Canada's Cautious First Step

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Heroin maintenance is a radical step forward, in political terms. But if it's carried out in a sound fashion, we know it works.

The northern North Americans in Canada are taking another cautious step for drug policy reform. NAOMI, the North American Opiate Maintenance Project, will shortly begin providing maintenance doses of heroin to addicts in Vancouver, moving later in the year to Toronto and Montreal as well. Drug warriors in the U.S. and Canada alike are likely to characterize the project as reckless or wrongheaded. In reality it is a cautious first step only, but an urgently needed one.

In Vancouver's Downtown East Side, where many of the city's hard drug users congregate, the addicted each day face unnecessary levels of risk from overdose, spread of infectious diseases such as hepatitis or HIV, marginalization from society and the health system, a wearing and time-consuming search for money to pay for expensive street drugs, general destabilization of their lives, and all the obstacles to survival, recovery or prosperity these conditions present.

Prescription heroin is not a panacea capable of instantly transforming every addict into a happy, productive, model citizen. But the experience of countries such as Switzerland, The Netherlands, Great Britain, even the early 20th-century United States, show that legal access to the drug of choice enables many such people to accomplish that for themselves. The consequences of prohibition are defining and harsh. Counterintuitive though it may seem to some, without prohibition, heroin and even heroin addiction would be markedly less destructive than they are today.

One famous advocate of prescription heroin was Danny Sugerman, long-time manager for the music group the Doors and coauthor of the famous Jim Morrison biography, No One Here Gets Out Alive. Danny, who sadly passed away last month from cancer, also wrote an amazing book, Wonderland Avenue: Tales of Glamour and Excess, telling the story of his descent into serious heroin addiction while living the fast life in West Hollywood. It's the kind of book that you don't want to put down until you've finished it.

Wonderland Avenue made crystal clear that Danny held no illusions about heroin. He keenly understood its dangers – he almost died from them, many close to him did – but he also comprehended the impact of prohibition on addicted drug users. In an interview four years ago, Danny said, "If you prescribed heroin to current addicts, you'd save an entire generation." Those words were spoken from hard experience and deep thought combined.

In the context of that idea, saving generations of addicts, the NAOMI trial seems much too little – a few or several hundred participants, people who have already tried other therapies unsuccessfully, followed by a weaning off with the potential for a return to the street once the study's done, absent changes in drug policy to permit continuation. Canada has tens of thousands of active heroin users. Doubtless it has to start this way; even in Canada – even in Vancouver – heroin maintenance is a radical step forward, in political terms. But we know heroin maintenance works, if carried out in a sound fashion, and the record from other places and times, the people from those places, are there to offer insight and aid. So amid my satisfaction at this historic step, I cannot forget the uncertainty the future and present alike hold for many, many people who could be saved now.

Still, Canada deserves congratulations – a lot of them – for this cautious but major first step. With favorable results, unceasing pressure, and maybe a little luck, more and larger steps can follow.

David Borden is executive director of DRCnet.

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Canada's Cautious First Step

By David Borden, DRCNet. Posted February 15, 2005.

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Canada really deserves a pat on the back for its recent efforts.

Certain other countries could learn a thing or two from their northern neighbour.

Let's hope Canada's progressive steps forward carry through to the rest of the Commonwealth nations, and indeed the whole world.
 
Lets hope rather the US pressure dosen't fuck the whole Harm min movement globally to satisfy murderously wrong (proven) methods of abstinence based treatments.
 
Well over here (Australia), despite our right wing Prime Minister's love for Bush, harm minimisation is flourishing.

Indeed, the first time I heard the phrase was in drug ed at school. A class which I did exceptionally well in! :D
 
Is the US going to be the last to implement harm reduction matters, as opposed to strict prohibition? ARE WE GOING TO IMPLEMENT HARM REDUCTION ONLY AFTER CAMBODIA!? 8o
 
Yeah, fuck what the US Government says.

I think this is a great thing and a step forward in the way of veiwing drug problems as health issues and not a crime.
 
I fucking hate the U.S. Is a degree from a U.S.-accredited university valid/good for anything in any other country?
 
Are you Canadian? I'd assume so, because most Americans know that a lot of people come here to get degrees at Universities.
 
Im glad simply because the rest of the world will be able to see exactly how well it works ( if at all).
 
American schools are very highly respected however the academic community in the US should hardly be confused with official government policy (they've run contrary paths for years now)
 
I'm sure I'll get flamed for my unresearched opinion, so please bear with me.

Although I'm not a part of that community, I live about three kilometres from the infamous Downtown East Side in Vancouver. I drive through there quite often and sometimes walk through the area when headed to some dance clubs in the area. I truly don't see how giving drugs to people who are addicted will help them in the long run.

The truth is that few of us here can be truly objective because we are users ourselves. I am fully aware that there is a wide range of people here from non-users to truly addicted junkies. Drugs are seductive and addictive. They offer an escape from the harsh realities of many peoples' lives.

I'm not stupid. I can see that drug prohibition is not working. I truly want to understand, so be gentle with me. Do you think that handing out drugs to people is going to get them off the street and leading normalized lives? I'm no expert, but do any of you who champion Canada realize the great percentage of these people who are mentally ill to a degree that has them on the street?

I'm not even going to be dumb enough to say that I don't want to subsidize others' drug habits with my taxes because I realize that the drains on our social system under the current system of prohibition is taking an awful toll.

Maybe my analogies are stupid, but should obese people going to weight clinics be given chocolate cake, should alcoholics be given free liquor, crystal to meth addicts? Truly, what makes heroin or opiates different? I've seen the effects of the welfare systems in both the United States and Canada, and I have yet to see that handouts to people help them in the long run because they begin to rely on and in some cases abuse the systems that were put in place to help them.

I think these are far reaching social problems that go far beyond whether or not we as a Canadian society should be handing out drugs.

Maybe some of the answers lie in my own experience. Because I discovered Bluelight and Dancesafe at the same time I discovered drugs, I never had to go down the path of excess and into misery. Because of the resources I had available to me, my experience with drugs has almost without exception been extremely positive. Otherwise, after that first magical encounter with Ecstasy I probably would have done it every week. Then again, I cared enough to want to educate myself. That's a personal and individual decision about which many don't seem to care.

Are there any career experts or knowledgeable persons who have conrete information on how harm minimisation has positively impacted those countries in which it has been practised? I'm not talking about heresay, but more firm evidence. I would love to be convinced, I really would.
 
blase deviant said:
I fucking hate the U.S. Is a degree from a U.S.-accredited university valid/good for anything in any other country?

Uhh, yes moron.

I go to school in Canada, and if are canadian you know that many many many people from Canada go south to go to school.

If you don't, you probably hang with a bunch of losers who couldn't get into university.
 
Re: vancbc

vancbc :

I'm not going to flame you, but I would just like to respond to some of your comments about the concept coming from an actual heroin addict. I have now been on buprenorphine maintenance and have 6 months sobriety under my belt.

I truly don't see how giving drugs to people who are addicted will help them in the long run.

You might be right, but this isn't about "giving drugs" to people. This is about giving medication to people who are sick. This solution is only a short-term solution and is not meant for the long-term. While these heroin addicts are being stabilized, they can function enough to attend outpatient programs and 12-Step meetings.

Do you think that handing out drugs to people is going to get them off the street and leading normalized lives?

Yes, I do, to some extent. Think of it this way: You are very ill. You can't get out of bed. You are flat broke and cannot afford medication to go to work and complete your daily chores. You are practically forced to find a way to be able to afford the medication to function. Wouldn't it be great to be able to go to a clinic and pick up your medication on a daily basis and be able to function? You'd be able to go to work, explore and conquer your addiction, and help yourself get ahead, while not having to steal things and rob people to fund your habit.

Maybe my analogies are stupid, but should obese people going to weight clinics be given chocolate cake, should alcoholics be given free liquor, crystal to meth addicts? Truly, what makes heroin or opiates different?

Your analogies aren't exactly accurate. When an overweight person, or a weed/meth/coke addict stops indulging in their drug - they don't suffer from the horrible flu-like and painful withdrawals that heroin & alcoholics go through. These withdrawals are the purpose for the heroin prescriptions. The heroin allows them to function in their daily lives and get back on track. It's not about giving them a high, it's about stablizing them enough to get them on their feet.

Are there any career experts or knowledgeable persons who have conrete information on how harm minimisation has positively impacted those countries in which it has been practised?

I can tell you as a heroin addict for many years, that my stabilization with an opiate is the only thing that stopped me from going on to use again. I had gone in and out of 6 rehabs before finding suboxone and it was my cure. It was amazing how so many psychiatrists/psychologists had me believing that just another opiate would be substituting my addiction, yet I had to find this cure to my addiction through my own investigation. I can't imagine how much loss and pain I would have caused other people, not only within my family, had I kept on using. I probably have saved society thousands upon thousands in average citizens' and taxpayers' money.

I hope I have answered your questions and convinced you that opiate stabilization is a good solution for some people. Feel free to argue your points or ask more questions, if necessary. I would be glad to answer more questions or PM me, if you like.
 
korver

I want to thank you so much for what you have written. It has really helped me understand so much better, and I really don't feel the need to argue my points. What I posted did not represent any disagreements with the proposal, but rather they mirrored my own lack of education and some questions that arose in my mind.

I do have another question for you. What is the long term approach in terms of actually stopping the substance use/abuse? Are dosages fractionally lowered, or doesn't this work? By the time you are hopefully ready for outpatient programmes and 12-step meetings, have you been weaned off the opiates; or the opiate use to continue for quite a lengthy period of time?
 
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