When addiction is the disease, perhaps the poison is the cure. Such is the mentality behind a controversial investigative report recently published by the RAND Corporation which argues “prescription heroin” — no, that wasn’t a typo — could be a beneficial alternative for drug addicts who often turn to the black market where their opioids can be laced with illicit fentanyl.
In the midst of an opioid crisis which saw more than 72,000 drug-linked deaths in 2017 alone, U.S. researchers have began looking to the political policies of other industrialized nations, such as Australia, Canada, and the European region, assessing the merits of their supervised injection sites serving addicts their potent vices — a drastic difference from standard U.S. government practices such as prohibitions and jail time for junkies.
Under “prescription heroin,” otherwise called heroin-assisted therapy (HAT), doctors would be given the responsibility of handling their patient’s pharmaceutical-grade heroin — also known as diacetylmorphine or diamorphine — that are otherwise obtained through illegal and unsafe channels monopolized by the drug cartels. Junkies, despite knowing the risk of tainted drugs, are proven to go to these desperate lengths if such legal clinics don’t exist. The intention isn’t to just reduce overdoses, but alleviate the financial coercion that forces junkies to a life of stealing, violence and other crimes to get drugs.
Medical professionals would handle these injections with considerably measured dosages with a keen focus on patient safety, pre-prepped with the opioid overdose antidote naloxone in case of dire circumstances.
“These are controversial interventions,” writes lead author Beau Kilmer, the current co-director of RAND’s drug policy research centre. “There are some people that don’t even want to have conversations about this, but given where we are with opioid deaths near 50,000 and fentanyl deaths near 30,000, it’s important that we have discussions about these interventions that are grounded in the research and grounded in the experiences of other countries. This is just another treatment that could help stabilize lives.”
Kilmer’s team cites several randomized controlled trials (RCT) that were conducted throughout Canada, the United Kingdom and the Netherlands which all concluded the HAT sites reduced the likelihood of drug users returning to their life on the black market. According to the RCT’s “strong evidence” cited in the RAND analysis, patients were more likely to stay in heroin prescribed treatment programs on average compared to those using tamer “consumption sites” offering methadone, buprenorphine and naltrexone as a way to combat heroin cravings and were less likely to commit crimes.
These treatments, however, don’t yield the same benefits for long-time heroin addicts who, when screened for the HAT program in Canada, were shown to have tried quitting over a dozen times on average. The report indicates that while only 5 to 15 percent of people using such harsh opioids are going to benefit from the procedure, it’s important to remember 1.5 million are currently using heroin within the United States. “Addressing even a small proportion of an enormous problem can produce large benefits in absolute terms,” the report concluded.
If quitting is impossible, can maintenance therapy at least mitigate the damage? NPR reports such practice was common among western doctors during the prohibition era of the 1920s. It was only ended in the U.S. due to relatively recent federal drug laws which blindly outlawed substances regardless of the views of those within the medical field. Some professionals who advocate the practice note there’s currently a black market for treatment the government is gatekeeping.
“It’s hard for me to imagine heroin-assisted treatment because I think right now even talking about getting more mainstream treatment like methadone, buprenorphine and naltrexone to people, there’s already so much stigma around it,” says Dr. Chinazo Cunningham, an addiction specialist at Albert Einstein College of Medicine, who spoke with NPR last week. “We have treatment that works, we just need to provide it in a way that is accessible to people.”
She was joined by her fellow university colleague Dr. Aaron Fox who announced his decision to explore these methods in other countries and “figuring out how to do a pilot” back in the U.S.
“People need additional options for something like cancer,” Fox explained. “If people fail responding to treatment, there are other treatments. If people aren’t able to stop or cut down on their heroin use when enrolled on methadone or buprenorphine, we need other options for people. I’m not going to say, ‘I tried my best, that’s it,’ when there are these other tools shown to be effective in other countries,” he continued. “Why not use that in the U.S.?”
It surely depends whether America is ready to detox its drug war problems. Allowing doctors to use innovative medical practices, which is at the root of corporate apologia for those against Medicare-For-All, could wash its citizens of the addiction and suffering that black markets create. Granting even incremental policy RAND suggested, such as injectable hydromorphone — an opioid often used in legal painkillers — could mitigate the rising death toll. It’s better for patients to be under the watchful eye of their own doctors than druglords who see their customers’ pain not as a bug of the black market, but a feature key to their upholding notorious criminal empires.