PRESCRIBED DRUGS A STEP FORWARD

It's worth working toward an ideal world in which people would not be
dependent on drugs. In the meantime, we should be looking at measures
- -- like prescription heroin -- that would make our society safer and
more secure.

Even if we can't stop people from abusing drugs, perhaps we can stop
them from breaking into our cars.

The North American Opiate Medication Initiative, a.k.a. the NAOMI
project, has completed a three-year trial that tested the idea of
prescribing heroin and a heroin substitute for confirmed addicts.

The participants, in Montreal and Vancouver, had all been through
repeated addiction treatments without success. "Society had basically
written them off as impossible to treat," said Dr. Martin Schecter of
the University of British Columbia, who led the project.

The project tested three approaches: Methadone substitution, which is
the current norm; prescribed heroin; and prescribed hydromorphone or
Dilaudid, a prescription opiate-based painkiller.

The results were striking. All three therapies were effective. But
based on every measure, prescribed heroin and hydromorphone were far
more effective than methadone.

After 12 months in the program, almost 90 per cent of those
prescribed heroin or Dilaudid continued to participate, had entered
treatment or were clean. Only 54 per cent of those using methadone
met the same standard, indicating a higher rate of relapse to illegal drug use.

Those receiving prescribed heroin or opiates were less than half as
likely to also use heroin illicitly. They reported having spent less
money on drugs of any kind in the previous month after a year in the program.

Those who stayed on the therapeutic program, whether with methadone
or heroin, demonstrated improved physical and psychological health.
The amount they report spending on drugs in the previous month fell
from a median of about $1,500 -- or $50 a day -- to about $400.

And, not surprisingly, the number of participants who said they
committed crimes fell from 70 per cent to 36 per cent and the level
of criminal activity was also cut in half. Freed from the need to buy
street drugs, the users were much less likely to resort to crime to get money.

And the study found no negative impact on communities.

None of this is surprising. Similar studies in other countries have
produced the same kinds of results. Freed from the daily scramble to
get illegal drugs -- and the money to buy them -- peoples' lives
improve. The stability and improved health allows some to work or
make the decision to enter treatment. Crime is reduced.

The idea of prescribing drugs, or substitutes, troubles some people.

But if we accept addiction as illness, then the goal should be
effective treatment and management. The evidence from NAOMI and other
trials is that prescribed drugs can play an important role.

Not, of course, for everyone. The NAOMI participants were all over
25; the mean age was 40. All were long-term users who had been
through treatment at least twice. There is no thought of making drug
access overly easy.

The NAOMI project dealt only with heroin addiction. But studies in
other countries have reported similar outcomes in trials of
prescribed substitutes for cocaine and crystal meth.

Too much of our drug policy has been based on myth, ideology and
wishful thinking. It is time to look at the measures -- like
prescribed drugs -- that really make a difference for those who are
addicted and their communities.