MAKING ADDICTION LESS DEADLY

CHAPEL HILL - Last month San Francisco health officials met with
groups that supported the idea of opening a "safe injection" center --
the first in the United States. It would be funded by the city and be
limited to intravenous users of heroin, cocaine and other drugs.
Addicts would bring their own drugs, receive clean needles and inject
themselves under medical supervision instead of shooting up in the
streets.

Advocates of the proposal believe that the creation of such a facility
would reduce fatal drug overdoses and curtail the spread of HIV and
hepatitis C caused by the sharing of needles.

Formidable obstacles stand in the way of this proposal: The facility
would violate federal law that criminalizes the possession of such
drugs, and it is certain to run into a political firestorm. So far,
not one San Francisco politician publicly supports the idea. The
meeting between city health officials and the groups advocating the
site had hardly ended when a spokesman for U.S. drug czar John Walters
blasted the notion as "poor public policy" and "a form of giving up"
on curing drug addiction. Yet there are numerous safe-injection sites
in Europe, and studies have found them to be effective.

Consider Switzerland's experience. In 1994, persuaded by favorable
results of a drug maintenance program in Liverpool, England,
Switzerland launched the largest and most scientifically designed
trials ever attempted. Over 1,000 volunteers were selected --
hard-core heroin addicts, who were at least 20, were afflicted with
serious health problems and had repeatedly failed other programs. They
were offered heroin, morphine or methadone and initially opted for
heroin. Addicts were allowed to adjust their own doses. They
self-injected with equipment prepared by the staff, who also provided
advice and supervision.

In the final report issued in July 1997 the Swiss government stated:
Within a month the patients had settled on stable and relatively low
dosage levels that allowed them to dramatically improve their health
and their economic and social functioning.

No overdoses occurred, and no heroin was reported to have leaked into
the illegal market. The percentage of addicts with stable jobs
increased from 14 to 32. After a year and a half, 92 patients switched
to methadone, and 83 chose a rehab program that would help them give
up heroin altogether. The government report noted that the probability
of switching to an abstinence program increased the longer the
individual remained in the program. Law enforcement and health
officials in Switzerland declared the program a success. So did
voters. In a nationwide referendum in September 1997, over 70 percent
opposed an initiative that would have ended the trials. In October
1998 parliament voted overwhelmingly to make the program permanent and
agreed to have it evaluated by the World Health Organization, which
concluded that heroin maintenance was feasible and would bring about
improvements in health and social functioning.

l l l THE OFFICIAL U.S. REACTION WAS HOSTILE, and proposals to
undertake similar experiments here were met with outrage. For example,
in 1998 professor David Vlahov of the Johns Hopkins School of Public
Health suggested undertaking similar trials in Baltimore. Maryland's
Democratic governor said, "It doesn't make any sense. It sends totally
the wrong message." Impressed by reports from Europe, Vancouver, B.C.,
set up an injection drug center four years ago -- the only one in
North America. After facing much initial skepticism the facility has
won the support of the mayor, the police chief, merchants and a
majority of the public. A rigorous study by a team of researchers
headed by Dr. Thomas Kerr found that the Vancouver center has
prevented overdose deaths, helped prevent the spread of disease and
led to a decrease in abandoned syringes, needle-sharing and
drug-related crime. The research also credited the facility with
increasing the number of addicts seeking drug treatment.

U.S. drug czar Walters reacted angrily to Vancouver's safe-injection
center. He said "The very name is a lie. There are not safe injection
sites. It can't be made safe."

Dr. Kerr disagrees. He sums up the evidence this way: "It's really
been studied to death -- it's time to move on. It's obvious this is
something that works."

I agree. What a shame that America's anti-drug fervor blinds us to
overwhelming evidence that medically supervised injection sites for
addicts would bring enormous benefits to our society. The health and
social functioning of addicts would improve; they would commit fewer
crimes to get a fix; and their connection with health professionals
would help many kick the habit. In addition, safe injection sites
would diminish the spread of AIDS, since, according to the Centers for
Disease Control, about 30 percent of the AIDS cases in the United
States -- and a majority involving children! -- are caused by dirty
needles.

(Arthur Benavie is professor of economics, emeritus, at UNC-Chapel Hill. His
book "Drugs: America's Holy War" is forthcoming.)