional assistance to fill the hole left by our lack of willpower/dysfunctional neurochemistry/absence of God/insert your own pet theory here, regardless of the consequences.

    The British drug treatment field doesn’t dish out methadone because it likes the people that it treats and wants to be nice to them — if that were the case, they’d be prescribing us heroin and cocaine, and keeping a look-out on our behalf while we wash it up into stones. No, the treatment field continues to prescribe methadone because there’s an overwhelming body of evidence, replicated all over the globe, that methadone maintenance reduces criminal activity, reduces drug related deaths and other health problems, keeps families together that are otherwise on the verge of collapse and allows addicts to start leading a normal, functional life.

    And again, not everyone succeeds on methadone. Some people have only moderate success in that they might use illicit drugs less frequently.

  • Frank P

    As according to his column today our good doctor has retired and is addressing more important problems, such as how to cook Brussels Sprouts correctly, he is unlikely to take up Mr Grieve’s invitation to get himself brainwashed after being dragged kicking and screaming into the new libertarian modus operandi of modern medicine, I nevertheless think, just in case he might be tempted (perhaps for journalistic research purposes), we should draw his attention to the following website to which Dr Grieve seems to be connected.


    Due diligence is always a good idea before embarking on invitations to participate in anything, just ask Bernie Madoff’s clients.

  • Baggo Brown

    Oops. Cut off, mid-comment. I continue:

    Unfortunately, Dalrymple makes an error that is common to many clinicians in that he confuses correlation with causality. He blames the worthless lives that some people lead, on the drugs that they us, rather than stopping to ponder whether they wouldn’t be worthless people even if heroin never existed?

    On the other hand, you have someone like William S. Halstead, the father of modern surgery. Halstead is considered to be the most innovative, influential and important surgeon in US history — and throughout the majority of his career, he was injecting heroin and morphine.

    His addiction wasn’t so obstructive that it stopped him from being promoted to Chief of Surgery at Johns Hopkins Hospital in Baltimore — one of the most prestigious hospitals in the USA. Halstead introduced a whole raft of innovative medical practice. An early advocate of sterility, he introduced gloves to surgery. He developed the mastectomy, haemostasis, a range of different surgical techiques. He’s one of the great surgeons of the 19th century and he was addicted to morphine throughout that period.

    Did he try to quit? Of course he did, repeatedly. And like those of us who are chronic addicts, he failed repeatedly too.

    Today, Halstead would almost certainly be on a methadone programme. His chances of a morphine script are slim to none, so he’d be on methadone, along with the rest of us.

    He wouldn’t be practicing surgery though, and what a loss to the world *that* would be.

  • Stuart S.

    Wm. S. Burroughs (famously addicted to opiates on and off his entire life) was part of the literature agreeing very much with Mr. Dalrymple.

    He said (paraphrasing from memory) that “kicking heroin is easy; it only takes a few days, a good jazz record, and some marijuana”.

  • Paul Grimwood

    I cant believe my eyes reading this garbage. going cold turkey is no answer to solving heroin addiction, the methadone is there to help a user gradually come off heroin to ensure physical risk of overdose, damage to mental health and ability to learn life skills and put them in place before a user resorts to destroying the lives of Family ,friends and the community he/she lives in. Crime reduction is affected greatly when an addict becomes stable in treatment and includes themselves back as a productive memeber of society with their own empowerment, instead of becoming crime waves that can devestate local strenght and belief in community.
    Does this person put into context why the methadone poisoning was high. could it be because a user had a low tolerance and used on top sending them into overdose.
    And forgive me for damming the proof of 1875 , aint that a little out of date, as seem so service are only just getting the message that there is more to treating a heroin addiction with prescribed meds. They just treat withdrawal symptoms and not the underlying realities that cause addiction to class a drugs. for once can Big Wigs with no clue concentrate on treating the person and not the affects they have on crime or withdrawal symptom.

  • paul grimwwod

    this guy is piss poor. I bet he lives in upper class society where real life of people who aint so lucky to make such ridiculous conclusion from books wrote in 1845 . instead they learn from reality of experiencing communities torn apart from such vile substances and have to witness the desperation user have to go to just to feel normal never mind get high. And how dare he judge all users with the same stereo typical brush of junkies. just because we have an addiction mate dont mean we have had labotomiies.

  • Frank Pulley

    Now that I have read the book “Romancing Opiates” by “Theodore Dalrymple” I heartily recommend it to anyone embarking upon a career in medicine, policing, social services, education, journalism, parenthood or indeed anyone reading or commenting within the blogosphere. Violet (above) would find it very interesting, I’m sure, as would Verity whose pithy perspicacity is a constant source of revelation and entertainment in blogworld.

    As for Paul Grimwood, I doubt you would be able to stomach the grim data and philosophical truths contained in the book, but perhaps if you peruse the following Website it will disperse some of your crass assumptions about the background and experience of the acclaimed Dr Dalrymple/Daniels:


    or perhaps not, as there are none so blind as those looking for their next fix.

  • Tuffs Not Enuff

    This article misses two basic facts. First, that many heroin addicts get to this drug as self-medication for an underlying Major Depression. Life, itself, is difficult for them due to neurochemical imbalances over which they have little control. Sleep disorders are more a part of the problem, than not. Methadone/Suboxone and psych treatment make a charitable (roughly Christian) effort to assuage their problems. (The posting from Mr. Ray Taylor is frightening. His antagonism to treatment for addicts would Do Harm.)

    Second, many more individuals, today, are coming in to opioid addiction through prescription drugs. NHS has fallen in love with Dihydrocodeine (DHC) in recent years along with a host of other drugs. If a drug is cheap, it gets out. Drugs that are banned/outlawed worldwide are generally available, legally in the U.K.

    All of these drugs interact with alcohol and other drugs with frequently fatal effect. No one chooses such things. Virtually no one in the “recreational drugs” crowds has any idea what is happening to them.

    This article and the nasty postings recall the Red Top press calling Amy Winehouse “Wino,” while making every pound they could off watching her get torn to pieces through 2007 and well into 2008. The government allowed that scandal to go on and on — which exceeded for callousness what George Bush did to the prisoners at Guantanamo Bay.

  • rocketfuelled

    you are an uneducated narrow minded bigotted man theodore…forget human rights and think about what the law states – any one imprisoned has the right to receive treatment equivalent to what they would receive from the nhs…..

  • tim;ex heroin addict

    It’s amazing that someone can be as informed as you say you are and still be so completely ignorant.I live in a small town where I have known addicts who have died as a direct result of heroin detox,Either by their own hand in a response to the absolute despair created by detoxing or in conjunction with ill health due to months or years of heroin use.A prefectly healthy person can withstand the rigors and depression caused by heroin addiction but by the time someone “kicks” heroin ,their health is already very poor.I think that unless you have walked in their shoes,as I have for 20+ years, then do everyone a favor and get informed.You will find that the ability to see past the end of your own nose in not as scary as it at first seems.Get a life

  • jaydee

    As a former heroin addict I agree with the author. While withdrawal is unpleasant at best it is rarely life threatening. I do believe that heroin addicts should be given a chance for treatment rather than imprisonment. The addict should be given only one chance at rehabilitation and any use after that should be a law enforcement matter.

  • M.Williams

    As a person has gone through the ‘trivial matter’ of heroin withdrawl I would make two observations.
    If you consider constant diarrhea and vomitting, excruciating abdominal pains, extreme pain in every joint, anxiety of a level that would constitute an ‘attack’, paranoia, fear and depression with no prospect of sleep for days trivial, then I agree.
    Finally, for all its ‘torture’ it is not believed to be fatal. However, the statistics do not show how many people commit suicide as an alternative to the withdrawl symptoms.

  • strings

    “as a professional jazz musician of 56years of age who has come across users of all types its amazing the ignorance of users and non-users alike.getting to the truth of drug use abuse etc is no easy matter the subject being surrounded by a haze of anecdotal evidence,fear prejudice,and outright lies.funnily enough,the most accurate guide to the true history and effects of drug use/abuse,-including withdrawel can be found in the high times encyclopaedia of recreational drugs,which anyone can google-but not from a public library,which in my experience block this literature, i presume as a prescriptive of the nanny-state.i moved abroad many years ago and so have not been brainwashed like the rest of you by the government and media.i have 1st hand experience and can tell you that heroin withdrawels may not kill you but you certainly may wish it would, whilst going through it.interestingly,it is a learned behaviour,but once learned its very tricky to forget!all this is beside the glareingly obvious point,that prohibition,not drugs ie handing the prescription and distribution of such over to the criminal element by washing our hands of it smacks more than a little of the pontious pilate in all of us.before all the recent hysteria on the subject,ie the war on drugs,the problem was far smaller due to lack of incentive.now the financial possibilities are endless,coupled with what italians term”the perculiar charm of illegality”all those unlucky unemployables have something to do.the economic crisis must be exacerbated by the billions poured into this black hole.when will we stop shooting ourselves in the foot. stop criminalising our youth. and remember what we tell the children,that no one wins a war….. leave drugs in the hands of doctors,good and bad.its not perfect,like the rest of this world,but its a million percent better than the farcical situation at present.i taught music in jail for years(as highly paid non-uniform staff,not as an inmate,in case you wondered)and as its proven impossible to keep them out of this highly regulated and expensive environment,due to human nature,what mad fantasy fuels the idea that any free society could ever be “drug-free”?indeed,why should we?if we are rational adults,surely individuals should be left to make their own minds up.prohibition should be reserved for those wishing to make political or financial gain from public campaigns or private dealings.as one serving politician put it”i know what should be done about drugs,but not how to get re-elected`.as long as experts are castigated for telling the truth and we allow our politicians to get away with sacking them and not taking their advice on board,the situation will deterioratewake up peoplewe can change this./drug-free may be the ideal state hypotheticaly,but this is the real world and its impossible to achieve,as evidenced by prisons.““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““““`

  • molly

    The author of this article is nothing short of a moron… Have you ever seen a newborn withdraw, or is that just another act too? Poor research and an antiquated knowledge base are the basis on which this foolish article supports its argument. Withdrawal is both horrific and life threatening, in certain circumstances. Retarded article!

  • George Henderson

    Hey, they proved in in the 1930s, no need to look at more evidence!

    Dalrymple is demented. I certainly wouldn’t trust him with my own care, as he would be perfectly capable of explaining away any pain or dysfunction I suffered as delusional. I’d be OK as long as I didn’t die.

    The only research he cherry picks from the entire field is some tests done on prisoners by one researcher in the 1930s. I’m sure that was fun for all concerned. Opioid withdrawal is manageable if you go to considerable effort, use a high-fat, allergen avoiding diet, and take the right supplements (and Ibogaine, better still), and addicts should never be discouraged from doing it, but with sadists like this around, no wonder most junkies relapse.

  • Captain

    Old article but comments made are dangerous and ludicrous, has the author every been addicted to opiates? I find it extremely unlikely and instead is just hateful and wicked. The stupid statement that opiate withdrawals are feined in someway isn’t backed up by one bit of evidence and if it were true why do Monkeys and rats display both physical and psychological symptoms. Normally I wouldn’t wish the pain of withdrawal on my worst enemy and the statement opiate withdrawals are never fatal is also false is wrong. Alcohol, Barbs and Benzo withdrawal symptoms are much more likely to be fateful is true but long term addicts often in poor body health maybe with HIV hepatitis or full blown AIDS have and do continue to die when withdrawing from opiates. I hope the author is involved in an accident that causes chronic pain leading to opiate addiction like happened with me. Hopefully it’ll happen in USA too where the Drs are terrified of the DEA so prescribe far to low doses and continue to supply combination drugs so they stay sched 3 instead of the more appropriate sched 2. The author is a foul disgusting individual and although its obvious they’ve never had an issue its also obvious they’ve not read up to date papers written on opiate addiction and the claim of opiate addicts given water and told it was morphine so felt better is so far from the truth its comical, even somebody who’d never been given morphine would know if it was water because their pain wouldn’t improve and also the rush within 20 seconds of morphine being injected wouldn’t be there if it was water. If the author does look at the comments periodically I hope if something ever does happen your Dr would leave you in pain because you don’t understand how useful opiates are andalso the majority of heroin addicts only began to use it to self medicate as its a well known fact that opiates are the most effective anti depressants on the planet and before prohibition heroin was routinely prescribed to upper class patients going to their Dr because of that. Modern day anti depressants are notoriously ineffective with basically everyone only performing slightly better than placebos. Recent papers have been written about people in deep medical depression unresponsive to SSRI type drugs but when put on low doses of oxycodone unaware what the drug was had close to 100% improvement and even after 12 months not needing to increase the dose while still experiencing the therapeutic effect. Obviously its not suitable for everyone because of the huge abuse risk but when someone doesn’t leave the house, doesn’t speak to anybody etc the risk of addiction/abuse is far out weighed with the very favourable increase in quality of life. There’s literally hundreds of off label quality of opiate/opiod drugs and without a doubt they’re one of the most valuable drugs on the planet, they’re a lot less dangerous than alcohol and if the world leaves alcohol as a basically unrestricted drug opiates should also be unrestricted and would save the NHS millions every year cause patients could treat themselves.

  • Laurie

    It sounds like this “trivial” author has never experienced any “trivial” amount of withdrawal from anything “trivial.” Explaining the close-mindedness and ignorance of another uninformed know-it-all.

  • jo

    if the fool who wrote this article actually went through heroin addiction and withdrawal himself he would change his tune pretty damn fast

  • Georg Bernhard Riemann

    I have been on and off opiates for years at a time and stopping in a day. I have taken many thousands of doses. No withdrawl, no nothing it is all psychological bullshit created by TV. Normal aches and pains hurt a little more for a couple of days the rest is just Hollywood bullshit people believe. Opiates do not kill pain they are distractive, they down regulate normal sensation they make the mind not care so much about the pain so when they go away the distraction moves front and center but not for long. Everything back to normal in a day or two.Addiction is just a huge medical scam.

  • Mahi Tuna

    The key to withdrawal in jail has been overlooked in this article. Although it is very uncomfortable to detox one has to look at the environment as well. Cold jail cell, no privacy, nothing like crapping every 10 minutes with your cell mates gazing at your situation. Hard bed, little in the way of blankets or pillows, terrible food. Loud environment, banging doors, people yelling. There can be no worse a place to experience heroin withdrawal than a jail cell.

  • Johnny Mac

    This is the most ignorant rubbish I have read for quite some time, and I read three newspapers most days. Well done, sir. Your referral to an 85 year old study as if it was damning evidence in support of your moronic rant was certainly the pièce de résistance!

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