Larry Love is one of the patients named in the law suit. He describes his life before SALOME as “a life of hell” and claims that the heroin maintenance program has provided him with “vastly improved” health and well-being. He believes it can save lives and allow addicts to become productive members of society.
His voice “quivering with emotion,” Dr. Scott MacDonald of the SALOME project responded to the federal government’s opposition to the program: “As a human being, as a Canadian, as a doctor, I want to be able to offer this treatment to the people who need it. It is effective, it is safe, and it works…. I do not know what they [the federal government] are thinking.” He claims that about 10 percent of those addicted to heroin require heroin maintenance. Of those, about half are able to move to less-intensive treatment or abstain altogether.
Other jurisdictions have already proven the value of similar maintenance programs. In Liverpool, England, for example, Dr. John Marks reported to work at a clinic that offered treatment to drug addicts.[44] This was back in 1982. At his facility, if users did not wish to work toward abstinence, and if they satisfied certain other criteria, they were offered a drug maintenance program instead. This meant that physicians gave users a prescription for their drug (heroin, cocaine, crack cocaine), which they could take to a pharmacy where it would be filled for free. As part of their therapy, they were expected to attend meetings to show they were otherwise healthy and crime-free. If they did not comply, they were dropped from the program.
Dr. Marks thought prescribing dangerous drugs to addicts was silly, and he planned to shut the clinic down and replace it with a psychiatric program that he believed would succeed. However, the success of the drug maintenance program was so convincing that Dr. Marks changed his mind. Addicts in the program remained free of AIDS, and most of them became healthier and obtained jobs. Police reported a 94 percent decrease in theft, burglary, and property crimes around the area of the clinic, and there was a reduction in drug use. Unfortunately, this program was shut down in 1995 despite its clear success. Dr. Marks put this down to the fact that the American television show 60 Minutes aired an episode highlighting the clinic’s work, and that this approach to addiction flew in the face of the American War on Drugs.
Dr. Marks explained his view of drug treatment (aimed at abstinence) versus drug maintenance (aimed at harm reduction and maintenance) this way: “If they’re drug takers determined to continue their drug use, treating them is an expensive waste of time. And really, the choice that I’m being offered and society is being offered is drugs from the clinic or drugs from the Mafia…. [Giving them drugs] doesn’t get them off drugs. It doesn’t prolong their addiction either. But it stops them offending; it keeps them healthy and it keeps them alive.”
Switzerland has also tried different approaches to drug addiction. After the failure of “Needle Park,” a location where addicts could gather and use drugs without fear of arrest, the Swiss opened a number of safe injection sites, which resulted in a reduction in both the number of overdoses and the spread of AIDS. After visiting Dr. Marks’s clinic in Liverpool, Swiss organizers went on to establish the “largest scientific heroin maintenance project ever attempted.”[45] Addicts had to meet a number of conditions before being provided with drugs (either free or for a nominal fee). The final report of the Swiss government was so positive that citizens voted overwhelmingly in a nationwide referendum to continue the program. The report said that the “individual health and social circumstances [of users on the maintenance program, who were “hard-core” drug addicts] improved dramatically, usually in a very short time.” Stable employment increased, unemployment decreased, users learned to function independently, criminal activities decreased dramatically, and costs of medical and social care and crime control dropped by about half.
The Global Commission on Drug Policy reported that in the Swiss program, between 1990 and 2002, the annual number of new heroin users dropped by 82 percent.[46] The overall population of users declined by 4 percent per year during that time, and several areas in Switzerland reported a decrease in injection drug use.
The advantages of a public health approach to heroin use are many. So are the negative effects of its criminalization. Addicts court disease and death by shooting up in back alleys to avoid the law. They must buy their drugs from criminals who specialize in violence, extortion, and corruption. They may commit crimes themselves in order to purchase heroin on the black market. The heroin, controlled by gangs and cartels, may be adulterated with unknown dangerous substances. The purity of the drug will be unknown, so overdoses can result. Members of the community as well as the addicts themselves may already suffer from family breakdown and community disruption caused by drug abuse. These problems are exacerbated by the criminalization of the drug, as addicts are further separated from their families and society by incarceration, and can contract diseases in prison that will then spread outside the prison walls when they are released.
Therapeutic Uses
Despite heroin’s reputation for producing serious addiction and health problems, many credible voices have called for its use as an effective painkiller. As noted earlier, heroin works better for many addicts than methadone because it is more effective at eliminating the pain and discomfort associated with withdrawal. It has also been shown to produce better results in helping patients become drug-free: one study showed that only 1.2 percent of clients became drug-free after using methadone, while 12.5 percent succeeded using heroin.[47]
What about using heroin to treat pain in a therapeutic setting? While legislators and physicians and many members of the public reject the notion of prescribed heroin, in some cases it provides the best remedy for chronic, excruciating pain, particularly for patients who are terminally ill with cancer. The main opposition to the use of heroin comes from those who believe patients run the risk of becoming addicted. Others respond that this concern is not germane, especially if patients are suffering and have only a short time to live.
We also know that people are generally less likely to become addicted when taking the drug for therapeutic purposes rather than for pleasure. According to WHO documents, “research makes it very clear that addiction is a negligible occurrence among patients with no history of addiction who receive opioids for pain.”[48] In one review of such cases, only seven out of twenty-four thousand patients became addicted. The authors say “cancer patients can stop taking opioids when the pain stops; i.e., they do not crave opioids when they no longer need them for pain relief.” They further state that the number one impediment to the medical use of opioids, according to a recent survey of governments, is the confusion and misinformation disseminated on the subject.
Canadian doctor W. Gifford-Jones has been championing the use of heroin for pain relief in terminally ill cancer patients for decades. In 1984, the Ministry of Health finally did legalize the use of heroin for this purpose. However, many restrictions were attached to its use: doctors were required to present their reasons to a hospital committee before permission to prescribe heroin was granted, and the drug had to be kept in a secure location and transported by armed guards. Because the process was so difficult, few doctors prescribed heroin, and ultimately the pharmaceutical company that was licensed to import the drug stopped doing so.
In a recent survey, Canada and the United States were listed in ninth place as the “best place to die.” England, which holds first place, allows prescribed heroin for end-of-life pain.[49] In fact, it has been using heroin for easing palliative pain since the early 1900s.[50]
When the Royal Canadian Mounted Police stated that there was a security risk associated with prescribed heroin, Dr. Gifford-Jones travelled to England to learn about the experience there and to assess these risks. He was told by Scotland Yard that there were few problems, and that hospital pharmacies were never broken into. Rural doctors even carried heroin in their bags for use in emergencies, and he was told that even children dying of cancer were given the drug because it gave them comfort and a “fuzzy” feeling.
Dr. Gifford-Jones emphasizes that the biggest fear of dying patients, especially cancer patients, is the fear of pain. His experience in England confirmed that terminally ill cancer patients do not become addicted to heroin. Why? Because