Treatment for drug addition accomplishes two things. First, it reduces the crime and violence associated with drug users trying to get enough money to support their habit. Secondly, it alleviates the pain and suffering that both the user and the user's family and friends endure.
The health commissioner of Baltimore recently pointed out that addicts commit 90 percent of all crimes and the cost of addiction in terms of crime, incarceration and medical care amounts to $3 bil-lion per year.Making drugs illegal has not proved adequate. Communities must also seek alternative approaches to containing and reducing the problem. One obvious place to start is better and more available treatment.
Heroin maintenance is one approach, but it is not for everyone. Recently, heroin maintenance received an unwarranted burst of media attention following an educational conference at the New York Academy of Medicine where study proposals from Europe and Australia were shared. Contrary to the public charges that heroin maintenance is "legalized drugs" and only "serves to keep addicts addicted," the programs were tightly controlled, clinically supervised protocols with the goal of stabilizing patients to assist them in controlling their addiction and leading toward abstinence.
I know this because I have worked with a group of 3,000 injection drug users for more than 10 years and have looked at issues such as whether they got into treatment, what medical care they received and the effect of addiction on their families. All of us who work with intravenous drug users want to see them in treatment and off drugs. But the fact remains that only a fraction are in treatment because treatment slots are limited and no one treatment fits all.
When an injection drug user applies for a treatment program, he or she is put on a waiting list for spaces that may become available months in the future. In addition, methadone has a sullied street reputation among young injection drug users. Some alternatives are needed.
At the New York conference, I listened to investigators from Switzerland, England, the Netherlands, Australia and Spain. Each country had considered heroin maintenance as an adjunct therapy to provide to a limited set of drug users highly resistant to traditional forms of therapy. To understand how this therapy works, let's review one study.
The Swiss study enrolled 1,000 participants. Using American-developed measures, the Swiss investigators reported substantial declines in crime and illegal income. The amount of heroin used (dosing) first leveled off and then started to decline within nine months. Retention rates exceeded those typically reported for treatment. The program had intense supervision and participants made up to three visits per day. Because of the stringent requirements, 40 percent of the program dropouts opted to enroll in methadone, which requires only daily visits.
One might well ask if the United States could anticipate similar results. It is hard to say. In both Switzerland and the Netherlands, 70 percent of opiate users receive some form of substitution therapy. In the United States that number is only 15 percent.
With other countries more open toward alternative therapies, there is a pressing need for the United States to guide users into therapy. With a truly dismal record for treatment in this country, a carefully supervised pilot program involving heroin might succeed as an outreach to lure and stabilize appropriately selected drug-dependent people so that they can be effectively transitioned into more traditional and efficient therapies with the ultimate goal being abstinence.
With any treatment option, those of us who work with drug users work not to suppress, but to elevate, individuals families and communities. Through an open partnership among communities, researchers, drug users and their network of family and friends, we can have the kind of discussions that broaden our array of options to a life without drugs.