Perhaps a little knowledge of the brain is in order.
There are receptors.
When the receptors are filled you can't get any "higher".
When the receptors are chronically filled the brain makes more.
Physiology accounts for several of your points. i.e. tolerance and increasing tolerance with use.
The work done by the NIDA is superior to the NIH. The NIH takes more of a layman's view. i.e. it is descriptive without looking at the underlying mechanisms. The NIDA looks at the science. Descriptions tell you nothing about the why.
Since addiction is in part genetic is there a police method for fixing that? Well in fact if you want to go far enough there is. Genocide.
The book "Drug Warriors and Their Prey" looks into that question. I review the book here:
How To Put An End To Drug Users
Now the surest way to insure the "rushes" so many users like is to make the supplies irregular. A period of high availability will increase the number of receptors. Cut off supplies for a while and the next availability causes a super rush as the empty receptors are filled.
Now we know how to wean people off drugs if their use is incidental - say for some medical procedure. It is called detox. The detox regime varies according to the drug with barbiturate detox being the most difficult and taking the longest time.
What we do not know how to do is cure the underlying PTSD that makes some users return to drug use. Well actually we do know how to cure. In many cases the body will cure itself over time as long as it is not retraumatized.
What do we know: with no treatment about 5% of heroin users will spontaneously quit in any given year. With treatment the number is still 5%. The indication from a medical perspective would be to let users use with pure drugs of known quantity of active ingredients until the underlying conditions decline sufficiently to require no further use. With every user supplied with an opiate antidote in case of a misjudgment.
Given that what else do we know? Rehab costs 1/7th what the criminal justice system costs for "treating" the problem. Of course even cheaper is doing nothing and letting nature heal the underlying problem.
We also have to accept that for some depending on genetics and the severity of the trauma life long use may be required. Despite what you have seen in the movies heroin is not an especially debilitating drug if you compare it to chronic alcohol use. It is much easier on the body than alcohol.
A look at the work of Dr. John Marks in England is instructive. Here is a newspaper account that should serve to give you some search terms to find out more.
In the first of a two-part series, Nick Davies argues that the disease and moral collapse associated with class A drugs is due to criminalisation, not the drugs themselves
To understand this war and to understand the problems of heroin in particular, you need to grasp one core fact. In the words of Professor Arnold Trebach, the veteran specialist in the study of illicit drugs: "Virtually every 'fact' testified to under oath by the medical and criminological experts in 1924 ... was unsupported by any sound evidence." Indeed, nearly all of it is now directly and entirely contradicted by plentiful research from all over the world. The first casualty of this war was truth and yet, 77 years later, the war continues, more vigorous than ever, arguably the longest-running conflict on earth.
Drugs and fear go hand in hand. The war against drugs is frightening - but not, in reality, for the reasons which are claimed by its generals. The untold truth about this war, which has now sucked in every country in the developed world, is that
it creates the very problem which it claims to solve. The entire strategy is a hoax, with the same effect as an air force which bombs its own cities instead of its enemy's. You have to go back to the trenches of Flanders to find generals who have been so incompetent, so dishonest, so awesomely destructive towards those for whom they claim to care.
This is out of sequence but gives you some points to ponder:
The Swiss, for example, in 1997 reported on a three-year experiment in which they had prescribed heroin to 1,146 addicts in 18 locations. They found: "Individual health and social circumstances improved drastically ... The improvements in physical health which occurred during treatment with heroin proved to be stable over the course of one and a half years and in some cases continued to increase (in physical terms, this relates especially to general and nutritional status and injection- related skin diseases) ... In the psychiatric area, depressive states in particular continued to regress, as well as anxiety states and delusional disorders ... The mortality of untreated patients is markedly higher." They also reported dramatic improvements in the social stability of the addicts, including a steep fall in crime.
There are equally impressive results from similar projects in Holland and Luxembourg and Naples and, also, in Britain. In Liverpool, during the early 1990s, Dr John Marks used a special Home Office licence to prescribe heroin to addicts. Police reported a 96% reduction in acquisitive crime among a group of addict patients. Deaths from locally acquired HIV infection and drug-related overdoses fell to zero. But, under intense pressure from the government, the project was closed down. In its 10 years' work, not one of its patients had died. In the first two years after it was closed, 41 died.
The core point is that the death and sickness and moral collapse which are associated with class A drugs are, in truth, generally the result not of the drugs themselves but of the black market on which they are sold as a result of our strategy of prohibition. In comparison, the drugs themselves are safe, and we could turn around the epidemic of illness and death and crime if only we legalised them. However, it is a contemporary heresy to say this, and so the overwhelming evidence of this war's self-destructive futility is exiled from almost all public debate now, just as it was when those congressmen met.
Start with the allegation that heroin damages the minds and bodies of those who use it, and consider the biggest study of opiate use ever conducted, on 861 patients at Philadelphia General hospital in the 20s. It concluded that they suffered no physical harm of any kind. Their weight, skin condition and dental health were all unaffected. "There is no evidence of change in the circulatory, hepatic, renal or endocrine functions. When it is considered that some of these subjects had been addicted for at least five years, some of them for as long as 20 years, these negative observations are highly significant."
The confusion between the effect of the drug and the effect of the black market is exacerbated not only because of government policy but also because government statistics completely ignore this distinction, with the result that teams of researchers study drug policy, use compromised statistics and simply recycle the confusion, thus providing politicians with yet more false fuel for their fire.
