This is a really tough question and one I've given some thought to as a former heroin addict.
I mean, one option is to go with a model like in some European countries where one can get legally prescribed heroin (although this seems to be becoming less and less common) if you are already addicted and haven't been able to quit through the usual methods (detox, methadone, etc). But in practice only a small fraction of heroin users are prescribed the drug and it does little, if anything, to stop the illegal drug trade. For example in London there are maybe around 100 people prescribed heroin, yet some estimates of the number of heroin users in the London area have been as high as 50,000-100,000, with at least 1000 new heroin addicts each year. However a lot of the problems may be because the prescription system is poorly implemented, a lot of which I believe is due to pressure from the US. Still, even a well-implemented more easily accessible heroin prescription program would not solve the problems that come with illicit heroin use for new users or users who don't meet the requirements, unless you went with a program with very little requirements where physical dependence wasn't even a prerequisite.
I like your idea of an approach that emphasizes harm reduction and recovery, while making heroin available in order to reduce many of the adverse consequences of it being illegal. However, there are still some potential issues with a formalized licensing process. I don't know if a lot of heroin users would like the idea of being on a government list of registered heroin users. And how would people be prevented from just selling their heroin to others? I think the whole thing with methadone programs in the US forcing people to go into for daily supervised ingestion is demeaning and adversely impacts the lives of methadone patients, and it would seem even less practical for heroin since the vast majority of people can't just use heroin once a day if they are physically dependent. So I don't like the idea of people being forced to only use their heroin under supervision at a clinic, but I also don't like the idea of people just getting a bunch of heroin to take home that they can then cut and sell on the black market. Personally I think I'd prefer the possibility of diversion over extremely strict rules a la methadone though.
How to integrate recovery...? I would say that might be very difficult in the US (I'm assuming that is where you live and are referring to? BL is an international forum), because drug companies don't care about people, they are sociopathic entities. If a pharmaceutical company gets a license to produce heroin, and the clinics/pharmacies/wherever they sell it are for-profit, then they would have no real interest in helping anyone get off of it. There are such enormous problems already with opioid maintenance programs, including (among many other things) people being deceived about dependence liability and people being encouraged to stay on methadone/Suboxone forever. I think that things would have to
radically change.
If we are coming up with some utopian situation where anything is possible, I would say that a good start would be that people who use drugs like heroin should be treated with respect and compassion and there should be a huge support network to help them in
many aspects of their lives, which at the same time is not forced upon them against their will (not rules like "going to the specific government approved meetings 3 times a week is a requirement in order to get your drugs"). This would be very costly initially and would require an individualized approach. If we had the ability to do something like this we should have the ability to reduce a lot of the problems which cause people to become addicted to opiates (and/or stay that way), and reduce a lot of the harm that comes with it, in the first place.
I'm sorry, I'm probably not being that helpful. I am just pessimistic about ANY form of legal heroin use EVER happening in the US, let alone a form I would personally approve of.
I could talk about this subject all day, just going around in circles. I do believe though that the perfect should not be the enemy of the good and we
really need
something other than methadone and Suboxone being the only options for opiate addicts. I would be in favour of pretty much any form of legal access to heroin, morphine or hydromorphone, even if it was limited to people who have a serious physical dependence who did not find methadone effective. Not that people should be forced to go on methadone in order to eventually get prescribed a shorter-acting more effective opioid that has much less severe and much shorter-lasting withdrawals. I really think any of those drugs would be far better options than methadone if people were able to use them safely and legally.
Truly encouraging recovery, even without any form of legalized opiate use, is something that I believe will require
major changes to society, politics, and the way opiate addicts are viewed/treated.
Ok I'll shut up for now
PS - I don't live in the US, I live in Canada, but I highly doubt it's going to happen here any time soon either, there is so much backlash to a simple study of 25 people being prescribed heroin. But the US? Never.
ETA: Pagey and people: legalized doesn't mean totally unregulated/anyone can get it!! And I STRONGLY doubt that heroin use would skyrocket if it were legalized and there is evidence to the contrary, considering that countries have legalized or decriminalized various drugs have
declining rates of use. One of the reasons I wanted to try heroin was
because it was illegal and there was so much hype and stigma surrounding it. And no one seems to be responding to the OP's ideas about harm reduction training, real honest education about the risks, easy access to HR supplies and Narcan, etc.
![:\](https://bluelight.org/xf/BL_Images/Orig_Emoji/wrygrin.gif "wry grin :\")
