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Prescribing Heroin Instead of Methadone. The Pros and Cons of Prescribed Heroin Treatment
A recent Canadian case study examined prescribing legal pharmaceutical heroin to addicts in need. The study authors gave heroin to long term chronic heroin addicts who had tried repeatedly over a period of many years to quit using, without success. The users were given clean heroin in a supervised setting 3 times a day.
The study authors say that the trial was a great success and that the users' health and well being increased dramatically under the prescribed drug protocol; and since the users no longer needed to spend all their time sourcing money for illicit drugs, they were able to participate much more readily in society (getting jobs etc.).
The mayor of Vancouver (the trial city) has responded enthusiastically in support of the concept of prescribed heroin. Many others remain skeptical and the issue is both very political and contentious.
Should we prescribe heroin to those that need it?
Here are some of the pros and cons
- Prescribing heroin attracts people into treatment who are not attracted to treatments such as methadone. (Some people will not tolerate the side effects of methadone or buprenorphine, and some users find these drugs ineffective).
- Users given prescribed heroin stay in treatments for longer
- Giving users affordable and safe medical heroin reduces crime. It reduces the profits made in selling illicit drugs and reduces petty crimes associated with addiction and a constant need for drug-money.
- Giving users medical grade heroin ensures a consistent purity and safety – which in turn greatly reduces the odds of overdose.
- Having users inject under supervision further reduces the risks of overdose.
- Having users inject under supervision (and without fear of legal repercussions) reduces HIV and Hep C transmission.
- Retaining heroin users in "heroin treatment" enables health services workers to provide peripheral services to an often inaccessible population of users.
- Giving people access to heroin may make them less likely to attempt treatments such as methadone or Suboxone.
- People with unfettered access to heroin may be less likely to attempt cessation of use.
- The continued use of injection as a delivery method is risky, even under supervision.
It remains a very controversial idea. Some argue that until further studies prove that prescribed heroin is as beneficial to addicts as it is to society (through reduced crime, HIV transmission etc.) that doctors will be unlikely to advocate its use.
Others argue that any legalization of hard drugs begins a slippery slope to dangerous full legalization and increased rates of use.
And still others argue that since no treatment seems effective for a core group of long time opiate users, anything that improves their quality or life and health while also benefiting society is a very positive thing.