Using Heroin To Treat Heroin Addiction
What is a 'heroin injection site'?
A heroin injection site is an injection site in which, among other drugs, you are allowed to inject heroin. Injection sites have been put into business, I think in something like 90 different cities, many in Europe, a span of seven different countries and the purpose of it is two fold. One is to take care of local nuisance problem where addicts assemble and cause nuisance to that particular neighborhood. The other go and the other thing that you can achieve is that if people take drugs inside and injection facility, they do so in a hygienically manner, they do so in a safe manner because they are not alone the water they use will be clean water not water of some unhygienic source. If they have a medical problem it will be attended to, so that's the basic philosophy of this injection site in which people can also inject their street heroin.
What controversial heroin treatments are being tried in Europe?
Harm reduction treatment, and also harm reduction education, is very controversial. With regard to harm reduction, prevention is very controversial because it teaches safe use. Instead of saying don't use it; it says if you are going to use it —we're not happy about it— but use it safely. With regard to treatment, it's very much the same kind of thinking. It says, it's your choice to use drugs; we can't stop you doing that. The least harmful way of doing that is getting them legally, or injecting in an injection site using sterile equipment and so on. And that's what the whole philosophy of harm reduction oriented treatment is about: making it safe, keeping people alive, with not too many harms on their soul and their body in the time they have drug use in their lives.
How do police departments in the United States and Canada react to injection sites?
You have to make a very large distinction between Canada and the United States with regard to how Police react to in injection sites. In Vancouver, where an injection site was set up, this was with the full support of the Canadian Mounted Police. They saw that the things that one had done hitherto was not effective, and they totally supported the try for something else. In the United States, police have been very restrictive, and have sometimes jailed local people who were just passing out clean syringes. For instance, there is a law in place that will not tolerate federal funding being used for spreading syringe exchanges, and that really illustrates how differently police departments take positions on this.
How is prescribed heroin administered to a user?
Prescribed heroine is administered to the user preferably in the form that he already uses the drug in. This can best be illustrated in a Dutch heroine trial because the Dutch were criminalists in a way that many of the heroin users are not injectors. It would be totally irresponsible to introduce heroine prescription in the form of injectable heroine, to people who were not injecting. So what they do is they provide smokable heroine to people who smoke heroine and injectable heroine, to the people who are already injectors. In principle one could conceive of crossovers. It would be preferable for an injector started to smoke for instance. That would be a little advance on the health risk scales of that particular drug user's life. One could conceive of other crossovers to safer forms. Right now, most places it is delivered in sterile ampules where people will get their precise dosage of injectable heroine on a 2-3 times daily basis.
Who pays for prescription heroin treatment facilities?
Well, in principle, the prescription of heroin could be done completely different ways, according to what policy you want to adopt. Some places, the prescription of heroin is totally paid by taxpayers dollars, (pop up stating FACT: In the United Kingdom, it costs between $20,00 and $30,000 per user annually.) and other places an amount is paid by (pop up leaves the screen) the user for being able to access that facility and in private practicing in England, people will pay the full amount for the whole cost of that treatment. Now, I would like to add, when it comes to discussing the price of this, that it's also been subject for cost benefit analysis, and it shows, for instance in the Dutch heroin prescription trial, that providing addicts with heroin was a great dollar saver, or rather euro saver in Holland. It was close to 30,000 Euros cheaper for society a year, per user than not providing it, because you had fewer hospital admissions, you had less crime, you didn't have to put people in prison, and so on. But if you add all the expenses of that up, and it's not cheap to put people in jail, then it proved very cost efficient.
Is heroin-assisted treatment safer than methadone?
I think the most important point to make is that not being in treatment is very very dangerous. That your risk of dying if you are just out there trying to take care of yourself and using a lot of drugs is very very high, compared to if you are in any kind of treatment program, whether that be methadone or heroine. Once you get into a treatment program, you will receive some legal drugs, you will receive some sort of medical attention and you will stabilized. You will use less and you will not take the same kind of chances. Your life will not be in chaos. So in the respect of safety, they are both much more safe than not being in treatment. The differences between them are minor to not being in treatment at all.
How effective is heroin-assisted treatment?
Heroin-assisted treatment is completely ineffective if you expect someone to take the drug for a very short while and then become clean and productive citizens, and not people who still have considerable problems. If you're realistic, you expect something less and you'll find very big improvements on a large number of parameters. One being the risk of dying is considerably lower. One being your health will improve. One being your social life will also improve. One being the risk of being engaged in crime and illegal markets will also greatly diminish. So there are great results from administering legal heroin to people if you have an eye for relative improvement.
How has the World Health Organization (WHO) reacted to heroin-assisted treatments?
The World Health Organization (WHO) is part of the UN and the UN has generally responded quite negatively towards any kind of trial with heroine. The World Health Organisation (WHO) has actually been evaluating which were the first and really for the first time show whether it was feasible and whether there was beneficial at all to be treatment and they were very positive. I mean they look at the facts and they look at the research and said generally we prove of the logical points the way it tested and we don't have any exemptions to the signs in it.
Why is US drug policy considered repressive by some countries?
As a European, I'd say it's a very precise description to say that United States have been the motor behind the worldwide prohibition, and the very hard line on drugs. It's, I'd say, a matter of fact, the United States has, for instance, certification of all other countries with regard to how they perform in the war on drugs, and that's one way of pressing your policies down the throat of the rest of the world. United States also has a lot of strong-arm politics, diplomacy, and training of police, and so on, that puts particular policy to be very dominant worldwide. So I'd say, just like the rest of the world has taken a liking to a lot of American products like hamburgers and whatever, we've also adopted a policy which has most of its origin in the United States.
How does prescribing heroin affect drug-related crime rates?
From the very onset it was not known how much affect one could suspect in regard to reduction of crime when addicts got heroin legally. There were reports from early on that in England prescribing doctors could almost eliminate legal markets in that area, their patients would not steal overall or commit any other crimes. But this was not very documented. It was more a testimonial kind of thing than really science behind it. But once you got into conducting real Heroin trials, we made the statistics as well, you compare with official court statistics and so on. And you found significant reductions in crime in the population of addicts that got people access to Heroine. It was so much that even if there were no other gains from prescription, I think this alone would be one that could make many people sway towards more, let us do it. But fortunately there are also help full issues for the addicts themselves. It is not just a crime fighter. Many drug users lead a life in which there are only two real things that matter. Money and drugs. And that is very unlucky because you cannot keep up your addiction with a job usually. So you resort to doing crime at one time or another, and you get into that circle of committing crimes to pay for drugs. Now people have to acknowledge that a lot of the crimes being done are actually not done because people are under the influence of the drugs, they are under the influence of prohibition. Which means that the drugs are very very expensive and that is why they are doing the crime. Once they get legal access to the drug of their preference, that means there is no need to commit the crime and it is actually not a very comfortable like to be a criminal. It is risky. it is hard. And many people who commit crimes do not like it. They do not like the life of a criminal and they stop once they get legal access. Others continue, but at a lower-level because they do not need to make that much money.
