GIVE THEM ICE: How treating drug dependency with drugs works

March 09, 2015 The Noffs Team Comments

I don't really like the word addiction. I prefer to say dependency. To me, dependency is a much better characterisation of the problem: when you depend on something, there is an element of that thing having control over you, and loss of control is one of the scariest things you can experience.

When someone has reached this place in their lives, any joy associated with substance abuse is long gone.

To a person who is dependent on a substance, there is nothing "recreational" about their use of the substance. All they get is relief. Like quenching a thirst.

Now imagine trying to offer someone psychological help when they are dying of thirst.

That is what it's like trying to treat a drug dependency at the same time as someone is going of the drug cold turkey.

I firmly believe that the single best way we could go about improving our success rate in treating drug dependency is to allow treatment centres to prescribe the very drugs that the person is dependent on.

In other words, we need to decriminalize supply of drugs, not just usage.

THE ONE SIDED DECRIMINALIZATION DEBATE

When academics, researchers and law enforcement professionals discuss decriminalization, the thesis invariably revolves around the fact that drugs are bad, people who sell drugs are evil, and people who take drugs are their victims.

As a result, the approach to decriminalization focuses on removing criminal penalties for drug users but still making it illegal to produce and supply those drugs.

There has been some good progress in the move towards regulation of cannabis in the United States with 3 states at the time of writing having moved to a regulated market for cannabis (similar to the way alcohol or cigarettes are sold) rather than prohibition or decriminalization of usage. Stats coming out of those experiments is very encouraging.

Still more progress is being made towards the medicinal use of cannabis in countries all over the world, including Australia. But the focus is on the use of cannabis in pain management for various illnesses.

Whilst I applaud these efforts as a step in the right direction I think there are two fundamental flaws in these policy changes: it continues the stigma that there are safe drugs and dangerous drugs, good drugs and bad drugs, which I don't agree with. Some drugs have more acute effects and some have more chronic effects, so the approaches to regulating them needs to differ, but any drug can be abused.

More importantly, though, it overlooks the use of all types of illicit substances in treating one of the major health afflictions facing our nation, namely substance abuse.

PRESCRIBING DRUGS TO CURE DRUG DEPENDENCY

Several drugs which are now illegal have been legally prescribed by physicians for a range of conditions in the past. Heroin was prescribed in Australia as late as the 1950s for relief of flu symptoms.

More astonishingly, in the same decade, Australian woman who were giving birth were commonly given heroin to relieve the pain.

But what about prescribing drugs to help people manage drug dependency?

Methadone is a pharmaceutically produced heroin substitute that replaces heroin or other opiates by producing the same physiological effects. It lasts for longer too, which means only one daily dose is required.1

As part of a treatment program, it gives heroin users the chance to find a regular, managed supply through prescription. Some use methadone to withdraw from heroin over a short period of time. More common, though, is a longer-term ‘maintenance’ program, which can have many benefits, reducing the risks of injecting, of overdosing on bad batches of illicit heroin, of associating with criminals, or engaging in criminal behaviour in pursuit of maintaining an active drug habit.2

Treatment programs involving methadone also have higher success rates than those without.3

In Australia, methadone programs have been around since 1969, but gained real traction from 1985 onwards and were made a concrete part of the federal Government’s strategy on tackling harmful drug use in 1993.4

But what about, rather than prescribing methadone, going directly to drug dependant individuals and offering to prescribe them heroin?

The Swiss conducted a trial, beginning in 1994, to test whether this approach could work. The drug was given to heroin addicts in a clinic and had to be injected on site; none was allowed to be taken away.

The results were unequivocal: health of addicts improved markedly; criminal behaviour declined; the use by addicts of other drugs, such as cocaine, fell significantly; and the drugs market itself suffered, reducing supply of illegal heroin and preventing casual users from purchasing drugs with ease.5 Switzerland’s drug addiction treatment programs still make significant use of this tactic and the reported results are still significant reductions in crime and of the various risks associated with long-term heroin dependency.6

Since then, a number of other countries or regions have followed suit, notably Holland and Vancouver in Canada. The Dutch study, which published results in 2003, looked at 549 heroin addicts and prescribed some of them heroin rather than methadone. Again, the results were very clear: as the trial’s co-authors wrote, “Supervised coprescription of heroin is feasible, more effective, and probably as safe as methadone alone in reducing the many physical, mental, and social problems of treatment resistant heroin addicts”.7

So Vancouver, one of North America's most progressive cities in respect to drug policy, will conduct a groundbreaking experiment: prescription heroin. The study, agreed in November 2014 but in the face of opposition from the federal Government’s health minister, Rona Ambrose, will look at continuing an initial, small-scale trial with 26 drug dependant users and broadening that to include up to 120. Vancouver has successfully provided needle exchanges and health drives to assist heroin addicts and this study is the next step for the forward-thinking local administration.8

We've found it helpful to be able to suggest methadone to people undergoing treatment in our centres for heroin dependency, but I personally think it would be even more effective if we could just prescribe them heroin. Relapses to taking poor quality, more expensive street heroin would be virtually non existent.

And why stop with heroin? There's no comparable substitute for ice. Why can't we prescribe ice to people with ice dependency issues?

Let's take it a step further: Why can't we setup a medically supervised injecting centre specifically for methamphetamine use?

It's a different take on the heroin centre because where the heroin centre focuses on saving lives from overdose, the ICE centre would keep the person stable and in a safe environment for a period of time - therefore reducing the burden on the community.

SOLVING ONE PROBLEM AT A TIME

When someone's life has descended into chaos as a result of drug dependency, the set of problems they are experiencing is complex. There are no quick fixes.

Allowing people to continue safely and inexpensively using the substance they are dependent on while they deal with all the various problems in their lives would make the prospect of seeking treatment much more attractive.

As it is now, people need to make the decision to seek treatment and the decision to immediately stop using the substance they are dependent on at the same time.

When they fail to abstain from ever using the substance again on the first go, they feel guilty, they feel like failures. Resolving their drug dependency problem just becomes one more thing they can't deal with.

The situation seems hopeless.

REGULATION DOES NOT MEAN SELLING DRUGS OVER THE COUNTER

If we focus on helping sufferers succeed whilst still using the substance they are dependent upon, and then gradually replacing their destructive habits with constructive ones, we will not only see a vast increase in the numbers of people seeking treatment, but we'll also see a dramatic decrease in demand for these substances on the black market.

Trust me: people who are suffering from severe dependency are not having fun anymore. If there is a way for them to get continue accessing their drug of choice while rebuilding their lives and reducing their dependency gradually, they will take it.

Most drug users do not fall into the dependant bracket, though. A study in Holland showed that heavy smokers of cannabis account for a disproportionately high amount of the drug smoked; they are also more likely to identify as a cannabis smoker, smoke the drug for longer, suffer mental health or social problems as a result, and have greater difficulty giving it up.

The mean use of cannabis compared to the mean shows how much heavy users account for cannabis use The mean use of cannabis compared to the mean shows how much heavy users account for cannabis use 9

This graph of cannabis use in Colorado, prepared by a think-tank in the United States, makes the same point:

The vast majority of cannabis use is accounted for by just a few users 10

The picture for cocaine is just as stark. Drug-dependant, heavy users take the drug cocaine at a rate approximately eight times that of light or recreational users. As the graph below shows, that means that even if recreational use is declining, the growth in heavy use of the drug more than cancels that out.

Cocaine use in the United States showing heavy and light users Cocaine use in the United States showing heavy and light users 11

So if you can reduce demand from people who are dependent on a substance you essential destroy the black market entirely. There will still be a black market, but it will be supplied from the high quality pharmaceutical supplies that are sold under prescription - either stolen or embezzled or over prescribed by unscrupulous practitioners. This is no different from the black market that currently exists for prescription drugs.

We don't have to assume that in order to effectively regulate the sale of drugs they need to be as easy to obtain as cigarettes or alcohol.

In short, your kids will probably still come into contact with these drugs at a party, but if they develop a dependency they won't destroy their lives because of it.

At the very least, we need to start opening up our minds to new solutions.

We need a vision for a better a safer society.

Matt Noffs

 

REFERENCES

1. Heroin dependence - medication treatments By Better Health Channel - State Government of Victoria, Australia via http://www.betterhealth.vic.gov.au/
2. Methadone treatment in Victoria - User information booklet By Department of Health and Human Services, State Government of Victoria, Australia via http://www.health.vic.gov.au/
3. Review the effectiveness of methadone maintenance treatment and analysis of St Mary's Clinic, Sydney By Authors: Judy Rankin, Richard P. Mattick
4. REVIEW OF METHADONE TREATMENT IN AUSTRALIA - Final Report By October 1995 Commonwealth Department of Human Services and Health, Australia
5. THE IMPACT OF HEROIN PRESCRIPTION ON HEROIN MARKETS IN SWITZERLAND By Martin Killias and Marcelo F. Aebi - University of Lausanne, Switzerland
6. Swiss experiment with prescription heroin By Reporter: Philip Williams
7. Medical prescription of heroin to treatment resistant heroin addicts: two randomised controlled trials By Wim van den Brink, professor; Vincent M Hendriks, senior researcher; Peter Blanken, researcher; Maarten W J Koeter, assistant professor; Barbara J van Zwieten, delegate to CPMP; and Jan M van Ree, professor
8. Vancouver experiments with prescription heroin By Matt Schiavenza
9. A Career-approach to Cannabis Consumption among University Students: Identifying Differentials between Stages of Use By Stefan Solinski (s0157597); 1ste begeleider: Dr. Marcel E. Pieterse; 2de begeleider: Dr. Henk Boer; Afdeling: Gedragswetenschappen/PCGR - Enschede, Augustus 2009
10. Three Ways of Looking at Marijuana Consumption Data By Keith Humphreys
11. Controlling Cocaine: Supply Versus Demand Programs By C. PETER RYDELL & SUSAN S EVERINGHAM / RAND 1994 - Prepared for the Office of National Drug Control Policy United States Army, DRUG POLICY RESEARCH CENTER, Approved for public release; distribution unlimited, ISBN: 0-83330-1552-4

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