Your Opinion about a Diacetylmorphine (Heroin) Maintenance Program in Australia

[opi8]

I found this petition asking the Australian Parliament to introduce heroin prescription programs in Australia today and obviously, because I would support this, I signed it straight away.

I don't know much about heroin maintenance programs, even though I should because I'm on opiate maintenance myself, and it's an area that interests me greatly. I think I know there is currently a small amount of people in the UK who are on a heroin maintenance trial (maybe a trial, maybe not), and I believe there's another European country that currently has one but I'm not sure which country, or if it's only a trial or not.

I'd like to hear YOUR opinion, whether you're for or against this method of treatment for heroin addicts, and why.

For me personally, I am on methadone and it has worked in the fact that it prevented me from offing myself when I thought I had no other options. It's not perfect (by far), has very undesirable side-effects and I'm dreading the day that I eventually taper off, with it's long half-life and even longer PAWS, but, apart from the longer withdrawal period and PAWS, it's going to be painful getting off any opiate.

I know people who methadone or bupe simply doesn't work for and never will. At the moment, their lives are controlled by this drug, and they're never going to get out. It deeply saddens me because some of these people are very close to me. If they could go on a program such as heroin maintenance, they could begin to get their lives back together, start contributing to society and become a lot happier and healthier, face a lot less risks each day than they currently do and have their quality of life improved 1000%.

Just like regulation of all drugs which I support, some might imagine and religious and conservative nut-jobs love to portray, even if it did happen, I wouldn't want it to be a free-for-all. That's right. I wouldn't want kids to go to a candy store and buy a gram of heroin with their lunch money. I also don't think that if you have a 100mg a day codeine habit, or even a mild oxycodone addiction you should simply go straight onto heroin maintenance for the rest of your life. However, I strongly believe there are cases where heroin maintenance could mean the difference between life and death, literally, for some people. This is why I think it's important to have the option available to medical professionals.

I have many of my own thoughts on the matter, some of which are based on personal experience and personal relationships, but I created this thread because I'd like to hear others' opinions.

I'd like to understand why those who are adamantly against the idea, are so against the idea of giving someone who has already become addicted to heroin, generally I must add because of deep seeded mental issues, post-traumatic stress, or intense physical pain (or any combination of the above) the same drug they are addicted to, legally, in order to save their life and prevent them from living as a criminal, instead allowing them to get help from trained professionals, and contribute to society without needing to worry about getting the next fix, or being unreliable or simply unemployable because of their addiction.

It would be great if those who may have access to studies, papers or any other material related to the subject could post whatever information they may have.

It'd also be great if this could be a sensible discussion on the topic at hand, not "give me free heroin too plz!1!111", "let all the junkies die, the world will be better off anyway" or sensationalist bullshit that I can read on any other online forum, reader comment section, or even editorial section of whatever newspaper I have laying around.

Cheers.

 

[footscrazy]

I know people who methadone or bupe simply doesn't work for and never will. At the moment, their lives are controlled by this drug, and they're never going to get out. It deeply saddens me because some of these people are very close to me. If they could go on a program such as heroin maintenance, they could begin to get their lives back together, start contributing to society and become a lot happier and healthier, face a lot less risks each day than they currently do and have their quality of life improved 1000%.

Why do you think heroin would be better for maintenance than the other options? I don't have enough experience with methadone or bupe to know about their side-effects, downsides or reasons why they don't work for some people, and the benefits heroin may have over them.

I support heroin maintenance, I just don't know enough about it to know its benefits over other treatments. Just from my fairly clueless position I would've thought heroin might've been more difficult to maintain on becuase of its short half life. Surely you'd have to have multiple doses a day? That seems like it could tie people even more so to a clinic, unless clinics were more lenient with take home doses.

The other thing I wonder about is method of administration. I'm fairly sure in the studies I've looked at the heroin used for maintenance is injected. This could pose a barrier to addicts who don't inject. I know heroin has a shit oral bioavailability, which would prevent that ROA; I guess it could be provided as a suppository or something, for those who don't shoot.

 

[opi8]

I think it would be better for some people, that's one of my main points.

Multiple dosing could be an issue, but this has been overcome in UK and elsewhere, that would be a model to look at. Maybe 2 supervised doses during the day, plus 1 take home dose to prevent diversion/overdose or whatever. If you've only got 1 shot, you're not going to sell it or swap it for methadone. Whereas swapping/selling methadone for smack happens all the time.

There's already a system in place that makes it extremely difficult for people on methadone to get take-home doses at all, you need to build trust with your prescribing practitioner which the guidelines state something like 3 months of clean drug tests before you can get 1 take-home dose or something ridiculous for someone trying to get out of addiction and become a productive member of society again. I can't comment with great accuracy on the ease of getting take-away doses of bupe because I haven't been prescribed it, however I believe it's easier than methadone.

 

[DeathDomokun]

I can't see too many people wanting a nurse at the clinic sticking a syringe up their ass, multiple times a day, daily. Especially Australian men.
I don't think giving addicts heroin for an undefined time is the answer to addiction, although I do think this option should be available.
I mean if someone is using opiates for psychological issues (which I think is quite common?) then we should be looking to resolve those issues as opposed to just supplying them with good/clean heroin for an undetermined time. As I said, irrespective of whether it will help someone with an addiction (subjective topic/question) I'm all for it.

 

[Crankinit]

I can't see too many people wanting a nurse at the clinic sticking a syringe up their ass, multiple times a day, daily. Especially Australian men.
I don't think giving addicts heroin for an undefined time is the answer to addiction, although I do think this option should be available.
I mean if someone is using opiates for psychological issues (which I think is quite common?) then we should be looking to resolve those issues as opposed to just supplying them with good/clean heroin for an undetermined time. As I said, irrespective of whether it will help someone with an addiction (subjective topic/question) I'm all for it.

First of all I agree with Domokun, just parking addicts on any kind of maintenance is a cop out, there needs to be further treatment for whatever lead them to addiction in the first place, if (and only if) they want it.

Why do you think heroin would be better for maintenance than the other options? I don't have enough experience with methadone or bupe to know about their side-effects, downsides or reasons why they don't work for some people, and the benefits heroin may have over them.

It doesn't necessarily have to be heroin, but buprenorphine and methadone, while they do prevent withdrawals and provide some level of relief from cravings, even pain reduction for those who need it, they really don't scratch that psychological 'itch' that is opiate addiction, especially since bupe has quite a low ceiling dose and methadone gets dangerous at higher doses, meaning you end up parked on a dose, your tolerance outstretches it and it starts to do very little for you. This is why so many people end up going back to other opiates either part-time or full time.

Now, as for heroin maintenance itself. I think it's a good idea and should be looked at, but the implementation is problematic. I think firstly, to start with, we should look at a system similar to the Swiss one, wherein an addict can present to the clinic twice a day and receive a dose of heroin. It's worked for them and has been a success by every measure, but it's not perfect and I think would need to be adjusted, as we eventually adjust our attitude towards drugs as a society.

Firstly, there's the issue of having to present twice daily. This would be very difficult for a lot of people, since having to schedule your whole day around going to a clinic kind of goes against the whole purpose of maintenance (which is to structure your life around something other than drugs). This could be addressed in a couple ways. The obvious one is take-away doses, which we currently have for other maintenance drugs. The problem here is that people fear diversion, but I think that realistically diversion isn't going to be a serious social problem. At worst, any heroin diverted will simply replace street heroin which the person would have bought instead. You could start with giving one TA dose a day, to allow the patient to get by without having to visit the clinic twice, then eventually look at getting days off.

The one issue here is that the whole TA concept needs to be revamped. Currently, with Bupe and Methadone, you get 6 TA's a month after 2 months on the problem, then don't get any more until 9 months, then again no more until 18. Instead it should be a regular increase, every fortnight or month, as a reward system for attendance.

The second thing that should be explored is oral substitutes. I know a lot of opiate addicts become fixated on the needle itself and injecting becomes almost as important to their addiction as the high itself, but for those who feel otherwise, would it be possible to formulate an extended release pill with heroin (or a similarly euphoric opiate) which could maintain it's effects when dosed every 24 hours? I'm no pharmacology expert, but the only XR pills I've seen go up to 12 hours, is it possible to make them last longer?

The second issue is dose flexibility. With current maintenance programs, the patient gets parked on a set dose, and is then forced to go up or down very gradually, often capping at a certain arbitrary dose regardless of tolerance. This is an imperfect system, I feel. Firstly, because a 'one size fits all' approach doesn't work for an addict. I know when I was shooting up regularly, I'd adjust my dose depending on what I was doing, keeping it lower if I was working or otherwise busy and couldn't afford to be intoxicated, then higher so I could enjoy the feeling when I was able to relax. I feel that any system would have to allow a patient to adjust their dose, within reason, as their circumstances warrant. Obviously this system would have to be designed with TA doses in mind, to prevent patients from taking home extra drugs and then diverting them.

Likewise, a clinic could perhaps offer the patient the choice of whether they wish to take their dose orally or as an injection, allowing them to choose between a once daily pill or twice daily injection as their schedule allows.

Hopefully the system could be made more flexible as attitudes towards drug use change, but that's my opinion on how such a thing would best be done currently.

The biggest barrier, of course, is getting over the absurd moralistic idea that addicts aren't allowed to feel good from their drugs, that getting high off chemicals is somehow inherently a bad thing.

 

[footscrazy]

I think it would be better for some people, that's one of my main points.

I'm interested to know why you think it'd be better for some people though. As I said originally, I don't know enough about maintenance to be able to comment on why heroin maintenance would work better for some than other forms, so I'm interested on your take on it.

The biggest barrier, of course, is getting over the absurd moralistic idea that addicts aren't allowed to feel good from their drugs, that getting high off chemicals is somehow inherently a bad thing.

This is really the main problem I think. This view is so ingrained that almost noone questions it. It feels almost intuitive - of course we don't want people getting high on their maintenance (or in any other aspect of life). But, why not?

 

[Divine Moments]

My understanding is that one of the strongest reasons against using heroin as opposed to other (less fun) opioids for OMT is the black market. No matter which drug is used it will inevitably find its way in fairly considerable quantities onto the street. The 'better' the drug is to the user, the more likely it will be abused or sold instead of used as prescribed. I assume it isn't practical for most people to receive every dose under supervision, which is probably the only way to actually avoid this issue.

Though, from a user's POV, it could be a good thing. Some pharmaceutical grade H on the street might put the pressure on the regular shit to improve ... Probably not though.

 

[Crankinit]

No matter which drug is used it will inevitably find its way in fairly considerable quantities onto the street

Is it ineveitable? It's not like the streets are flooded with bupe or methadone, most of what's sold is because they're exchanging it for heroin or another euphoric opiate. Nobody is going on methadone then making bank by selling their script. And I mean if an addict is getting free heroin from a clinic, is he going to go giving a ton of it away? Most addicts I know cling to every scrap of their DOC they get, even when they have reserves.

And even if they do give it out in large quantities, which seems unlikely, all it would be doing is replacing current street heroin, depriving dealers of their money and replacing dirty black market H, which seems like a plus to me.

Worst case scenario, avoid handing out TA's.

 

[footscrazy]

^ (Divine Moments) I'm sure some would find its way onto the street, but I would've thought most people on heroin maintenance would be fairly interested in keeping it for themselves. I can't really see considerable quantities getting out, I might be wrong, but it seems to me that unless someone was incorrectly on the program (ie, they didn't need their prescribed dose to be well) they'd have a vested interest in keeping their dose to themselves, so they weren't sick. I would've thought this would be even more pronounced with a drug, that as you said, is considered 'better' - whereas someone on methadone/bupe might sell their dose so they can replace it with euphoric opioids they can get high on for a bit, would that same incentive be there for addicts already on the cream of the crop?

 

[DeathDomokun]

I think the stigma of heroin would be more of a deterrent than the worry of it ending up on the street. I mean if we can get prescribed hydromorphone...

 

[shimazu]

My understanding is that one of the strongest reasons against using heroin as opposed to other (less fun) opioids for OMT is the black market. No matter which drug is used it will inevitably find its way in fairly considerable quantities onto the street. The 'better' the drug is to the user, the more likely it will be abused or sold instead of used as prescribed. I assume it isn't practical for most people to receive every dose under supervision, which is probably the only way to actually avoid this issue.

exactly. it would only work if the addicts could be trusted, and it doesnt take a rocket scientist to see what an oxymoron that is

 

[DeathDomokun]

Not even going to humour that comment. Not only are there ways to get around people misusing it, as well as the premise that all addicts are untrustworthy, or that the government is trustworth-
Not going to humour it.

 

[Crankinit]

exactly. it would only work if the addicts could be trusted, and it doesnt take a rocket scientist to see what an oxymoron that is

They do it in Switzerland, and the streets aren't flooded with pharmaceutical heroin diverted from clinics there.

Honestly, I think the whole 'fear of diversion' is a cop out. Even if the heroin did get diverted for some reason, it'd go to current addicts, it's not like they'd be giving it to their kids or whatever.

I think a lot of these complaints are honestly just a cover for the fact that, deep down, something in us rebels when we suggest giving a drug to an addict. Our society has been so pumped full of propaganda for the last century and it's an idea counter to what's been ingrained in us as people since we were young enough to ask what drugs were. Even those of us who use drugs have to struggle to step back and look at the idea objectively.

Even if some of the heroin did get diverted (lets say, for the sake of the argument, as much as we currently see methadone/suboxone diverted), would that really be bad enough to counteract the amazing impact a program like this would have on the lives of addicts and society at large?

 

[shimazu]

ok maybe things are different in Aus but thats exactly what would happen in the states, and is what happens with Subs and Methadone

 

[Crankinit]

ok maybe things are different in Aus but thats exactly what would happen in the states, and is what happens with Subs and Methadone

How do you know it's exactly what would happen? It's never happened in the states, you can't just make these broad assumptions.

Worst case scenarios, you don't give take away doses. Would those of you who oppose it on the grounds of diversion have a problem with it then?

 

[shimazu]

Suboxone and Methadone have longer half lives than H which is supposed to be the point of maitenance, the least amount of drugs possible to keep you from getting W/D. Why would using H over one of those two make sense when getting euphoria isnt (alleggedly) the goal.

 

[DeathDomokun]

I was under the impression the half life determines how long the substance stays in your system, not how long it affects you/is psychoactive?

 

[Crankinit]

Suboxone and Methadone have longer half lives than H which is supposed to be the point of maitenance, the least amount of drugs possible to keep you from getting W/D. Why would using H over one of those two make sense when getting euphoria isnt (alleggedly) the goal.

The goal is to stop the addict from needing to commit crime to support their addiction (and thereby becoming a detriment to society) , and to prevent them from dying of an overdose, so they can lead a longer, a functional and a happier life. Why does it matter if the chemical that allows them to do so also makes them feel good?

Half life can be circumvented through the use of XR oral formulations or twice daily administration for those too fixated on the injection process to give it up.

 

[shimazu]

because if that person wanted to feel good they should get a job and buy their own pleasure instead of making everyone else carry the burden. Im not anti-opiates or anything, I just dont like when people dont carry their load in society. Not saying you specifically, but almost every person Ive known that was on Maitenance (whether it be Methadone or Subs) was a waste of space as far as being productive goes. I used to do heroin (not as much as others on here Im sure) and stopped before I ruined my life. If you cant see youre addicted than you are never going to quit.

 

[DeathDomokun]

This sort of thing would allow people to be able to get and hold a job.
Buy their own pleasure? I assume you mean buying their own heroin?
What's your fucking problem with people having access to clean heroin in measured/known doses? Not enough harm caused by heroin in your book or something?