TIME TO RE-EXAMINE PRESCRIPTION HEROIN

While Insite, Vancouver's supervised injection site, continues to
serve an important and necessary function, the evidence is mounting
that what we really need is to provide prescription opiate and
stimulant substitutes to heroin and cocaine-amphetamine addicts.

Research conducted by the B.C. Centre for Excellence in HIV/AIDS has
shown that Insite is associated with many positive outcomes,
including a reduction in needle sharing and public disorder, and an
increase in the number of addicts seeking counselling and entering detox.

Despite these impressive developments, Insite's detractors, including
most recently the International Narcotics Review Board, argue that
the site does nothing to eliminate illegal drug trafficking or ensure
the purity of the drugs addicts inject.

The federal Conservative government, which has never been too "high"
on Insite, has expressed similar concerns. In fact, a document
obtained recently by the Vancouver Sun reveals that when the feds
were deciding whether to extend Insite's permit, they placed more
emphasis on the reaction of the international community than on
Insite's proven benefits.

This reveals that the Conservatives are more concerned with politics
than with science in deciding the future of Insite, which is
unfortunate, although not surprising.

In any case, Insite's detractors do make a legitimate point: Drug
trafficking continues to be a brisk and profitable business and,
while addicts are provided with clean needles and instruction in
safer injecting practices at Insite, there is no way of ensuring that
the drugs they get on the street are themselves clean.

Furthermore, addicts remain in control of their own injecting
regimen, which can be problematic, given the dangers associated with
heroin use. Indeed, according to a study in the current issue of the
British medical journal The Lancet, heroin is more dangerous than any
other commonly used illicit drug.

Researchers looked at a number of drugs, including heroin, cocaine,
barbiturates, marijuana, amphetamines, LSD and MDMA (ecstasy), and
asked independent experts to assess the danger of the drugs on three
scales: Physical harm, dependence and social harm.

Heroin was considered to be the most dangerous on each of the three
scales, and was ranked as an extreme risk for causing physical harm
and dependence. It was deemed midway between a moderate and extreme
risk of causing social harm. Clearly, this is not a drug that should
be in the hands of amateurs.

Fortunately, there is a simple way to drastically reduce the number
of amateurs who inject the drug -- ensure that addicts receive it, or
a substitute, under the supervision of a physician.

This is precisely what is occurring in the NAOMI (North American
Opiate Medication Initiative) trials, which are testing whether
providing heroin to addicts can produce better outcomes than
providing methadone. Although final trial results are not yet
available, preliminary results suggest that heroin maintenance has
helped to stabilize at least some users.

Furthermore, prescribing heroin to addicts would ensure the purity of
the product and the veracity of the labelling, and would shut down
much of the illicit trade in the drug.

Thus, while Insite remains an important intervention, moving toward
prescription heroin (and prescription stimulants) seems like a
winning proposition for anyone affected by addiction. And since we're
all affected by addiction, it's time to take the next step in solving
a problem that has festered for far too long.