<http://www.canada.com/vancouversun/news/business/story.html?id=9c0595c6-591c-403e-96a3-5a9d26042b4d>
Give the addicts their drugs
For those who bicker over two of the four pillars, harm
reduction and treatment -- Mayor Sam and Senator Larry, please
take note --heroin maintenance happens to be both
Peter McKnight, Vancouver Sun
Published: Saturday, April 29, 2006
To hear former Vancouver mayor Larry Campbell tell it, current
Mayor Sam Sullivan's proposal to provide drugs to addicts is
"very simplistic."
Yet in dismissing Sullivan's proposal, Campbell, who clearly
prefers the bully pulpit of the mayor's office to the sober
second thinking of the Senate, revealed that when it comes to
drug addiction, there's enough simplistic thinking to go around.
After all, Campbell also supports giving drugs to addicts, but
only to those who have failed to respond to other programs. So
he argues that Sullivan's proposal -- which might involve
providing drugs to a broader array of addicts -- amounts to
emphasizing harm reduction at the expense of treatment.
The former mayor's argument therefore reveals that he believes
harm reduction and treatment are necessarily two different
things, and never the twain shall meet. And Sullivan seems to
agree, since he opined that treatment doesn't need to be a
priority right now.
Thus, despite their minor disagreement -- which merely concerns
how far gone addicts have to be before being eligible for free
drugs -- the current and former mayor aren't so far apart after
all, in that they both agree that harm reduction and treatment
are two separate modalities, that harm reduction involves giving
addicts what they want, while treatment involves refusing to do
so, as it begins and ends with abstinence.
Now, that's simplistic thinking.
Contrary to what the mayors seem to believe, it's not always
possible to distinguish harm reduction from treatment. Indeed,
while prescribing heroin to addicts is usually viewed as harm
reduction, heroin maintenance is really a form of treatment, a
means of stabilizing addicts physically, emotionally and
economically.
And it's a treatment that has been around for a long time. Even
the United States, which now characterizes all illicit drugs as
The Great Satan, operated narcotic maintenance programs until
1925, when drug hysteria, motivated by anti-Chinese sentiments,
precipitated the end of such programs. (Anti-Chinese racism also
led to the passage of Canada's opium laws in the early 20th
century.)
The United Kingdom also ran opiate maintenance programs in the
1920s, and continued the practice until the early 1970s, when
U.S. opposition led to severe curtailment of the practice.
According to the Drug Policy Alliance, closure of the programs
resulted in a dramatic increase in heroin users in the U.K. --
from 2,000 in 1970 to more than 300,000 by the early 21st
century. Concerned about this development, British police
associations advocated expanding heroin maintenance programs,
and the U.K. has recently done so.
Of course, there were likely other factors that contributed to
the increase, but the skyrocketing number of users suggests that
heroin maintenance programs might qualify not just as harm
reduction and treatment, but as preventive measures as well. All
of which means they satisfy three pillars of Vancouver's four
pillar strategy -- prevention, enforcement, harm reduction and
treatment.
Buoyed by the U.K. experience, other European countries began
experimenting with heroin maintenance. Between 1994 and 1997,
the Swiss government provided heroin to 1,000 long-term addicts
who had failed at more traditional forms of treatment.
According to a report from the North American Opiate Medication
Initiative (NAOMI), 69 per cent of subjects remained with the
Swiss program for its 18-month duration, and more than half of
the dropouts became abstinent or switched to other treatments.
And the dropout rate was significantly lower than the rate seen
in studies of methadone maintenance.
Further, the Swiss subjects experienced improvements in almost
every aspect of their lives. Participants reported a dramatic
decrease in drug use, and while 43 per cent of subjects lived in
unstable housing at the start of the study, 18 months later that
number was reduced to 21 per cent.
The rate of employment more than doubled, to 32 per cent from 14
per cent, and arrest rates declined from 69 per cent to 10 per
cent. Indeed, Swiss police registered a whopping 50-per-cent
decline in all offences, which led the Swiss public to vote in
favour of a long-term heroin maintenance program.
There was one significant drawback of the study, however.
Researchers did not include a control group -- that is, they
didn't provide some addicts with methadone or other forms of
treatment to compare to the heroin maintenance group. We
therefore can't assume that the results obtained were solely
attributable to the provision of heroin.
Aware of this limitation, Dutch researchers began a study in
1998 that compared the effects of methadone maintenance with a
treatment involving a combination of heroin and methadone.
The results were similar to those obtained in the Swiss study --
participants receiving heroin enjoyed vastly improved physical,
mental and emotional health, improved social functioning, and
experienced a reduction in criminal behaviour. Most importantly,
the benefits of heroin/methadone treatment were significantly
better than the benefits of methadone-only treatment.
There was also one drawback to this study, though it wasn't a
result of the study's design: Researchers found that more than
80 per cent of those receiving heroin deteriorated substantially
following discontinuation of the heroin treatment. (One further
limitation of all heroin studies is that their results can't be
generalized to the provision of other drugs, such as cocaine or
methamphetamine, given their different psychopharmacological
properties.)
In any case, that heroin maintenance produced, among other
things, better physical and mental health reveals that it can't
be characterized as a mere harm reduction measure but is, in
fact, a form of treatment, and a powerful one at that.
Certainly, heroin didn't "cure" the subjects, in that they
continued using drugs, but then again, many treatments don't
cure diseases. It is this misguided, utopian belief in a cure --
that treatment is only treatment when it leads to abstinence --
which constitutes truly simplistic thinking, and which leads us
to dismiss potentially efficacious therapies.
The sad fact is, some addicts won't stop using drugs for a long
time, and some might never stop. But that's no reason to refuse
to treat them, to refuse to do what we can to improve their --
and our -- quality of life.
After all, while some people understandably object to giving
addicts what they want, to paying for their habit, we're already
paying for it. Heroin addicts account for enormously increased
health care costs, prison costs and costs associated with home
and car break-ins. According to NAOMI, the societal costs of
untreated heroin use amount to $45,000 per addict per year, and
with between 60,000 and 90,000 opiate addicts in Canada, the
total annual tab is $2.7-$4 billion.
For all of these reasons, the NAOMI trials are underway in
Vancouver and Montreal, and will compare the efficacy of
prescribing heroin/methadone with methadone-only treatment.
While we can't be certain that the results of the Swiss and
Dutch studies will be replicated here, preliminary results
suggest that heroin treatment is having a positive effect.
If these results are confirmed, then it will be time for the
current and former mayors to quit their bickering over which
pillars are most important. Indeed, it will be time for anyone
who values either harm reduction or treatment to support heroin
maintenance, because it happens to be both.
[EMAIL PROTECTED]
© The Vancouver Sun 2006
http://www.ourrights.0catch.com/
It's true. I'm tired of the self righteous, narrow minded, mindset
that thinks that everyone should live the same way. This bigoted
perspective on how to deal with people who are being ravaged by the
disease of addiction or have a propensity toward addiction is costing
everyone. The cost comes in many forms: quality of life, life itself,
medical, prisons, crime.... etc.
Just because our current administration doesn't 'personally' understand
how it feels to have an addiction to opiates ... doesn't mean that
people should be expected to live their lives in misery trying to deal
with addiction. Because our current administration does not have
personal experience with opiate addiction, they can't know the misery
of trying to live a normal life as an opiate addict. Why? Why do
people have to suffer? Why should people, who want to live normal
lives, hold jobs, own homes, ect., why should they be deprived of this
possibility?
They need to be able to recieve supplement for a brain that is
endorphin deficient. Whatever the cause of this deficiency (before
opiate use or after .. it doesn't matter), they need to have some type
of replacement for the lack of this "hormone" that would otherwise be
in their bodies. We cannot experience the joy of life without it ..
nobody can. What right does anyone have to tell someone who is
deficient of this "key to joy" that they have to simply "be strong and
do the right thing"? How could anyone who does not have an endorphin
deficiency ever understand? If you don't have a deficiency, you cannot
comprehend what it feels like to be devoid of joy .. devoid of
happines. You will never know what it is like to not be able to feel
the reward that comes from spending time with a loved one .. or eating
a delicious meal. When you cannot experience a satisfying amount of
joy from these actions/interactions .... it is impossible to live your
life without some form of supplement. Addicts are being asked to live
their lives in this manner. They are being asked, by this
administration, to live life without experiencing the joys that other
people have.
My only response to this is: how dare they? What gives them the right
to judge or control the level of anothers happiness? They don' t know,
yet they feel qualified to judge.
There was one significant drawback of the study, however.
Researchers did not include a control group -- that is, they
didn't provide some addicts with methadone
Heroin is an alternative to methadone.
If you do have such a control, the study is useless.
And : you are giving to any addict, or only to junky with a 10years old
story of drug use?
Further, the Swiss subjects experienced improvements in almost
every aspect of their lives. Participants reported a dramatic
decrease in drug use,
The rate of employment more than doubled, to 32 per cent from 14
per cent, and arrest rates declined from 69 per cent to 10 per
cent.
If you have free heroin , there is less drug use (?!) and less
offences.
I can argue that if you give money for free to robbers, there is less
crime...
Why should people, who want to live normal
lives, hold jobs, own homes, ect., why should they be deprived of this
possibility?
An IV heroin user can do this?
In MsgID<[EMAIL PROTECTED]> within
uk.politics.drugs, 'Albert0' wrote:
Further, the Swiss subjects experienced improvements in almost
every aspect of their lives. Participants reported a dramatic
decrease in drug use,
The rate of employment more than doubled, to 32 per cent from 14
per cent, and arrest rates declined from 69 per cent to 10 per
cent.
If you have free heroin , there is less drug use (?!) and less
offences.
If you sell heroin at what it really costs then there is no need for crime
as the real cost is negligible. Heroin groups lose their 'exclusive hidden
club' status and just become groups of people who happen to enjoy a non
alcoholic recreational drug. Problem solved. The problem in question being
the attitude of those who are bigotted enough to think that everyone
should live the same lives as theirs.
Let people do as they will, educate them and perhaps what they want will
change. Continue the current laughable battle against recreational drugs
and you will continue the current laughable loss as users continue to
take, and users of the harder physically addictive drugs continue to steal
off everyone to fund it's stupid expense.
Police time is wasted chasing the dealers, and keeping the crime high - in
direct proportion to the street price. More police time is then spent
dealing with the crime they have caused by keeping the price so high, and
so it goes on. It's a joke, and it's about time society realised that
freedom will triumph, the only question being how much that freedom should
cost the rest of us.
I can argue that if you give money for free to robbers, there is less
crime...
And I can argue that that is a completely different question to whether we
should continue making addicts so dependant on money that they need to
become robbers (only a tiny proportion of addicts behave that way anyhow,
most just accept the come-down cost of their indulgence as they run out of
money)
Dave J.
