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January 2004
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Free Heroin

If you’re going to read one article this week to gain a new perspective on the drug war, you must read this one by Dan Gardner in today’s Edmonton Journal.
It’s about one of those notions in the drug war that has been so ingrained into our consciousness by the drug warriors that we have a hard time wrapping our minds around the most effective reform.
My friends will tell me, “OK, I can see what you’re saying regarding legalizing marijuana, but what about the hard drugs? What are you going to do about heroin?” My response: “Give it away for free” is meant to shock them. However, it’s also the truth. It is, in fact, the only approach for some heroin addicts that has historically been shown to be effective. In some cases, it is the best approach to reduce crime, increase the life-span of addicts, reduce new addictions, and eliminate the profit incentive for dealers.

Conservative Switzerland set up the first modern experiment with heroin prescription in the mid-1990s, producing results so promising the Swiss expanded the program and made it a permanent facet of health care. Holland followed with a more rigorous study that ended in 2001 — again producing positive outcomes and government approval to continue the research. Germany, Spain, Italy and Australia have planned or launched their own projects. The United Kingdom is working on a scheme to expand the prescription of heroin by individual doctors, even general practitioners.

Whether courageous or outrageous, the idea of prescribing illicit drugs to addicts has spread with astonishing speed, leading the media and the public to assume it’s a revolutionary new idea. It’s not.

The continuing prescription of drugs such as heroin to addicts — or “maintenance” as the practice is often called — is actually a very old medical technique that was dropped in North America when drugs were criminalized early in the 20th century. The story of how this medical technique met its demise is the story of how law enforcement snatched the issue of drugs away from medicine, turning what had been a health issue into a crime problem. It’s the story of how the cops beat the doctors.

This article gives an amazing detailed history of heroin maintenance efforts and the political pressures that have often forced governments to scrap effective programs.

By 1920, as historian David Musto wrote in The American Disease, “advocacy of maintenance was repressed as sternly as socialism” in the U.S. Doctors and pharmacists were arrested. Clinics doing the same work the Swiss and Dutch would experiment with 70 years later were raided and shut down. A total ban on heroin in medicine followed.

Desperate addicts looked elsewhere for drugs, and a criminal black market in narcotics blossomed.

Finally, in recent years, some countries have again been gradually looking at maintenance for extreme cases, and finding phenomenal success. Of course, people like our drug czar have never let facts stand in their way.

Opposition to such clinics has been fearsome. John Walters, the White House’s top anti-drug official, wrote in the Wall Street Journal that patients at these clinics, far from being “productive citizens,” are “demoralized zombies seeking a daily fix.”

In response, Barends points through the window of a meeting room where a seemingly ordinary woman in her late 30s talks with a counsellor. “Does that look like a zombie to you?” he asks, grinning.

Heroin use is an odd thing. Most people who take the drug do so for a short time, or sporadically, and never become addicted. Of those who get hooked, most stop using the drug without any formal treatment within a few years. Of the rest, most can ultimately be helped off the drug with treatment or at least be stabilized with regular doses of heroin’s chemical cousin, methadone.

Just a small fraction of users ultimately falls into the classic profile of a broken-down junkie whose addiction keeps a fierce grip as years and decades crawl by. Unfortunately, that fraction tends to be made up of the addicts who are most damaged and alienated. They tend also to be the heaviest users of heroin and the likeliest to commit crimes to pay for their drugs. They are the wretched of the inner cities, the junkies who populate the ghettoes, prisons and morgues.

Dr. Martin Schechter, chair of epidemiology at the University of British Columbia and some of his colleagues, are pushing to add clinics in Toronto, Montreal, and Vancouver.

“In Canada, we are discussing trying things, like safe injection sites, like medically prescribed heroin trials, that we would never have dreamed of talking about five or 10 years ago. And I will predict this will continue, and we will eventually, I don’t know when, but the issue of decriminalization and the conversion of drugs into a public health and medical situation will be on the front burner in this country in the future.

“That debate will occur. There is just no escaping it.”

Read the article.

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