… I’m still just as excited as Crommunist apparently is about the recent results of a study conducted in Vancouver on the efficacy of prescribing heroin as part of clinical treatment for addiction.
So… here’s the story: there was this little pilot project conducted here in Vancouver, in my beloved Downtown Eastside (home to one of the worst heroin epidemics, and some of the worst urban blight, in the developed world) called NAOMI. The idea is prescribing heroin (diacetylmorphine) to addicts, and providing it to them free of cost, as part of either a harm reduction or treatment plan. NAOMI was run out of a little corner store on East Hastings to a select trial group of patients recommended through other clinics (presumably patients for whom other treatments such as methadone or in-patient detox were ineffective).
The harm reduction aspect of the project was fairly straightforward. First of all, the heroin being distributed would be safe and controlled for potentially dangerous additives. Patients’ use could be regulated and monitored. Patients would not need to purchase their drugs with their welfare money (which is proportioned based on the assumed minimum one requires to pay for necessities such as shelter, food and toiletries) and thus be better able to afford basic necessities, which carries innumerable health benefits. Patients would not need to steal, engage in sex work, or turn to other forms of crime in order to finance their addictions. And in the event that such a project were instituted on a large scale, it would deal a significant financial blow to the dealers, gangs and smuggling rings that meet the demand for heroin. Between the effect on organized crime and petty street crime, it would have an immense impact on crime reduction.
The treatment part is where things get interesting, and where this study has produced singularly important (and potentially paradigm-shifting) results. What NAOMI found was that prescribing heroin, rather than heroin substitutes such as methadone or buprenorphine, actually produces better results in terms of ultimately achieving abstinence. I understand your incredulity, so here’s a link to the original article. This is primarily due to a significant decrease in drop-out rates from the treatment program. Methadone is all well and good, but if dissatisfaction with its ability to manage cravings ultimately leads the recovering addict to relapse, the whole thing was pointless. But doling out gradually decreasing doses of heroin will give patients far more incentive to remain in the program, and keep them “hooked in” to the treatment plan rather than simply giving up. Of course, a genuine desire to ultimately get clean would be required for treatment to be effective, but this is true in the case of any addiction treatment.
The idea of keeping addicts “hooked in” to the healthcare system is also of pivotal importance in general. Social programs designed to address social issues, provide assistance, reduce harm and produce overall community benefits only work in so far as those targeted are aware of those programs, interested in the programs, able to access them, and willing to access them. This is one of the subtler, but just as important, benefits of projects like InSite, Vancouver’s safe injection site. In addition to the immediate benefits such as keeping needles off the street, preventing overdose, reducing transmission of blood-borne pathogens and so on, having a sort of bridge between the street-level addicts and homeless and the social projects that can help them is of vital importance. In addition to sterile rigs and a safe place to shoot up, InSite provides information and access.
A NAOMI-like project would have similar benefits. Rather than addicts simply being derelict and off the grid, they’d be participating in the healthcare system, where they could be provided direct access to doctors, social workers, help with getting income assistance or disability benefits, help finding treatment for whatever health issues they may have (mental health issues, dental hygiene, treatment for HIV, treatment for infections, abscesses, etc.) and all kinds of other things.
The long term cost and benefit analysis is very important here too, though. In terms of the potential increase in beneficial outcomes for treatment, treating addicts with heroin and keeping them in the program (even if it doesn’t always lead to abstinence, but instead a maintenance / harm-reduction model) will save an enormous amount of money in terms of treating the health problems associated with falling out of treatment programs and back onto the street. Simply keeping addicts in the care of doctors, using safe and controlled heroin, has immense potential in terms of preventative medicine, and avoiding complications that lead not only to considerable and prolonged suffering on the part of the patient, but also to considerable expenditures on the part of the health system.
When you take the amount of money that would be saved in terms of not having to treat preventable complications from patient drop-outs and poor outcomes, and compound it with the amount of money in property losses and police-spending that would be saved by the widespread reduction in drug-related crime, and you have incredible financial benefit acting as an incentive in addition to how well such a model would be more compassionate and better help the patients themselves.
NAOMI comes out, once again, proving that the actual medical evidence falls overwhelmingly on the side of harm reduction and moving past our long-since-proven-useless punitive and moralistic models for drug policy. This excites me, because we have yet another trump card in our already staggering winning hand in terms of arguing that progressive drug policy is clearly the one supported by all the real-world evidence.
Though ever the cynic, I worry about the fact that we already have a staggering degree of evidence supporting harm-reduction and progressive drug policy. We already know they’re more effective than what we’ve been doing. But the Harm-Reduction, Prevention and Treatment “pillars” are all still pitifully underfunded in comparison to the runaway juggernaut of Enforcement. And so much time and energy has been spent rendering drugs a moral issue, so much was invested in the strategy of stigmatizing them in the misplaced hope of deterrence, so much of our cultural attitudes and public institutions are based around the assumption that we must must must not under any circumstances tolerate or “enable” addiction (even if it’s obviously the best and right to do!).
And directly giving heroin to heroin addicts? That runs direct against the grain of received wisdom. It would require either being done very, very quietly (hopefully without our southern neighbours noticing and sticking their noses into it), or totally undoing a century’s worth of cultural conditioning, and while we’re at it admitting that the powers that be were not only wrong, but totally, completely wrong. It would require admitting, collectively, as a nation, that we’ve spent the last 70 years taking exactly the wrong approach to the problem of drug use and addiction. It would require admitting to one of the biggest fuck-ups in the history of policy-making.
Ever noticed how rare it is to even notice one person in an internet comment thread admit they had something wrong? Yeah.
So, I hate to kill a policy boner, or give Crommunist policy blue balls, but I’m just not all that optimistic about the potential for this to make it to policy. Especially with Harper still Prime Minister. And his robocall-ensured majority parliament and “mandate”. And C-10 around the corner. And all the new prisons he wants to build.
I just hope the whole “that wasn’t actually a democratic election” scandal can lead to a vote of no-confidence. Then, MAYBE, we’ll see things like some steps forward in terms of drug policy. You know… policy actually based on evidence.
And maybe that little equal-rights-for-trans-people thing too. That would be nice.