PRESCRIBING HEROIN

Sir, - Fintan O'Toole's thoughtful article on the need to at least
seriously consider State prescribing of heroin to addicts makes for
depressing reading (The Irish Times, June 3rd). In one critical regard
it is also flawed.

The phenomenon of cellular tolerance - the increasing dose required
for effect as sensitivity diminishes - means that there is no ceiling
on the amount of heroin that will eventually be required by the
addict. If, as with every other drug, the medical establishment
implements a therapeutic ceiling, we are back in the situation of a
black-market demand for the drug.

Even with methadone, a prescribed drug where physiological stability
can be achieved, after three decades of widespread use and research
there is still no universal agreement over low-to medium-to
high-dose prescribing. The argument remains that too little of the
drug will lead to "topup" drug use, while too much will see
black-market selling of the "surplus". The consequence, beyond the
battle of wile and wit between patient and therapist, is methadone
diversion, and an increasing number of methadonerelated deaths.

To consider that such a high price in health and crime consequences
can be avoided with heroin prescribing, where physiological
stabilisation is not a realistic option, must be, in Wilde's words, a
case of the triumph of hope over experience. - Yours, etc.,

Lorne Patterson, RMN,
Senior Addiction Clinician,
NeuroElectric Therapy,
Marian Avenue,
Edgeworthstown,
Co Longford.