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April 12, 2001 Addiction experts here look cautiously at European ‘harm reduction’






by Sylvain Comeau

A hot debate is raging right now between the abstinence camp and the harm reduction camp of addiction treatment.

Dr. Louis Charland of the University of Western Ontario, in a lecture this term sponsored by the School of Community and Public Affairs, discussed a harm reduction project for heroin addicts that may stoke the debate in Montreal.

“At several recent conferences, addiction researchers have been discussing setting up a facility in Montreal which could provide medically prescribed heroin to chronic addicts. The emphasis would be on reducing the harm they do to themselves and to society.”

The facility would be modelled after a medical trial conducted in Geneva, Switzerland, in 1995-96, in which addicts were given heroin doses high enough to satisfy their addiction, but without increasing tolerance to the drug. The program was more of a social experiment than a medical one, since the intention was to see if there was an improvement in the addicts’ social functioning and health.

“The result was that their illegal drug use and other illegal activities dropped dramatically, the majority of the participants stopped living on the street, and they also stopped risky activities like sharing needles. Some actually got full-time jobs.”

Charland said a similar program is now underway in Liverpool, England, noting that political and social opposition would make it virtually impossible for researchers to get permission in the U.S.

“This would be unthinkable in the U.S., but in Europe, the problem of addiction is seen more in medical terms. Heroin is seen as just another drug that alters the brain chemistry of its users, and it doesn’t matter why it started; they have a medical problem now.”
Charland said that he sits on the fence in the debate, but in the case of heroin addiction, he said that abstinence is simply not a viable option for most.

“We have learned, by examining the brains of heroin addicts with MRIs, that they actually undergo a neurological transformation that is almost impossible to deal with without some form of drug therapy.”

Researchers wanting to set up this kind of facility would have to vigorously emphasize such medical arguments; Charland said there would be legal obstacles to overcome here, and some opposition, particularly from abstinence advocates like Narcotics Anonymous.

“The abstinence camp may argue that prescribing heroin could encourage addiction. They may say that it is better to let people hit ‘rock bottom,’ which is the point where most addicts are finally ready to do whatever it takes to rid themselves of their addiction.”

Another concern is one of consent. Today it is no longer enough to simply get the subject to sign on the dotted line. Researchers have to be sure that subjects understand what they’re getting themselves into.

“For example, an addict may know the effects of the drug and still not appreciate the fact that they are an addict. They can recognize another addict, but that’s a far cry from admitting that they are addicted.”

Another problem with consent: How can addicts say no?

“One recovering addict, Cynthia, raised an objection to the Swiss trial, saying that addicts have a specific incapacity to say no to the drug — that’s why their lives are going down the drain in the first place. So if an addict cannot say no to an offer of free heroin, how can they consent?”