'HARM REDUCTION' WORKS IN EUROPE

We should be very clear that the role of harm reduction as part of a broad
strategy in addressing substance abuse is thoroughly documented in the
peer-reviewed literature.

That this literature and its conclusions are routinely ignored,
misrepresented or selectively mis-quoted by senior U.S. drug policy
advisers is equally well documented and Kevin Sabet provides a good example
of this in his comments on heroin maintenance (Why 'harm reduction' won't
work, March 20.)

The Swiss heroin trial was indeed critiqued by scientists and others on the
grounds that it was not a randomized study. This is a valid critique, but
equally applicable to all of the U.S.-based drug treatment court
evaluations, a program that Sabet clearly supports. It has not stopped
their expansion and indeed there is some evidence that for some people they
may be beneficial. That is, addicts who graduate from the court program,
(exactly like participants in the Swiss program) "experienced improvements
in health and wellbeing and less criminal behaviour."

More serious is his egregious omission from his review of the subsequent
randomized trial of prescription heroin by Dutch investigators. This trial,
which met the strictest scientific criteria, also found that previously
treatment-refractory, long-term, hard-core heroin addicts experienced
substantial improvements in health, social functioning and lessened
criminal activity when they were in the program. They also suffered
relapses when the program was withdrawn.

In both the Swiss and Dutch programs, some heroin addicts did become
abstinent and others transitioned to methadone, facts that Sabet overlooks.
The science, contrary to Sabet's contention, clearly and unequivocally
supports a role for heroin maintenance in Switzerland and in Holland.

Will it here? That is what the NAOMI trial seeks to establish.

The supervised injection site and the prescription heroin trials fill gaps
in our present system where we need to face the fact that not all illicit
drugs can be kept off the street, not all drug use can be prevented, not
all drug users are susceptible to our present treatment options and no
amount of wishing it were otherwise will make it so.