Tuesday, 2 December 2008

What Does Prescription Heroin Really Mean for Junkies?

Switzerland has just become the first country to include prescription heroin as part of official government policy after a referendum voted 2 to 1 in favour of it. Although the 1300 patients who already receive prescription heroin in Switzerland are breathing a sigh of relief, what does it mean to addicts worldwide? Will other countries follow suit and if so, what will be the criteria to be accepted into the program? 

Also heroin trials to date have focussed on one or maybe two cities in each country so that leaves the vast majority of addicts not able to participate until the trial is either extended to cover other locations or it becomes government policy like Switzerland.
Swiss Approve Prescription Heroin BBC 
(mmmmm . . . look at all that heroin!)
Swiss voters have backed a change in health policy that would provide prescription heroin to addicts. 
Final results from the national referendum showed 68% of voters supported the plan. The scheme, where addicts inject the drug under medical supervision at a clinic, began in Zurich 14 years ago before spreading across the country. But in another referendum, the Swiss appear to have rejected the decriminalisation of cannabis. 
The heroin vote was one of a series of referendums held to decide policy on illegal drugs. The policy is described as one of last resort - prescribing addicts with the very drug that caused their problems in the first place - but supporters say it works, and Swiss voters appear to have agreed, the BBC's Imogen Foulkes in Berne says. Switzerland would be the first country to include it in government policy. 
Supporters say it has had positive results - getting long-term addicts out of Switzerland's once notorious "needle parks" and reducing drug-related crime. 
Opponents say heroin prescription sends the wrong message to young people and harms the addicts themselves.
Firstly though, congratulations to the Swiss for leading the world in common sense and pragmatic health policies. The world owes a lot to the Swiss (and the Dutch) for having the courage to care more for their people than pleasing the United States or hysterical religious groups. 

Secondly, we shouldn’t forget that this is the second attempt at trying something new. The first project, dubbed Needle Park was a failed experiment but it was still recognition that treating addiction with strict law enforcement wasn’t working. 

There have been several heroin trials now and all with very positive results. Even though they have all been successful, only 2 trials have developed into more permanent programs. One in Switzerland and the other in The Netherlands. Spain, Germany, Belgium and recently Canada have all held heroin trials with the UK’s trial finishing shortly. Also Denmark has announced they will be commencing a 2 year trial with a few other countries toying with the idea. 

Whilst many heroin addicts must be relieved to hear the good news of an ever expanding prescription heroin trend, the reality is not as rosy as it seems. Geographically, it is impossible to include everyone in a trial which is not the objective anyway. Most trials last about 2-3 years and for a program to be approved and operated in other cities, it may be 4 or more years away. Then you have to qualify them. At the moment, trials are for hard core, long term addicts who have failed other treatments and continue to participate in risky behaviour. I think the general consensus is that only the homeless or really desperate addicts will get in on the trials but established heroin assisted treatment (HAT) programs encompass other long term users more readily. But what about those functioning heroin addicts with jobs who appear to live a relatively stable life? Are they eligible? 

This site has shown many functioning addicts who remain outside the law by using and/or selling an illegal substance and are kept in a world of shame by hiding profound issues from their families. The binding thread is that they have all failed repeated attempts at treatment. Will they ever be included in a program for prescription heroin or are they not considered ‘desperate’ enough. A cynic could argue that these addicts might be excluded because they won’t contribute to the success statistics of such a program when there’s no room for improving key issues like homelessness, employment and health. A slap in the face really for those addicts who have been strong enough to stay employed or healthy whilst living with the nightmare of addiction.

As an addict in Vancouver for 38 years I was certain I would have no problem attending the program. It seems they only took Downtown addicts which gave them a very limited demographic and my calls went from wait to forget it. You could contact the NAOMI people if you want info but you'll be searching through an unpublished project.I hope you discuss parameters as most trials make getting off of heroin a prerequisite, which kills the project as you may well imagine. Harm reduction and working and happy clients should be the goal.Don't let them set you up to fail. [...] In my case I offered to move to the moon if transport was available. They seemed to have some issue with my actually having a roof over my head. They seemed to think that if you had it together enough to actually pay rent you didn't need a maintenance program. 
-Terry McKinney. Vancouver BC
I imagine some addicts would consider changing their lives dramatically if prescription heroin was available but not where they live. The opportunity to receive clinical grade heroin as part of their treatment is a huge temptation which I can testify to. Although prescription heroin may have been perfect for myself a few years ago, I am happy on my current treatment. The idea of injecting daily again or having to visit a clinic twice a day doesn’t appeal to me currently and it’s bound to be the same for other recovering addicts on substitution treatment. That’s if we were eligible at all.

HAT will expand over the next decade as it’s success becomes more accepted by governments frustrated over current drug policies and so will the requirements for entry into the programs.

Heroin is basically non toxic and users are able to lead relatively normal lives if they don’t have to deal with the consequences of it’s illegality. Most of the problems associated with heroin addiction are purely because of man made laws and not the drug itself. Issues like the spread of blood borne disease (Hep C, HIV/AIDS etc.), crime, health, employment and social exclusion are recent problems caused solely by treating this medical condition as a law and order issue.

Before the 1960s, some countries already treated opiate addiction with either morphine or heroin and there were very few problems. Back then, a great proportion of addicts eventually weaned themselves off opiates and went back to their normal lives, often over a 5-7 year period which is sometimes called the natural addiction cycle. It’s ironic that in this age of advanced technology and medicine, we are starting to revert to treatments from over 50 years ago.

On a sad note, there are many who criticise HAT for all sorts of reasons except those that count. There’s the “sending the wrong message” argument and the “we should be getting them off drugs” excuse. These are all just philosophical opinions that have no bearing in the real world and are just placing the morals of drug use above the health and well being of someone with a medical issue. Associated Press reported that one opponent of the Swiss decision, Sabine Geissbuhler from Parents against Drugs was so adamantly opposed to the program that she publicly stated:

I would never, never, put my children into a heroin prescription programme. What kind of freedom is that? I'd rather they were dead -Sabine Geissbuhler - Parents against Drugs

Releated Links: 
Swiss vote on radical heroin rules 
Swiss likely to approve prescription heroin


Anonymous said...

My child has problems with heroin and I would never wish her dead. She is amazing and I am proud of her. I do not know what she is going through exactly but I know she is doing her best.

That last comment is appalling.

David Raynes said...

It is completely wrong to suggest this programme is a Swiss invention it is a variation on the "British System". The UK has for more than 50 years had a system of prescribed opiates for some users. We still have it with some doctors specially licensed to dispense heroin. There is no great enthusiasm for it even among the doctors who have taken the trouble to get the licence. It does not deal with the wider problem of opiate addiction. It is important not to misrepresent prescribed heroin as a solution to addiction. It is a useful tool to stablise the most chaotic addicts. Long term mainteneance treatement of all addicts is not on any agenda and would be politicaly unacceptable because of cost. It just could not be done when there are cost restrictions on (for example) other needed medical treatements. It really is a case of hips, hearts or heroin.

epicne said...

I'm amazed at the references to the Swiss trial being a "first". In the UK until 1969, any GP could presciribe heroin, cocaine, methedrine or morphine to an addict. It was solely amerikan pressure, during one of the endemic crises of the Pound Sterling, that forced them to restrict such supply in return for an IMF loan. By 1971 it was only available to a very few restricted specialists, as David Raynes mentions.

Terry Wright said...

Thanks Anon.
It's astounding how some people will do or say anything to stop people taking drugs regardless of the reason. I bet these people would want insulin banned if the patients reported an elated feeling of happiness. We can't have people being happy now, can we.

Good luck with your daughter and it's great to know you support her totally through an incredibly tough time.

Thanks for your comments David and Epicne.
I think they mean, it's a first for a medical trial of prescription heroin to become an official government policy. The UK system has never been tested or researched properly until the trial currently in progress. It was always just another condition that UK doctors could treat and until the 1960s, there was never a reason to question it.

So yes, the UK were prescribing heroin for addiction first but the Swiss put it up to research via a trial and it became law once they were satisfied it worked.

I wonder how this will affect the outcomes of the UK trial? I have already heard from someone involved in the UK trials who said it has been really successful so far. Will a positive UK trial result along with the Swiss decision convince the UK government to expand their prescription heroin program? Will it affect Canada, Spain, Germany and Belgium to go ahead with an extended trial or maybe a permanent program?

THR said...

Hey Terry,

There's a US radio program with podcast on drug use you may find interesting:


David said...

Why not present an argument for the beneficial use of drugs like heroin?

What is wrong with recreational usage of drugs?

I wouldn't mind my wife taking heroin if it reduced her nagging, for example. Or my kids taking it, if it increased their academic achievement.

Terry Wright said...

Thanks THR.
Great stuff!

Thanks David
I still have no idea what any of your posts mean but thanks anyway.

Voletear said...

I have, over many years, seen good friends die needlessly because methadone didn't work well-enough for them. I would have been the same were it not for a few lucky circumstances. My methadone has no effect on me at all. Granted, it's been 37 years or so and my dose (260)is kinda high but the point is that methadone never really worked well for me. There really is no need for methadone now. It was used originally mainly because of it's lipid-solubility and resulting long duration of action which meant, in the early days, less visits to the clinics. Now we have patches, micro-spheres, and other extended-release formulations of whatever is needed. Why don't they formulate a heroin-contin sort of thing now anyway?

Anonymous said...

i don't think prescription heroin is ok for me. but then again my main addiction is not opiates. its crystal meth. there were trials in toronto about 2 years ago where they were using adhd medication in an injectable for to treat hard core crystal meth addiction. my b/f on the other hand would benefit for precription heroin. he has been using opiates since he was 15 or 16 and he is now 33. sadly it isn't really the opiate that he's addicted to but the needle. so for him it is a dual addiction. sadly it is so for many heroin addicts. so the HAT programs serve the dual addiction. first it helps the physical heroin addiction, and then it relieves the much more volatile psychological addiction to the needle itself. my b/f has gotten high from injecting water and at more desperate times even flagging his blood into the needle and then re-injecting it. we are both on methadone now however my b/f decided to quit cold turkey from a high dose of 105ml. he ended up in the hospital and back on methadone four days later. i don't think he's ever gonna quit to be honest with you. so yea heroin prescription would be good for him. it means he could get on with his life. less stress for me...