Heroin versus Antidepressants

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Heroin versus Antidepressants

What their comparison tells us about American drug attitudes

by Brian Ballard Quass, the Drug War Philosopher

March 30, 2026

I have yet to hear any drug pundit have a kind word to say about heroin. And yet they'd surely change their tune if they shared my backstory. As a chronic depressive, I was placed on a Big Pharma drug 30 years ago, one that turned out to be far harder to kick than heroin. Far harder. When I mentioned my desire to get off the drug, a former psychiatrist of mine told me of an NIH study that found there was a 95% recidivism rate ¹ for long-term users who attempted to kick the drug. 95%. Compare this to the Lee Robins study of American soldiers in Vietnam, where heroin use was rife among the rank and file. Robins found that only 5% of those soldiers sought help getting off the drug when they returned to the States. 5%. ²

Incidentally, I found that the psychiatrist in question had been replaced on my next visit to the "mental health clinic," making me strongly suspect that he had been fired for his candor about that ostensible "miracle drug." He violated the party line by talking about dependency. Even the Mayo Clinic doesn't commit that heresy. In fact, there is no mention of the nasty dependence-causing propensity of Effexor on the Clinic's website, not even in the side effects section! ³

But then I suppose from a doctor's point of view, the dependence-causing nature of their drugs is not a downside. To the contrary, it assures them of a patient for life!

This makes me ask the following heretical question: If I have to use a drug every day of my life, why can't it be heroin instead of antidepressants? Drug propaganda aside, heroin users can live completely normal lives, even when the government is spending literally billions of dollars to do everything they can to destroy those lives, including disrupting drug supply and refusing to regulate product as to quality and dosage.

As Richard Lawrence Miller ⁴ writes:

Through the 1980s, investigators repeatedly found heroin addicts leading ordinary lives while steadily employed at middle-class jobs.

Richard Lawrence Miller, Drug Warriors and Their Prey: From Police Power to Police State ⁵

And yet many of our seemingly progressive drug pundits demonize heroin while failing to find any problem whatsoever with antidepressants. Worse yet, many of them actually praise antidepressants to various degrees. Carl Hart tells us in the opening to his otherwise informative book ("Drug Use for Grown-Ups") that the depressed like myself should be going to doctors and not using the kinds of drugs that could cheer us up in a trice.⁶ Imagine that: going to a doctor to see what's the best option for me. Does Carl not realize that the best option for the doctor is the exact opposite of the best option for me? I have no desire to become a ward of the healthcare state and to see a doctor half my age every three months of my life to answer humiliating questions, all for the privilege of receiving yet another prescription for an expensive, underperforming, and highly dependence-causing med. I have no desire to be treated like a child like that to my very dying day.

Of course, in a world where I was actually free to take care of my own health, I would use a wide variety of substances on a strategically intermittent basis (smoking an opium pipe today, using a little cocaine tomorrow, then a variety of phenethylamines, the huachuma cactus, etc.), just like wise users have always done, in order to avoid unwanted dependencies. I would do this both for my depression, for religious insight, and to follow-up on the philosophical speculations of William James with respect to the nature of consciousness. But if I could only choose between heroin and antidepressants, I would definitely choose heroin, first and foremost because I would much rather get my drug from a drug dealer that treats me like an adult than an RN that treats me like a child. Nor will the drug dealer require me to visit him every three months of my life to tell him how I'm feeling and whether I have considered suicide in the last three weeks. ⁷

It really seems that no one but myself has ever stopped to think of drug-related issues with med-dependent patients in mind, or else they assume that we are all just going to "shut up and take our meds." Libertarian Jeffrey Singer seldom has anything positive to say about outlawed drugs, and yet he champions government-administered drugs to help people get off substances like heroin. ⁸ This, of course, begs the question: why are we trying to get them off heroin in the first place? Could it be that we are just trying to fill the beds at the rehab clinics? Addiction treatment is a $35 billion industry, after all, according to Colleen Cowles, author of "War on Us." ⁹ And yet Cowles herself champions the power of pharmaceutical company drugs while also condemning outlawed drugs with faint (and rare) praise.

If we are going to insist on people getting off of heroin, we should also be insisting that they get off of antidepressants. But I will not hold my breath waiting for the pharmaceutical companies to create a drug that will help me with achieving that goal.

Some have argued that heroin causes addiction whereas antidepressants "merely" cause dependence, but this is a distinction without a difference, at least from the depressed person's point of view. Attempting to get off of Effexor put me in hell. How are we going to compare that with heroin withdrawal? Are we going to start comparing different kinds of hell? ¹⁰ That's a subject for an eye-catching philosophy paper, perhaps, but it has nothing to do with the price of tea in China as far as actual users are concerned. It will be argued perhaps that Effexor is not habit-forming, but that again is a distinction without a difference from the user's point of view. Heroin may send more pronounced signals to the brain that, "Hey, it's time to take your meds," but Effexor sends the same message, only in a more sinister way, by letting one's mood lower imperceptibly over time. This may not make you want to run to the prescription bottle, but it will eventually make you want to die, so I don't personally see that as a great improvement over heroin.

Some may still argue that antidepressants are "scientific," that they fix a chemical imbalance in the brain, but this has always been a myth, albeit one that was encouraged by the well-paid talking heads for the pharmaceutical companies on network television. Richard Whitaker not only debunked the "chemical imbalance" theory in his groundbreaking book of 2011, "Mad in America," ¹¹ but he went on to provide evidence that antidepressants may actually cause the imbalances that they purport to fix. If this is true, it could go a long way toward explaining why antidepressants are so difficult to kick. Even the Science gods have finally come clean on this topic. In 2022, Psychology Today published an article by Dr. Noam Shpancer entitled "Depression Is Not Caused by Chemical Imbalance in the Brain," in which the clinical psychologist began by dropping the following trio of platitude-busting bombshells:

"There is no convincing evidence that depression is caused by serotonin abnormalities.

Many people take antidepressants believing their depression has a biochemical cause. Research does not support this belief.

The notion that antidepressants work by elevating serotonin levels is not supported by the evidence."

¹²

Wow! Dr. Shpancer did everything but tell the tens of millions of chemically dependent patients in America that there is no such thing as Santa Claus. Not only do their "meds" not correct a chemical imbalance in the brain, but, says Noam, "We don’t know how antidepressants work," to which I would add that we don't even know that they DO work, if by "work" we mean that they help the user to achieve self-actualization in life rather than to merely keep them from killing themselves. This has got to be disappointing news for the millions of Americans who prided themselves on being scientific every time they took their meds. I can hear them now: "Do you mean that all we've been doing all this time is helping to buy new Maseratis for pharmaceutical company execs?!"

I write this essay because it is very instructive to compare the typical reaction of Americans to heroin use with their reaction to the use of antidepressants. It reminds us that drug prohibition is not really about health and safety but about the kinds of lives that we think people should be living. This is why we have no problems with prime-time ads for Jim Beam bourbon that are targeted at young people.¹³ This is why we never even notice that the toy shelves at Walmart are full of so-called "hydration games" that encourage young people to drink irresponsibly.¹⁴ We are not worried at all about public health; we are simply insecure. We are worried that people might be choosing lifestyles other than our own, thereby implicitly calling into question our own traditionalist convictions about what life is all about.

Of course, there is one objective reason why one would choose antidepressants over heroin if those were the only two drugs available for treating depression. That is the fact that our government is spending billions of dollars to make heroin use as dangerous as possible and to ruin our lives in countless ways should you or I make such a choice ¹⁵.

Personally, I would much prefer to smoke an opium pipe nightly than to "shoot" heroin, since I'm that guy who has to cover his eyes every time that the camera zooms in on an injection taking place on TV. But to save me from the peaceable nightly smoking of opium, the drug prohibitionists created a world in which far more potent opiates took the place of one's home supply -- a phenomenal error on their part assuming that their interest was in public health. But the fact that drug prohibition continues after one hundred years of unnecessarily killing and addicting millions shows that the prohibitionists are not out to make the world safe -- unless their goal is to make the world safe for intolerant conservatives, who can claim a monopoly for alcohol when it comes to psychoactive substances. It has yet to occur to them that if safety were the goal, that there's this little thing called education that has a history of... well, educating people... and that drug regulation would keep people from using corrupted product, etc.

Key Takeaways:

The Mayo Clinic does not even mention dependency as a downside of Effexor/Venlafaxine.
Heroin addicts (i.e. daily users) can lead normal lives, just as normal as the users of antidepressants.
The heroin user does not need to see a doctor half their age every three months of their life for a new prescription, after answering a long list of humiliating questions.
Antidepressants are not 'scientific', they do not fix a chemical imbalance in the brain; indeed, they may even cause an imbalance.
Drug prohibition is about the kinds of lives that we think people should live.

Notes for essay entitled Heroin versus Antidepressants: What their comparison tells us about American drug attitudes:

1: I have been unable to confirm this stat. But the WHO notes clinical recidivism rates for depression ranging from 50% to 85%. Do we count that as a recidivism rate of Effexor? Not when Biopharma is paying 75% of The FDA’s Drug Division Budget, as reported by John LaMattina in the Sep 22, 2022 edition of Forbes magazine. (up)
2: Hall, Wayne, and Megan Weier. 2016. “Lee Robins’ Studies of Heroin Use among US Vietnam Veterans.” Addiction 112 (1): 176–80. https://doi.org/10.1111/add.13584. (up)
3: Mayo Clinic. 2024. “Venlafaxine (Oral Route) Description and Brand Names - Mayo Clinic.” Www.Mayoclinic.Org. https://www.mayoclinic.org/drugs-supplements/venlafaxine-oral-route/description/drg-20067379. (up)
4: 15 Infuriating Quotations from Drug Warriors and Their Prey by Richard Lawrence Miller DWP (up)
5: Miller, Richard L. 1996. Drug Warriors and Their Prey. Praeger. https://www.goodreads.com/book/show/594749.Drug_Warriors_and_Their_Prey. (up)
6: “Drug Use for Grown-Ups by Dr. Carl L. Hart: 9781101981665 | PenguinRandomHouse.Com: Books.” n.d. PenguinRandomhouse.Com. Accessed August 29, 2026. https://www.penguinrandomhouse.com/books/534657/drug-use-for-grown-ups-by-dr-carl-l-hart/. (up)
7: In Praise of Drug Dealers DWP (up)
8: https://www.cato.org/people/jeffrey-singer. 2025. “Your Body, Your Health Care.” Cato Institute. April 8, 2025. https://www.cato.org/books/body-health-care. (up)
9: “War on Us – the War on Drugs Is a War on All of Us.” 2019. Waronus.com. 2019. http://waronus.com/. (up)
10: As Andrew Weil writes in From Chocolate to Morphine: "Cravings for opiates are no different from cravings for alcohol among alcoholics, and they are less strong than cravings for cigarettes, a more addictive drug." (up)
11: “Mad in America Book.” 2011. Mad in America. August 25, 2017. https://www.madinamerica.com/mad-america-book/. (up)
12: Shpancer, Noam. 2022. “Depression Is Not Caused by Chemical Imbalance in the Brain | Psychology Today.” Www.psychologytoday.com. July 24, 2022. https://www.psychologytoday.com/us/blog/insight-therapy/202207/depression-is-not-caused-chemical-imbalance-in-t (up)
13: Jim Beam and Drugs DWP (up)
14: Drug Prohibition is for the Birds DWP (up)
15: Miller, Richard L. 1996. Drug Warriors and Their Prey. Praeger. https://www.goodreads.com/book/show/594749.Drug_Warriors_and_Their_Prey. (up)

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Americans think that fighting drugs is more important than freedom. We have already given up on the fourth amendment. Nor is the right to religion honored for those who believe in indigenous medicines. Pols are now trying to end free speech about drugs as well.

Drug-designing chemists have no expertise in deciding what constitutes a cure for depression. As Schopenhauer wrote: "The mere study of chemistry qualifies a man to become an apothecary, but not a philosopher."

All drugs have potential positive uses for somebody, at some dose, in some circumstance, alone or in combination. To decide in advance that a drug is completely useless is an offense to reason and to human liberty.

The fact that drugs have positive uses for human beings is a psychological corollary of Husserl's phenomenology and Whitehead's philosophy of organism.

There are times when it is clearly WRONG to deny kids drugs (whatever the law may say). If your child is obsessed with school massacres, he or she is an excellent candidate for using empathogenic meds ASAP -- or do we prefer even school shootings to drug use???

The existence of a handful of bad outcomes of drug use does not justify substance prohibition... any more than the existence of drunkards justifies a call for liquor prohibition.

Uruguay wants to re-legalize psilocybin mushrooms -- but only for use in a psychiatrist's office. So let me get this straight: psychiatrists are the new privileged shaman? It's a mushroom, for God's sake. Just re-legalize the damn thing and stop treating us like children.

When scientists discuss suicide without mentioning the fact that their government has outlawed drugs, it is like scientists discussing deaths from bacterial infection without mentioning the fact that their government has outlawed antibiotics.

Let's arrest drug warriors, confiscate their houses, and deny them jobs in America -- until such time as they renounce their belief in the demonstrably ruinous policy of substance prohibition.

The Cabinet of Caligari ('62) ends with a shameless display of psychiatric triumphalism. Happy shock therapy patients waltz freely about a mansion in which the "sick" protagonist has just been "cured" by tranquilizers and psychoanalysis. Did Robert Bloch believe his own script?

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Heroin versus Antidepressants

What their comparison tells us about American drug attitudes

Key Takeaways:

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