GIVE THE ADDICTS THEIR DRUGS

For those who bicker over two of the four pillars, harm reduction and
treatment -- Mayor Sam and Senator Larry, please take note --heroin
maintenance happens to be both

To hear former Vancouver mayor Larry Campbell tell it, current Mayor
Sam Sullivan's proposal to provide drugs to addicts is "very
simplistic."

Yet in dismissing Sullivan's proposal, Campbell, who clearly prefers
the bully pulpit of the mayor's office to the sober second thinking of
the Senate, revealed that when it comes to drug addiction, there's
enough simplistic thinking to go around.

After all, Campbell also supports giving drugs to addicts, but only to
those who have failed to respond to other programs. So he argues that
Sullivan's proposal -- which might involve providing drugs to a
broader array of addicts -- amounts to emphasizing harm reduction at
the expense of treatment.

The former mayor's argument therefore reveals that he believes harm
reduction and treatment are necessarily two different things, and
never the twain shall meet. And Sullivan seems to agree, since he
opined that treatment doesn't need to be a priority right now.

Thus, despite their minor disagreement -- which merely concerns how
far gone addicts have to be before being eligible for free drugs --
the current and former mayor aren't so far apart after all, in that
they both agree that harm reduction and treatment are two separate
modalities, that harm reduction involves giving addicts what they
want, while treatment involves refusing to do so, as it begins and
ends with abstinence.

Now, that's simplistic thinking.

Contrary to what the mayors seem to believe, it's not always possible
to distinguish harm reduction from treatment. Indeed, while
prescribing heroin to addicts is usually viewed as harm reduction,
heroin maintenance is really a form of treatment, a means of
stabilizing addicts physically, emotionally and economically.

And it's a treatment that has been around for a long time. Even the
United States, which now characterizes all illicit drugs as The Great
Satan, operated narcotic maintenance programs until 1925, when drug
hysteria, motivated by anti-Chinese sentiments, precipitated the end
of such programs. (Anti-Chinese racism also led to the passage of
Canada's opium laws in the early 20th century.)

The United Kingdom also ran opiate maintenance programs in the 1920s,
and continued the practice until the early 1970s, when U.S. opposition
led to severe curtailment of the practice. According to the Drug
Policy Alliance, closure of the programs resulted in a dramatic
increase in heroin users in the U.K. -- from 2,000 in 1970 to more
than 300,000 by the early 21st century. Concerned about this
development, British police associations advocated expanding heroin
maintenance programs, and the U.K. has recently done so.

Of course, there were likely other factors that contributed to the
increase, but the skyrocketing number of users suggests that heroin
maintenance programs might qualify not just as harm reduction and
treatment, but as preventive measures as well. All of which means they
satisfy three pillars of Vancouver's four pillar strategy --
prevention, enforcement, harm reduction and treatment.

Buoyed by the U.K. experience, other European countries began
experimenting with heroin maintenance. Between 1994 and 1997, the
Swiss government provided heroin to 1,000 long-term addicts who had
failed at more traditional forms of treatment.

According to a report from the North American Opiate Medication
Initiative (NAOMI), 69 per cent of subjects remained with the Swiss
program for its 18-month duration, and more than half of the dropouts
became abstinent or switched to other treatments. And the dropout rate
was significantly lower than the rate seen in studies of methadone
maintenance.

Further, the Swiss subjects experienced improvements in almost every
aspect of their lives. Participants reported a dramatic decrease in
drug use, and while 43 per cent of subjects lived in unstable housing
at the start of the study, 18 months later that number was reduced to
21 per cent.

The rate of employment more than doubled, to 32 per cent from 14 per
cent, and arrest rates declined from 69 per cent to 10 per cent.
Indeed, Swiss police registered a whopping 50-per-cent decline in all
offences, which led the Swiss public to vote in favour of a long-term
heroin maintenance program.

There was one significant drawback of the study, however. Researchers
did not include a control group -- that is, they didn't provide some
addicts with methadone or other forms of treatment to compare to the
heroin maintenance group. We therefore can't assume that the results
obtained were solely attributable to the provision of heroin.

Aware of this limitation, Dutch researchers began a study in 1998 that
compared the effects of methadone maintenance with a treatment
involving a combination of heroin and methadone.

The results were similar to those obtained in the Swiss study --
participants receiving heroin enjoyed vastly improved physical, mental
and emotional health, improved social functioning, and experienced a
reduction in criminal behaviour. Most importantly, the benefits of
heroin/methadone treatment were significantly better than the benefits
of methadone-only treatment.

There was also one drawback to this study, though it wasn't a result
of the study's design: Researchers found that more than 80 per cent of
those receiving heroin deteriorated substantially following
discontinuation of the heroin treatment. (One further limitation of
all heroin studies is that their results can't be generalized to the
provision of other drugs, such as cocaine or methamphetamine, given
their different psychopharmacological properties.)

In any case, that heroin maintenance produced, among other things,
better physical and mental health reveals that it can't be
characterized as a mere harm reduction measure but is, in fact, a form
of treatment, and a powerful one at that.

Certainly, heroin didn't "cure" the subjects, in that they continued
using drugs, but then again, many treatments don't cure diseases. It
is this misguided, utopian belief in a cure -- that treatment is only
treatment when it leads to abstinence -- which constitutes truly
simplistic thinking, and which leads us to dismiss potentially
efficacious therapies.

The sad fact is, some addicts won't stop using drugs for a long time,
and some might never stop. But that's no reason to refuse to treat
them, to refuse to do what we can to improve their -- and our --
quality of life.

After all, while some people understandably object to giving addicts
what they want, to paying for their habit, we're already paying for
it. Heroin addicts account for enormously increased health care costs,
prison costs and costs associated with home and car break-ins.
According to NAOMI, the societal costs of untreated heroin use amount
to $45,000 per addict per year, and with between 60,000 and 90,000
opiate addicts in Canada, the total annual tab is $2.7-$4 billion.

For all of these reasons, the NAOMI trials are underway in Vancouver
and Montreal, and will compare the efficacy of prescribing
heroin/methadone with methadone-only treatment. While we can't be
certain that the results of the Swiss and Dutch studies will be
replicated here, preliminary results suggest that heroin treatment is
having a positive effect.

If these results are confirmed, then it will be time for the current
and former mayors to quit their bickering over which pillars are most
important. Indeed, it will be time for anyone who values either harm
reduction or treatment to support heroin maintenance, because it
happens to be both.