STIMULANT MAINTENANCE IS A GOOD BEGINNING

No one suggests that diverting coke and meth addicts to other
stimulants will make all their problems disappear, but it allows them
to focus on behaviour instead of their next hit

Given the high profile of heroin addiction, it's not surprising that
Vancouver's supervised injection facility and the city's participation
in the North American Opiate Medication Initiative (NAOMI) have
received most of the publicity.

But given that most experts suggest stimulant drugs such as cocaine
and methamphetamine are a bigger problem than heroin, it's unfortunate
that coke and meth addictions haven't received as much emphasis.

So Vancouver Mayor Sam Sullivan is to be commended for pushing for an
experimental "stimulant maintenance" program in the city.

Like methadone and heroin maintenance for opiate addicts, stimulant
maintenance aims to stabilize cocaine and speed addicts by providing
them with prescribed doses of other stimulants.

Sullivan will, no doubt, face opposition from the same people who
opposed the supervised injection site and the NAOMI trials, and who
will argue that taxpayers shouldn't be fueling drug addicts' bad habits.

But as more than a dozen published studies on the injection site have
demonstrated, it has reduced public disorder, has helped stabilize
many addicts both physically and mentally so that they can live
productive lives, and might even have contributed to some addicts'
entry into detox and treatment programs.

Similarly, although all the evidence is yet to be analysed, the
provision of heroin through the NAOMI trials also appears to be having
a positive effect on the lives of some users.

Now to be sure, given the different psychopharmacological properties
of stimulants, we don't know whether stimulant maintenance programs
will have the same positive effects as opiate maintenance. But that's
precisely why clinical trials are needed, to see if stimulant
maintenance can improve the lot of stimulant addicts -- and by
extension, the lot of everyone else, since drug addiction exacts a
heavy toll on society.

For those who have conducted such trials, the evidence seems
promising. While some experts were skeptical at first, many have been
won over by the successes of stimulant maintenance trials in other
countries, including Australia, Great Britain and, perhaps
surprisingly, the United States.

In fact, John Grabowski of the University of Texas has been
researching for some years the effects of providing dextroamphetamine
to cocaine addicts, and the results he's seen are encouraging.

The research by Grabowski and others has found that prescribing
dextroamphetamine has helped some users to reduce cocaine use, and to
attain some biological and behavioural stability, thereby allowing
them to concentrate on behaviour-control counselling.

Indeed, a trial in Sydney, Australia, in 2001 found that
dextroamphetamine therapy increased the likelihood of addicts
remaining in counselling. Further research has shown that addicts on
stimulant maintenance report fewer signs of depression and behavioural
disturbances.

Although these results are undeniably positive, it's important to
understand that stimulant maintenance isn't a panacea, that it's not
going to make everyone's problems go away. But maintenance does seem
like a good start, a way to help addicts to focus on solving their
problems, rather than focusing on getting their next hit.

That's reason enough to recommend stimulant maintenance trials for
Vancouver. Sullivan has said a "very good group" has come forward with
a proposal for a stimulant trial, and if the proposal is accepted, a
body of literature on the efficacy of stimulant maintenance programs
in Vancouver can be developed.

Better yet, we might possibly begin to arrest a serious problem that
has profound, and profoundly negative, effects on us all.