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Up Next: Free Heroin For Addicts

I posted an article about this before. I really have to disagree about giving addicts free heroin and Dilaudid. I was addicted to Dilaudid and I cannot imagine taking it and living a normal productive life!!


By Margaret Wente

November 20, 2008      Should we be giving free heroin to addicts?

Don’t choke. Researchers in Vancouver say yes. And they’ve just spent $8 million in public money to prove their case. Last month, after concluding a landmark clinical trail, they announced that the best way to treat hard-core heroin addicts is: Give them more heroin! They argue that methadone, a much safer treatment, doesn’t work with this crowd. But free heroin makes them happier, healthier and less inclined to steal so they can get their next fix. And since they can’t kick the habit, we ought to minimize the social harm and feed their habit, legally.

The findings from the NAOMI (North American Opiate Medication Initiative) trail were instantly endorsed by the same progressive folks who’ve filed to clean up Vancouver’s drug-infested Downtown Eastside. The media applauded widely, too. But a number of addictions doctors aren’t impressed. And they’ve missed a sweeping critique of the NAOMI trial that raises important questions about it.

“The trial was badly designed,” says Mel Kahan, head of addiction medicine services at St. Joseph’s Health Center in Toronto. “And there are better and safer solutions.”

The trial was supposed to study addicts for whom methadone had repeatedly failed. But Dr. Kahan says many of those recruited for the trial had scarcely tried methadone at all. The trial also relied heavily on self-reports. You won’t be surprised to learn that subjects lucky enough to get the real stuff (as opposed to the control group, which got a rather skimpy dose of methadone) said they were highly motivated to stick with a program that gave them pure and uncut heroin for free.

“It was quite delicious,” said Greg Liag, a trial participant who was tracked down by The Globe and Mail’s Jane Armstrong. Some of the addicts, he said, competed to see how much they could consume. “They were heroin pigs.”

A much smaller third group in the study also got lucky. They were given injections of hydromorphone (more widely known as Dilaudid), a potent legal narcotic that is similar in effect to heroin. They couldn’t tell the difference. NAOMI researchers know they’re highly unlikely to get Ottawa to authorize the use of prescription heroin. So they’re lobbying the B.C. government to approve a hydromorphone clinic on the NAOMI site.

The critics aren’t buying it. Vancouver’s real problem, argues Dr. Kahan, is an acute shortage of good methadone programs. The next step in tackling the heroin problem is to expand them. “In medicine, we try to get the principle ‘First, do no harm.’ You try the safest thing and you go from there.” A hydromorphone clinic, Dr. Kahan says, is a bad idea. “It’s a nasty drug. What kind of message do we send when it’s okay for a world-famous academic clinic to inject it”?

Stan de Vlaming, a Downtown Eastside addictions doctor who’s also a strong critic of NAOMI, says: “There’s a fine line between harm reduction and enabling. If I make it easier for people to stay addicted, am I doing them any favours?” Injecting any drug, he says, can have gruesome and life-threatening effects. And he sees them everyday.

Both doctors point out that keeping addicts addicted is nothing more than palliative care. They’d rather see the money spent on rehab. Even some of the most dysfunctional patients, they say, can eventually recover. “My work is incredibly satisfying, because a lot of them do get better,” says Dr. Kahan. “It’s kind of like a return to life.”

But many people in B.C’s drug policy establishment have a very different vision. They want to see prescription heroin made available on a broad scale, and some would even like to see it legalized. As far as they’re concerned, $8 million in federal research money to fund the NAOMI trial is money well spent.

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  1. November 20, 2008 at 3:59 pm

    I am still not sure how I (myself) feel about “free heroin” as a TREATMENT. I am not sure how I feel about FREE heroin even if it weren’t labeled treatment.I believe completely in HARM REDUCTION efforts like clean needles, decriminalization of drug use and free treatment to whomever needs it. It’s labeling free heroin as “treatment” that still bothers me. I consider it harm reduction at the most basic level, not an actual treatment. Of course, what treatment IS has yet to be rationally defined by the medical or addiction treatment community. In medical terms ANY intervention that helps a patient live a better life is considered treatment. Even “end of life” administration of morphine is considered “treatment” for a terminal patient.

    I don’t believe in laws that make drug use illegal- they do far more harm to addicts and their families than good. However, giving addicts heroin as a form of treatment for addiction seems to cross a line into what I believe is PALLIATIVE CARE i–it offers comfort when all measures to help someone get BETTER have failed. This isn’t the same as methadone or Suboxone treatment which offers HOPE of a better life not revolved around drug use, abuse and obsession. Offering free alcohol to an alcoholic and offering them a place to drink would do nothing to help a person recover from alcoholism. It may, if done appropriately, offer an alcoholic (with no hope or no desire remission) stay as safe as possible until the time came that they wanted treatment or died. However, there are many new drugs on the horizon that will ease the craving to get drunk and allow patients to get on with their lives in much the same way methadone does for me.

    With the drug policies now in place heroin addicts are faced with hurdles that alcoholics aren’t. They face far more detrimental outcomes to their health, stability and well being simply BECAUSE of the purity of their source, the legalities of using and obtaining their drug of choice AND most importantly access to their drug of choice comes with a much higher price tag which leads to criminality out of desperation. By giving heroin as a treatment we reduce some of the harm that comes to addicts simply because drugs are illegal. It’s not really a treatment, it’s a way to make drug use legal to reduce the harm that comes from outlawing drug use.

    The problem comes in deciding who is the hopeless addict who gets “palliative care” and who is the patient that has a chance of doing even better than “getting by” by utilizing treatments like methadone and Suboxone? When we are sick with addiction can we really decide for ourselves what we need? Who is all knowing and all powerful and just enough to be able to make that decision for us if we aren’t able? in the above article some of the statement assume that it is the patient that gets “heroin or Diluadid” maintenance that is the “lucky” addict–I feel the opposite. The addict might feel that when when they are in the throes of active addiction, but those who find a way out of active addiction are really the LUCKY ones, aren’t they?–It wasn’t until I had been on methadone a few months before I realized how very lucky I was to have found the treatment. Before that I just resented not being able to get high anymore and considered the clinic a way to not be sick instead of it being a way to get WELL.

    Whenever I start thinking about these conundrums I remember ONE thing: If we gave back the power to our Doctors to make medical decisions about opiate treatment and maintenance for their patients, none of this would be an issue. After all, it is how we would treat any other disease–we place our trust for every other illness in their EDUCATE hands. Why should this be any different? Why shouldn’t it be my doctor and I who make the decision how my addiction is going and how it should be treated? If my doctor thinks I will do very well on methadone, he could give it to me. If I failed at that treatment and he thought it would work we could try another medication. If none of that worked and I was still miserable he could decide (based on his medical experience) that medical maintenance with Diluadid or Heroin was my only option and he would give that to me.

    Of course, that won’t happen in my lifetime. So for now we have to get help for people any way we can–and if that simply means we give them a safe place to use that also gives them medical care, safe using utensils, some sort of stability and access to counseling-then I think thats pretty dang good. Actually giving away the heroin is the part that is still under my “I DUNNO” file.


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