The case for prescription heroin

[thujone]

VANCOUVER, British Columbia — The Providence Crosstown Clinic is decorated with posters espousing the sort of medical advice you might expect at any other doctor’s office: Cover your cough, wash your hands, don’t use antibiotics to treat the flu, and ask staff if you need any help.

In the main treatment room, a familiar smell of rubbing alcohol lingers in the air — the kind of scent I associate with getting a vaccine shot. At Crosstown, the smell is the remnants of the medicine that 130 to 150 patients inject themselves with multiple times a day at the clinic.

Except the injection here isn’t a vaccine. It’s medical-grade heroin.

...

“People are forced into the illicit stream of opioids because they can’t get legal access to meet their opioid needs,” said Scott MacDonald, Crosstown’s head physician. “So they will access whatever is available and least expensive.”

Crosstown represents an international move toward providing a full spectrum of care for people who are addicted to drugs. It isn’t a first-line defense against opioid addiction, and it’s not going to solve the crisis by itself. But for a fraction of opioid users suffering from addiction (maybe about 10 to 15 percent), other treatments won’t produce good results, almost certainly leading users to relapse — and possibly overdose and die.

To combat this cycle, Crosstown offers these opioid users medical-grade heroin (called “diacetylmorphine”). Under supervision, nurses are at the ready with the overdose antidote naloxone and oxygen tanks in case of an emergency. These patients are the people for whom other treatments have failed. It’s a last resort. And it works.

https://www.vox.com/policy-and-poli...8/canada-prescription-heroin-opioid-addiction

 

[LucidSDreamr]

do you think this will happen in american before we hit the 100,000 fent deaths per year mark? after? Definitely not wish sessions at the helm.

 

['medicine cabinet']

do you think this will happen in american before we hit the 100,000 fent deaths per year mark? after? Definitely not wish sessions at the helm.

Idk...I don't see that ever happening in murica...not even if fent was killing hundreds of thousands of ppl...the gov prob would build more jails and try to police their way out of the problem, which as we all know has been a great success in the "war on drugs"

Maybe safe sites to inject with clean gear and medical staff on the ready in case of OD, but never Rx heroin. Sessions is trying to go after mmj providers, I'm sure he'd say there would be HAT in this country over his dead body...I'd say so be it l

 

[cduggles]

Even if Sessions gets canned, not with Trump.

 

[elijahkakahead]

nope america is run by too many old people with sad reasoning abilities . it saddens me how long its taking for marijuana to become legal in the state of rhode island . what it looks like every state is rough . so id say maybe california wouldbe the one to do something like this.

 

[cj]

Trump announced the plan yesterday. They are going to try and police the problem away with a healthy dose of failed prevention initiatives. There was no mention of any HR initiatives that I saw. Just more of the same unhelpful bs.

 

[Mafioso]

I think there is evidence that decriminalization is a much better route compared with outlawing a substance and anyone who uses it. I think the solution is changing the policies from punitive to rehabilitative. Rather than punishing anyone who uses the substance, allow them to receive the treatment and education they need. Labeling someone a criminal does little to nothing to deter and help the individual to make better life choices.

That said, I think prescription might be a step too far. It leaves too much possibility and incentive for corruption. A good example would be prescription opioids. I don't think the solution is related to the availability of the drug but rather the culture and beliefs surround the drug/drug use. People can stop using a substance while it is still readily available if they change their thinking and habits related to drug use. This may be difficult alone but is possible and made even more probable with proper support.

 

[Jabberwocky]

Prescription heroin has been shown to work EXTREMELY well in both the UK and Switzerland. I see no reason it wouldn't work well given similar regulatory schemes in the Canadian context, particularly Vancouver.

As it stands right now the Canadian program that is open for it in the trial phase are to restrictive to make any significant impact, forcing people to commute HUGE distances and not giving access to the people who really need it most in the skid row area.

 

[Mafioso]

Why would prescription heroin be any different than any prescription opioids? I would assume you don't believe that prescription oxycodone has been doing well for the last few decades.

What are the legitimate uses for heroin and who would "need" it?

 

[cj]

Why would prescription heroin be any different than any prescription opioids? I would assume you don't believe that prescription oxycodone has been doing well for the last few decades.

What are the legitimate uses for heroin and who would "need" it?

It's given like methodone treatment is now. People go the clinic and they have to use the drug at the clinic under supervision. It cuts out the illegal aspects of using and minimizes the risks involved as people get a set dose and clean tools.

 

[Mafioso]

While I'd agree that it can be done in the name of harm reduction I still am far from convinced it is a solution to an opioid use disorder even if it's administered with a strict tapered schedule along side rehabilitative treatment. Also, it does introduce large potential for corruption and the exploitation of the prescription just like any other prescription.

Even with additional treatment I don't think prescription heroin is beneficial beyond reducing some of the potential harm related to using adulterated drugs, using a substance of unknown strength and dangers associated with using dirty needles(which can be mitigated with needle exchange programs). What is the benefit for having prescription heroin when there are drugs like methadone and buprenorphine? IV heroin is definitely not a good way to taper off of opioids. Is it intended for people who have no desire to quit but want to use in a safer environment? Who would be qualified to receive a prescription and should it be covered by health care, even state funded health care?

 

[S.J.B.]

Why would prescription heroin be any different than any prescription opioids?

According to a recent Canadian study, it isn't any different than hydromorphone, at least. Participants couldn't even tell whether they were being given heroin or hydromorphone. Presumably oxycodone, morphine, etc. would be approximately equivalent as well. In Canada, the current focus is on hydromorphone maintenance, due to the results of the SALOME study and the fact that it has far less stigma attached to it and fewer regulatory barriers.

What is the benefit for having prescription heroin when there are drugs like methadone and buprenorphine? IV heroin is definitely not a good way to taper off of opioids. Is it intended for people who have no desire to quit but want to use in a safer environment?

At least here, the intention of health authorities is to provide these supervised hydromorphone or heroin maintenance programs to people who have tried methadone and buprenorphine but were not able to stay off street opioids. The main goal is to keep people from dying by poisoning via adulterated street opioids (which are exceedingly prevalent here, especially in the western provinces).

 

[Jabberwocky]

While I'd agree that it can be done in the name of harm reduction I still am far from convinced it is a solution to an opioid use disorder even if it's administered with a strict tapered schedule along side rehabilitative treatment. Also, it does introduce large potential for corruption and the exploitation of the prescription just like any other prescription.

Even with additional treatment I don't think prescription heroin is beneficial beyond reducing some of the potential harm related to using adulterated drugs, using a substance of unknown strength and dangers associated with using dirty needles(which can be mitigated with needle exchange programs). What is the benefit for having prescription heroin when there are drugs like methadone and buprenorphine? IV heroin is definitely not a good way to taper off of opioids. Is it intended for people who have no desire to quit but want to use in a safer environment? Who would be qualified to receive a prescription and should it be covered by health care, even state funded health care?

Read Chasing the Scream and High Price. They will give you a better idea why HAT has been highly successful pretty much everywhere it has ever been tried (for a time parts of the U.K., Switzerland and now certain places in Canada).

You can’t even begin to compare the harm done to heroin users via the substances’s criminalization, demonization and stigmatization compared to the biological and social consequences of its pharmacological effects. It’s beyond night and day.

 

[Mafioso]

According to a recent Canadian study, it isn't any different than hydromorphone, at least. Participants couldn't even tell whether they were being given heroin or hydromorphone. Presumably oxycodone, morphine, etc. would be approximately equivalent as well. In Canada, the current focus is on hydromorphone maintenance, due to the results of the SALOME study and the fact that it has far less stigma attached to it and fewer regulatory barriers.



At least here, the intention of health authorities is to provide these supervised hydromorphone or heroin maintenance programs to people who have tried methadone and buprenorphine but were not able to stay off street opioids. The main goal is to keep people from dying by poisoning via adulterated street opioids (which are exceedingly prevalent here, especially in the western provinces).

So it would be considered a form of harm reduction, similar to needle exchange programs, not a form of treatment.

If the goal is just to prevent people from using adulterated substance of unknown strengths, wouldn't there be a case for a prescribing any drug to someone who is struggling to overcome a substance use disorder?

 

[Mafioso]

Read Chasing the Scream and High Price. They will give you a better idea why HAT has been highly successful pretty much everywhere it has ever been tried (for a time parts of the U.K., Switzerland and now certain places in Canada).

You can’t even begin to compare the harm done to heroin users via the substances’s criminalization, demonization and stigmatization compared to the biological and social consequences of its pharmacological effects. It’s beyond night and day.

As far as I can tell, the criminalization, demonetization and stigmatizations would all have both biological and social consequences relating to it's pharmacology and the culture/society. Any unregulated substance is going to be more dangerous because of adulterants and unknown potency. Being too doped up to function normally would have social consequences regardless of legal status and stigmatization.

Care to clarify at all? Not sure what you are trying to say. Also, I don't doubt that it may have success in terms of harm reduction, but what are you terming as success?

 

[Jabberwocky]

I'm trying to say that it is very possible to live a highly successful meaningful like AND use opioids. I'm saying that pharmacologically opioids are not nearly as harmful as some other substances, such as alcohol/gabaergics and most stimulants, and that most of the negative harms associated with opioids have to do with how they're used, and how they're used it almost entirely shaped by the context in which they're used. And the context in which they're used (prohibition, the war on drugs, etc - which is why I suggest you check out those books) is specifically geared to create as much harm from drug users as possible. The war on drugs is literally geared to kill drug users, not to save them like politicians supposed try to make it out to seem like.

HAT removes most of those problems, giving people the chance to use the drugs while they also work on improving other areas of there lives. A lot of people make progress while on HAT such that they eventually get off it, similar to methadone. That isn't unusual at all. No one is saying that opioids should be available to people willy nilly, rather that the current criminalized framework causes more problems than it can hope to solve.

It seems you misunderstand a little bit about what harm reduction is. Harm reduction is a framework for addressing drug use based on a public health framework (and not narrow public safety agenda like the war on drugs). "Treatment" in a public health based drug policy would include substitution programs as well as it would include abstinence based programs. Just because an opioid is used as a part of a treatment doesn't make it any less valuable than a form of abstinence based treatment. In fact, ORT based programs are clearly more effective for people with opioid use disorder than abstinence based programs are (the best programs integrate both abstinence and replacement therapy).

I suggest you also check out Bruce Alexander's book, Globalization of Addiction. Along with High Price, it does a lot to demonstrate how the problem isn't drugs "hijacking" the brain so much as it is the inhuman environment most people who become addicts are born into, and how addiction is far more complicated than simply a big bad drug controlling someone or turning them into an addict. Addiction is about way more than drug use. In some cases, such as with many opioid use disorders, the substance involve in the disorder can actually be a part of the solution (which is another way of saying that there isn't anything inherently unhealthy about some substances - and that their impact on health has way more with how they're used than anything essential to them).

 

[S.J.B.]

So it would be considered a form of harm reduction, similar to needle exchange programs, not a form of treatment.

That's a semantic argument. It is in the same category as methadone or buprenorphine maintenance, wherever you would like to class those.

If the goal is just to prevent people from using adulterated substance of unknown strengths, wouldn't there be a case for a prescribing any drug to someone who is struggling to overcome a substance use disorder?

I think that would be a just thing to do, although if the intention is to monitor people each time they take the drug, it might not be very practical to implement for some substances.

 

[Mafioso]

I'm trying to say that it is very possible to live a highly successful meaningful like AND use opioids. I'm saying that pharmacologically opioids are not nearly as harmful as some other substances, such as alcohol/gabaergics and most stimulants, and that most of the negative harms associated with opioids have to do with how they're used, and how they're used it almost entirely shaped by the context in which they're used. And the context in which they're used (prohibition, the war on drugs, etc - which is why I suggest you check out those books) is specifically geared to create as much harm from drug users as possible. The war on drugs is literally geared to kill drug users, not to save them like politicians supposed try to make it out to seem like.

HAT removes most of those problems, giving people the chance to use the drugs while they also work on improving other areas of there lives. A lot of people make progress while on HAT such that they eventually get off it, similar to methadone. That isn't unusual at all. No one is saying that opioids should be available to people willy nilly, rather that the current criminalized framework causes more problems than it can hope to solve.

It seems you misunderstand a little bit about what harm reduction is. Harm reduction is a framework for addressing drug use based on a public health framework (and not narrow public safety agenda like the war on drugs). "Treatment" in a public health based drug policy would include substitution programs as well as it would include abstinence based programs. Just because an opioid is used as a part of a treatment doesn't make it any less valuable than a form of abstinence based treatment. In fact, ORT based programs are clearly more effective for people with opioid use disorder than abstinence based programs are (the best programs integrate both abstinence and replacement therapy).

I suggest you also check out Bruce Alexander's book, Globalization of Addiction. Along with High Price, it does a lot to demonstrate how the problem isn't drugs "hijacking" the brain so much as it is the inhuman environment most people who become addicts are born into, and how addiction is far more complicated than simply a big bad drug controlling someone or turning them into an addict. Addiction is about way more than drug use. In some cases, such as with many opioid use disorders, the substance involve in the disorder can actually be a part of the solution (which is another way of saying that there isn't anything inherently unhealthy about some substances - and that their impact on health has way more with how they're used than anything essential to them).

In terms of living a "successful and meaningful life", the same argument can be made about any drug. Someone with diabetes can live a fulfilling life, that's not to say they wouldn't be better off without diabetes. No one here is saying that drug use should be criminalized either. It sounds like we both see a point in some regulation though.

I'm not trying to argue that ORT has no place or no valid use, but I struggle to see how giving a heroin addict IV heroin is a form of opioid replacement therapy and not just a safer alternative. My confusion centers around the ROA mostly, not the therapy or the concepts surrounding the therapy or addiction.

It is partially an argument about semantics but there is a big difference in intent of needle exchange programs and opioid replacement therapy.