The case for prescription heroin

published on June 12, 2017 by German Lopez in Vox

Vancouver gives heroin to drug users suffering from addiction — and it works.

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.

A clinic where patients use heroin may sound shocking and irresponsible, particularly now, as a deadly and devastating opioid epidemic ravages North America. But this approach is meant to treat the victims of that epidemic.

The idea is this: If some people are going to use heroin no matter what, it’s better to give them a safe source of the stuff and a safe place to inject it, rather than letting them pick it up on the street — laced with who knows what — and possibly overdose without medical supervision. Patients can not only avoid death by overdose but otherwise go about their lives without stealing or committing other crimes to obtain heroin.

And it isn’t some wild-eyed theory; the scientific research almost unanimously backs it up, and Crosstown’s own experience shows it can make a difference in drug users’ lives.

“It’s just like any other chronic disease,” Keith Ahamad, a clinical researcher at the University of British Columbia, told me. “We need a stepwise approach to managing patients. If you’re not able to engage and stabilize patients on less intensive treatment, then, like you do for other chronic conditions, you step them up to more intensive treatment modalities.”

Yet while Canada considers expanding heroin-assisted treatment, the US isn’t able to meet the medical needs of as many as 90 percent of patients with drug use disorders, based on the surgeon general’s 2016 addiction report, due to the high costs and low supply of adequate addiction care.

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