Could Radical 'Pharmaceutical Heroin' Plan Fight America's Opioid Epidemic?

U.S. policymakers searching for solutions to the opioid crisis, which is killing about 50,000 Americans every year, may want to consider a radical approach that appears to be working in Holland.

The Independent Media Institute, citing an investigation by the Cleveland Plain Dealer, reported that the Dutch government has been giving away heroin to addicts for two decades.

As a result, crime rates have decreased, and fewer people are dying. Holland's drug-related fatality rate of 11 per million citizens is a fraction of the 245 per million in the United States. No other country comes close to the American death toll.

The heroin program “has been an enormous success,” according to Ellen van den Hoogen, who manages a clinic that dispenses the drug in Amsterdam. “I think it would work elsewhere,” she said. Switzerland was already providing free heroin before Holland adopted the strategy, and the United Kingdom and Germany have since followed suit.

The Dutch have a long-standing belief in gedogen, translated as “pragmatic tolerance.” National officials consider drug addiction an incurable, chronic health issue that is best handled by permitting addicts to continue their habit under medical supervision. The goal is to improve people's lives, rather than end their dependency on drugs. “It's not a program that is meant to help you stop,” van den Hoogen explained. “It keeps you addicted.”

Such an attitude would be sure to meet with strong resistance in the United States, where even needle-exchange initiatives are controversial. Most Americans continue to oppose drug decriminalization and legalization, which have driven down overdose deaths in Portugal and other countries.

John Walters, the American “drug czar” in President George W. Bush's administration, claimed that injection sites are immoral and not “real treatment.” He declared that Holland is “keeping people addicted for the purpose of controlling them,” which has led to “a colony of state-supported, locked-up addicts.”

The program's defenders argue that it serves drug users who have had no success with methadone or other treatments. Most of those receiving free heroin have been struggling with opioid addiction for years.

Peter Blanken of the Parnassia Addiction Research Centre in Rotterdam insisted that the program is “real treatment.” He noted that about 25 percent of the patients make a “complete recovery” from their dependence on synthetic painkillers.

The pharmaceutical heroin distributed by the government is regulated for consistency and relative safety. Few program participants are tempted to try dangerous opioids like fentanyl, which has killed thousands of people, including the musicians Prince and Tom Petty.

Philadelphia is one of several places in the United States where officials are considering the establishment of a safe-injection site. Some of the city's addicts are already receiving prescriptions of naloxone hydrochloride, in the form of a nasal spray, that has proven helpful in preventing opioid overdoses.

More than 1,200 Philadelphians died in 2017 due to accidental overdoses, 90 percent of which involved heroin, fentanyl or prescription pills. Authorities have responded by proposing what they call a Comprehensive User Engagement Site, where addicts would be monitored while taking their drugs. The facility's medical staff would hand out free needles, prevent overdoses, and refer users to treatment and detoxification services.

“We have to make every effort we can to keep them alive long enough to get them in treatment,” James Garrow of the Philadelphia Department of Public Health told The Guardian. City officials predict that the clinic would save as many as 76 lives a year.

The program has its critics. Jim Kelly, who volunteers at the Last Stop recovery house in Philadelphia's Kensington neighborhood, expressed doubt that “anybody down here would go to these places.”

Local author and radio host Solomon Jones told his listeners that injection sites merely “enable” addiction. “So, if we’re now saying that running a legal drug house is fine for people shooting drugs, then we need to give people their houses back, their cars back, their money back; all the stuff that was confiscated from black and brown people during the so-called war on drugs here in Philadelphia,” the commentator said. “We need to make the black and brown community whole.”

The Philadelphia clinic is not expected to open until next year. Authorities are searching for a location, and seeking groups to finance and operate the facility. There are also legal challenges, most notably a federal law prohibiting such programs. The Trump administration's Justice Department has threatened to arrest employees at injection sites and seize the properties.

The Pew Research organization, which researched information from the U.S. Centers For Disease Control, found that white men in Philadelphia between the ages of 45 and 54 are most at risk of opioid overdoses. Nationwide, 80 percent of the victims in 2016 were white. Just 10 percent of them were African-Americans, who make up 12 percent of the U.S. population.

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