As addiction to opioids, principally heroin and oxycodone, continue to ravage our country in a crescendo of drug-related crimes and overdose deaths, the most effective way of stopping this is .... with opioids. This fire vs. fire strategy may cause a moral malaise, but the results are better than anything law enforcement can accomplish. Enrollment in a program which administers methadone or suboxone- both opioids- has the greatest success rate.
In a recent editorial in The American Journal of Medicine, Harvard physician Sarah E. Wakeman makes several research-supported points: That opioid substitution therapy retains the majority of addicts in treatment, while behavioral interventions, like 12-step therapy, work less than a fifth of the time. Substitution (also call agonist therapy, as it stimulates the brain's opioid receptors) also lowers the incidence of HIV and hepatitis C infections- acquired intravenously, and reduces overdose deaths. But about 8% of America's IV drug abusers get this treatment (as opposed to 90% in England).
Why? It would cost money, but not nearly as much as law enforcement and incarceration expenses. In April's Harpers ("Legalize it All") author Dan Baum describes how government spends more on drug enforcement than treatment, even though it believes that treatment is much more cost effective. He describes how the government of Portugal, in 2001, decided not to prosecute possession, purchase and use of heroin, cocaine and pot. While problem drug use is roughly the same, the prison population is half of what it was, and as you may know, it costs us more to keep someone incarcerated than most people make in a year. The money saved can be used for treatment.
Addictions, be they to drugs, alcohol, gambling, or eating stimulate pleasure centers in the brain and ultimately change brain chemistry in a way that tends to control behavior. This has a strong genetic predisposition. This is why many see addiction as a disease, and why addicts do better with drug replacement therapy than with any other type of rehabilitation. Yes, some addicts stay on methadone for over a decade, but without exposure to dirty needles or overdose or having to scare up money for street purchase, the drug itself does little bodily harm, even over long periods of time.
While methadone and suboxone retain addicts in treatment for the longest times, there remains a residual core that fails these interventions. Addicted to heroin, often homeless, with high rates of HIV and hepatitis C infections, and reliant on crime to support their habits, they are the greatest drain on society. Nevertheless, Vancouver, Canada has found a way to mitigate the harms they cause to society and to themselves.
Heroin. The drug itself, fire against fire, is administered in a medically supervised inner-city clinic, up to three times a day, with clean needles and prompt treatment of overdoses. In just a few years, rates of new HIV and hepatitis C infections have plummeted, there have been no overdose deaths, and the fact that these addicts no longer need to sell drugs to fund their habits, nor need to purchase them from higher-level dealers, has rendered the drug trade obsolete in the area. The Vancouver program, the first of its kind outside of Europe (where several countries have similar programs) has caught the notice of several publications, like TIME, The Atlantic, The Globe and Mail, and the N.Y. Times, all of which describe the program in some detail. It was also noticed by the mayor of Ithaca, New York, which like many rural or semi-rural areas, has a big, unstoppable drug problem. As reported in the N.Y. Times, he would like to institute a Vancouver-type injection center; the obstacles - based on naïve idealism or ignorance of reality- would be many, but it has to be tried here sooner or later.
To understand the tenacity of opioid addiction, consider an opinion piece by Cornell psychiatrist Anna Fels, in the Sunday June 5 NY Times: Can Opioids Treat Depression. Her point is that certain types of mental illness respond better to opioids than to standard antidepressants, and that many opioid abusers become "normal" rather than "high" from the drugs.
Opioids are unique. People will kill to get them, and risk their lives to take them. They have special abilities to relieve suffering, physical and mental. No amount of moralistic puffery or law enforcement had been able to lessen their burden to society. Treating addicted brains with methadone, suboxone or heroin itself has proven successful, yet most of our efforts and dollars go uselessly misspent.