More than 100 doctors and scientists from around the world flocked to the New York Academy of Medicine on June 6 to learn about what may be the most controversial type of drug treatment: doctors prescribing heroin to hard-core addicts. This idea appears to be gaining credibility in the U.S., as evidenced by the impressive group of sponsors for the “First International Conference on Heroin Maintenance,” which included Beth Israel Medical Center, Columbia University School of Public Health, and Montefiore Medical Center.
The star attraction at this event was Ambrose Uchtenhagen, the Swiss social scientist introduced as the “pope of drug policy research.” Uchtenhagen unveiled findings from his three-year study of 1100 junkies conducted in Switzerland. The results are promising. Uchtenhagen found that giving heroin to longtime users slowed the spread of HIV, reduced crime, decreased homelessness, and led to more addicts getting jobs.
Some attendees hope the conference will mark the beginning of a new movement to conduct trials in the United States. New York city and state officials approved a heroin maintenance program as far back as 1971, but pressure from the federal government killed the project. In recent years, heroin maintenance has been gaining support from politicians and doctors in Europe, Canada, and Australia. Dutch researchers are about to test the Swiss findings with their own study, which is scheduled to start next month.
Meanwhile, the U.S. government remains hostile to any approach that seems to say “yes” to drugs. Most conference attendees seemed skeptical about the chances of operating a heroin maintenance program in the U.S. But Ethan Nadelmann, who organized the recent conference and runs the Lindesmith Center, the drug policy organization funded by financier George Soros, remains optimistic. “We are confident that we will be able to secure private funding for heroin maintenance trials,” he says.
The Swiss government launched the first large-scale study of heroin maintenance in 1994. The only junkies allowed to get legal heroin were those who had been using it for more than two years and had tried other treatment strategies but failed. For $10 a day, these addicts made several daily trips to a clinic and got heroin from a doctor. Then they were sent into a sterile “injection room” and took seats at a long steel table facing a mirror. While clinicians watched, addicts dabbed disinfectant on themselves and shot up.
The point of the program is not to get junkies off the drug, but to improve their quality of life. Addicts get help finding housing, landing a job, and repairing family relationships. After three years, all of the homeless junkies in the program found a place to live. The number of users who were unemployed fell from 44 per cent to 20 per cent. And in just the first six months, the number of crimes committed by addicts in the program dropped by about 60 per cent.
Eighty-three users left the study to join abstinence treatment programs, even though this path is neither encouraged nor discouraged. “We are not very convinced that pushing works,” says Uchtenhagen. Before quitting heroin, he says, “people have to feel ready.”
Uchtenhagen and others see heroin maintenance as one treatment strategy among many. “Methadone maintenance works the best for the most people,” says Nadelmann, a former political science professor at Princeton University. “Abstinence-based therapy works better for others. But there are inevitably going to be some cases where heroin and methadone don't work. Our view is: Do whatever works.”
Not all the conference attendees were so convinced. Beny Primm, who served on President Ronald Reagan's Commission on AIDS, says he plans to visit the heroin maintenance trials in Switzerland and Holland before deciding whether he supports the treatment. But, he says, “I think one should look at everything and not be closed-minded about different approaches to solving the illicit drug use problem.”
Many drug policy experts disagree. “In the United States, it would be a disgrace to waste any resources on heroin maintenance or even on research on heroin maintenance,” says Herbert D. Kleber, executive vice-president of the Center on Addiction and Substance Abuse at Columbia University. “If I have a dollar to spend on treatment, why would I put it into an unproven modality?”
At the recent heroin maintenance conference, one veteran researcher felt a sense of deja vu. David Lewis, director of the Center for Alcohol and Addiction Studies at Brown University, had been considering a job offer as medical director of New York's heroin maintenance trials before they were canceled. “This conference has a similar ring to what happened before,” he says. “People from the prestigious universities are present in large numbers to hear what is happening in other countries.”
But Lewis feels that politicians' and the public's attitude toward drug use had changed in the last two decades. “The moral crusade has hardened up,” he says. “Even though Nixon had a war on drugs in 1971, we probably had a better chance then of doing a heroin trial without public opposition than we do now."