Could prescription heroin be the next step in treating addiction? | Opinion
The idea of providing individuals who use substances with a safe space to use them might sound radical, but the United States is behind the curve of evidence-based addiction solutions.
Last week, when Philadelphia announced its support of Comprehensive User Engagement Sites (CUES) — also known as safe injection facilities — the trolls came out in full force, to battle with misinformation and zero data.
On news sites and social media, I saw it all:
"When will the city make a child molestation safe zone?" one person joked.
"Not with my tax dollars!" cried others.
Some cited The Wire as if it was peer-reviewed evidence.
And not everyone opposed to the sites hid behind their screens. On Good Day Philadelphia, radio personality and columnist Dom Giordano tried to prove that the city has taken this too far: "Why don't we provide the heroin, then?" he asked.
I laughed out loud. Prescription heroin? Sure. Let's do it.
After all, why shouldn't we?
The idea of providing individuals who use substances with a safe space to do so might sound radical, but globally, the United States is behind the curve of evidence-based addiction solutions. Portugal decriminalized all drugs in 2001, after nearly 1 percent of its population had become addicted to heroin. Now, Portugal loses only 5.8 per one million adult citizens annually to overdoses, compared with America's nearly 200. Several other countries, including Canada, Switzerland, the United Kingdom, Germany, and the Netherlands, provide a prescription for medical-grade heroin to individuals for whom other treatments have failed.
Medication-assisted recovery — which is the use of FDA-approved medications such as methadone, buprenorphine, and extended-release naltrexone (combined with psychosocial therapy) — is irrefutably the most effective treatment for opioid use disorder. But for the nearly 40 percent of individuals for whom it is ineffective, heroin-assisted treatment is a viable second-line option.
Every study on the use of diamorphine (pharmaceutical heroin) to treat heroin addiction under medical supervision has demonstrated positive outcomes. In the countries where it's provided, it's created a sharp reduction in illicit drug use, crime, disease, and overdose. It's also improved individuals' overall health and well-being and helped them reintegrate into society by securing stable housing and employment.
Oh, and it improves the chances that individuals receiving it will stay in treatment.
So why does this solution sound so radical?
The answer is complicated.
Humans — all animals, actually — are creatures driven to catch a buzz.
Dr. Ronald K. Siegel spent more than 20 years collecting evidence that humans are not, in fact, the only species that seeks out substances to use recreationally, and wrote extensively about this in his book Intoxication: The Universal Drive for Mind-Altering Substances. Through Siegel's book, and in his interviews in Johann Hari's book Chasing the Scream, Siegel explains that people who use drugs aren't bad; they're just human.
Unfortunately, though, for 10 percent of us in the United States, that little buzz isn't enough.
Despite this science, our society treats people with addiction as though they don't deserve the same tax dollars, empathy, and evidence-based services as individuals with other disorders and diseases.
Ask anyone who's needed treatment for both substance use disorder and cancer, and I promise you they'll affirm the fact that they're treated differently depending on the diagnosis.
Imagine if more than 1,200 individuals died of cancer in Philadelphia last year, and our city proposed a location for them to receive a death-reversal antidote and medical treatment when they need it. Imagine if someone with cancer needed a medication called diamorphine to keep them alive and improve their life. Those patients would not be denied that treatment.
So why should it be different for those addicted to substances? The answer is that it absolutely shouldn't.
But unfortunately, our country has made drugs illegal and turned those who use them into criminals, thanks to a misguided and biased War on Drugs.
Now, this is where most Americans – over-saturated with anti-drug messaging – clap back: "But drugs are so strong that anyone will become addicted after trying them. Look at what happened with the opioid epidemic, caused by Big Pharma!"
While we should hold Big Pharma accountable for its deceptive marketing practices, and the chemical makeup of some substances does put individuals at higher risk for dependence, the opioid crisis is much more complicated than that.
Environmental factors such as trauma, loneliness, isolation, and unemployment are not to be ignored either when trying to understand how we got here. Those hit hardest by the Great Recession experienced all of the above. It's also worth noting that the problems we associate with addiction – like crime, disease, and overdose – start when the substances are taken away. The spike in overdoses since the government's crackdown on Big Pharma supports this.
So before you dive into the argument against Comprehensive User Engagement Sites, ask yourself this: Why are these substances illicit and these behaviors illegal in the first place?
The alternative is hardly as radical as America's draconian drug policy would have you believe.
Jillian Bauer-Reese is an assistant professor of journalism at Temple University, where she teaches a course called Solutions Journalism: Covering Addiction. She is also a person in long-term recovery. email@example.com @thesmallpicture.