Heroin Harm Reduction

Do heroin harm reduction policies help create excuses for junkies?

Kevin Thompson, 43, a participant in two Canadian clinical studies where patients were given doses of pharmaceutical heroin, says he was given three fixes a day at a downtown Vancouver clinic. The injections, Thompson told a Vancouver journalist, meant he could live free from worry about how and where to obtain his next dose. “It can be a lot of hassle just to get what you need for the day,” Thompson recalled.

As an addict, Thompson says he shoplifted, scrounged for money, and woke up in an anxious state, fearing withdrawal symptoms, for years. The cycle was finally broken when he applied and was approved for two Canadian studies that are part of Vancouver’s longstanding “harm reduction” public policy. The first, the North American Opiate Medication Initiative (NAOMI), took place from 2005 to 2008. The Study to Assess Longer-term Opioid Medication Effectiveness (SALOME) was conducted in 2013. Both provided treatment in the form of diacetylmorphine – a.k.a. prescription heroin.

Like others who participated in the studies, Thompson reports that it wasn’t long before he went from being homeless to being employed and having a place to stay. “I’ve gone from using hard-core every day and being homeless to having a roof over my head and working,” he says. “With your heroin habit supported, you can start thinking about bettering your life. It gives you a chance to think and get your head back together.”

But the controversial program is not without its detractors. This past October, Canada’s Health Minister, Rona Ambrose, went after one of the larger loopholes in Canadian federal law to try to prevent drugs like heroin, cocaine, and ecstasy from being prescribed at all. The move prompted Providence Healthcare of Canada and five SALOME participants to gear up for battle in British Columbia’s Supreme Court: they want Vancouver’s doctors to be able to prescribe drugs like diacetylmorphine whenever it’s deemed medically necessary. The plaintiffs hope to convince the court that ample evidence exists showing prescriptions of this sort (also known as “heroin maintenance”) can represent a valid and compassionate form of medical treatment.

Vancouver has long been known for not turning its back on its more down-and-out citizens. For years before the first NAOMI trials even started, the city enjoyed a mobile needle distribution system, where clean syringes were provided by those driving vans around the Vancouver area. Making more recent news are the vending machines that sell none other than Pyrex™ glass crack pipes. The price for each is a generous 25¢ (Canadian). The idea is to decrease the spread of infection (and ostensibly to make visits by Ontario Mayor Tom Ford more comfortable though bumbled pipe purchases make excellent fodder for American media, which needs something now that it can no longer exploit the search for Malaysian Air Flight 370.)

The thinking behind monitored doses and prescription heroin is similarly about harm reduction. Proponents believe that by bringing addicts into the healthcare system, you simultaneously lead them away from the crimes frequently associated with addiction.

Here’re a few “Principles of Harm Reduction,” as proposed by the Harm Reduction Coalition. They:

• Accept, for better and or worse, that licit and illicit drug use is part of our world and choose to work to minimize its harmful effects rather than simply ignore or condemn them.
• Do not attempt to minimize or ignore the real and tragic harm and danger associated with licit and illicit drug use.
• Affirm drug users themselves as the primary agents of reducing the harms of their drug use, and seek to empower users to share information and support each other in strategies which meet their actual conditions of use.

No, these aren’t part of a Ten Commandments for Dope Fiends; they’re for Overdose Prevention Healthcare workers facing one person dying of a drug overdose every 19 minutes in America.*

Movin’ on…

When the case does go up before the Canadian Supreme Court, the legal future of “evidence-based care” of this nature will have some heavyweights to back it up, such as trial results reported in the New England Journal of Medicine and legislators in New York State who are primed to expand the accessibility of a heroin overdose prevention drug called naloxone. In other words, despite stated “Prevention” anti-drug policies of Canada and the United States and the fact that American needle exchanges and other treatment programs do without public funds, it would seem that community-based healthcare workers and advocacy groups are actually gaining ground. At the very least, they’re doing the legwork: providing better evidence and making more sense than talking heads within the two governments.

Now I’ve never used heroin, so maybe I don’t have a dog in this fight. On the other hand I do know people struggling with addiction, and of course there’s the fiscal issue of whether or not to spend public funds to study overdose reversal or how to decrease the spread of HIV among IV drug users (to me, it’s a no-brainer that we should).

If Kevin Thompson is able to get his heroin by visiting government approved clinics, he no longer needs to lie, cheat, and steal to get drugs. He says he’s able to focus on bettering his life as a result, because the accessibility provides him with more time to think and get his head together. So on the surface, the math seems easy. But isn’t there still the reality of heroin addiction being a part of his daily life? In other words, isn’t Thompson using the compassionate city in which he lives as an excuse to remain a junkie?

So here’s my question: Just because a program in which someone participates eliminates the need to commit crime to score dope, isn’t someone like Thompson still expecting to get what he wants out of life on his terms? And isn’t there an excuse to get his way in there somewhere?

Admittedly, this was a lot of background to get through to merely wind up questioning whether or not there’s an excuse here (there is). But walking through these public-policy gray areas  is necessary to arrive at the one thing that matters most: someone is out there sharing a needle.

If it’s possible to nod our heads at the genuine and theoretical benefits of the two Canadian studies, as well as the efforts being made by healthcare workers in New York, certainly it’s possible for us to get out from under the War on Drugs mindset.

Not that I see supervised injection sites and heroin prescription stations next door to your local weed shop (the one by the Starbucks) anytime soon, but this dialogue does bring us to what the future will require to reduce crime and overdose statistics, decrease the spread of HIV and other STDs, and help people help themselves in a compassionate progressive manner.

We just need to keep our eyes on the excuses in the meantime, ’cause there’s nothing gray about them.

 

 

Related:  Why Go Easy on Junkies? Reforming mandatory minimum sentences for low-level drug offenders.