UP NEXT: FREE HEROIN FOR ADDICTS

Should we be giving free heroin to addicts?

Don't choke. Researchers in Vancouver say yes. And they've just spent
$8-million in public money to prove their case. Last month, after
concluding a landmark clinical trial, they announced that the best way
to treat hard-core heroin addicts is: Give them more heroin! They
argue that methadone, a much safer treatment, doesn't work with this
crowd. But free heroin makes them happier, healthier and less inclined
to steal so they can get their next fix. And since they can't kick the
habit, we ought to minimize the social harm and feed their habit, legally.

The findings from the NAOMI (North American Opiate Medication
Initiative) trial were instantly endorsed by the same progressive
folks who've failed to clean up Vancouver's drug-infested Downtown
Eastside. The media applauded wildly, too. But a number of addictions
doctors aren't impressed. And they've issued a sweeping critique of
the NAOMI trial that raises important questions about it.

"The trial was badly designed," says Mel Kahan, head of addiction
medicine services at St. Joseph's Health Centre in Toronto. "And there
are better and safer solutions."

The trial was supposed to study addicts for whom methadone had
repeatedly failed. But Dr. Kahan says many of those recruited for the
trial had scarcely tried methadone at all. The trial also relied
heavily on self-reports. You won't be surprised to learn that subjects
lucky enough to get the real stuff (as opposed to the control group,
which got a rather skimpy dose of methadone) said they were highly
motivated to stick with a program that gave them pure and uncut heroin
for free.

"It was quite delicious," said Greg Liang, a trial participant who was
tracked down by The Globe and Mail's Jane Armstrong. Some of the
addicts, he said, competed to see how much they could consume. "They
were heroin pigs."

A much smaller third group in the study also got lucky. They were
given injections of hydromorphone (more widely known as Dilaudid), a
potent legal narcotic that is similar in effect to heroin. They
couldn't tell the difference. NAOMI researchers know they're highly
unlikely to get Ottawa to authorize the use of prescription heroin. So
they're lobbying the B.C. government to approve a hydromorphone clinic
on the NAOMI site.

The critics aren't buying it. Vancouver's real problem, argues Dr.
Kahan, is an acute shortage of good methadone programs. The next step
in tackling the heroin problem is to expand them. "In medicine, we try
to go by the principle 'First, do no harm.' You try the safest thing
first and you go up from there." A hydromorphone clinic, Dr. Kahan
says, is a bad idea. "It's a nasty drug. What kind of message do we
send when it's okay for a world-famous academic clinic to inject it?"

Stan deVlaming, a Downtown Eastside addictions doctor who's also a
strong critic of NAOMI, says: "There's a fine line between harm
reduction and enabling. If I make it easier for people to stay
addicted, am I doing them any favours?" Injecting any drug, he says,
can have gruesome and life-threatening side effects. And he sees them
every day.

Both doctors point out that keeping addicts addicted is nothing more
than palliative care. They'd rather see the money spent on rehab. Even
some of the most dysfunctional patients, they say, can eventually
recover. "My work is incredibly satisfying, because a lot of them do
get better," says Dr. Kahan. "It's kind of like a return to life."

But many people in B.C.'s drug policy establishment have a very
different vision. They want to see prescription heroin made available
on a broad scale, and some would even like to see it legalized. As far
as they're concerned, $8-million in federal research money to fund the
NAOMI trial is money well spent.