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."
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