Europe: Heroin Maintenance Comes to Denmark

On Monday, Denmark opened its first heroin distribution clinic, two years after the Danish parliament passed a law legalizing the distribution of medicinal heroin. The opening was delayed until after the city of Copenhagen agreed to house the program.

Denmark thus joins Germany, the Netherland, and Switzerland, and to a lesser extent, Great Britain, as countries that allow for the provision of heroin to hard-core users who have proven unamenable to the traditional treatments, such as methadone maintenance. A pilot heroin maintenance program is also underway in Vancouver, Canada.

The Copenhagen clinic will serve about 120 of Denmark's 300 or so identified hard-core users. Only addicts who have been referred from a methadone treatment center will be accepted. While subjects will be prescribed heroin, they will have to consume it at the clinic.

"Our objective is not to cure heroin addicts, but to help those who are not satisfied by methadone by providing them with clean heroin, allowing them to avoid disease and the temptation of criminal acts to obtain the drug," a doctor and head of the clinic Inger Nielsen told Agence-France Presse. People in the program will get methadone for the first two weeks "so we can determine how much heroin to prescribe," she added.

The Danish User Association, a group that represents drug users, while supportive of heroin maintenance, criticized the program for requiring users to go to the clinic twice a day, seven days a week, to get their fixes. "This means living like a zombie, without being able to hold down a job or study or have hobbies," said head of the association Joergen Kjaer.

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Malkavian's picture

A good, decent, honest step in the right direction

I, being a Danish citizen too, am happy to see this move towards a more compassionate attitude towards this group of opioid users. It's such great a victory for the Danish User Association and the Street Lawyer, and it's of huge benefit for those enrolled in the program.

Another good thing is that this is not one of the so-called "experiments". This should, hopefully, ensure a kind of permanence to heroin maintenance as one of the tools available for furthering the well-being and development of those dependent of opiates.This is remarkable - and paradoxical - considering that the current conservative government inaugurated zero-tolerance ideology as the basis for current policy (2003/2004 and ahead).

If anything critical should be said it's probably that the legislators have been a bit too zealous in certain regards. There are huge demands on the experience and professionalism of the staff, and as such a nation-wide solution may be quite difficult to achieve due to a lack of qualified personnel. This can only result in under-treatment.

Sitting behind a desk in a bit of a hostile environment, yet clearly with good intentions, it's not so surprising that they wanted to be ambitious. Not the least because lax security protocols could turn into disaster in case of the odd overdose death or other complications.

Yet such over-zealousness adds tremendously to the costs and compounds the criticism from many conservatives who have a hard time wrapping their heads around the basic concept of "giving away free heroin".

It also seems to ignore the the question: what's the alternative to this heroin maintenance program? Those admitted to the program often hang out in the streets where they buy illegal and often contaminated heroin, and they inject with tremendous haste in fear of being apprehended by police. Some injected using tap water, even water from puddles and ... worse ('nuff said).

Basically, if they can do in in the street under such hard conditions, one might somewhat rhetorically ask why they suddenly seem to need a whole team to assist them in injecting 100% pure and safe heroin with sterile syringes and in the cosy comfort of decent, well thought-out indoor conditions?

As far as I remember, but someone correct me if I'm wrong, it's also not an option to smoke the heroin. Allowing this would be a significant harm reduction compared to injection use.

Going ahead as they do will build confidence in their own solution. In time I would expect the guidelines to soften as a more relaxed attitude emerges. When it does the valid concerns raised by Joergen Kjaer will hopefully be addressed and pave the way for a new setting where those needing opiates to function (similar to ADHD patients needing amphetamines to function properly) will be even more decent and allow for a more efficient integration back into society for this marginalized group.

Regards,

Jesper Kristensen

Heroin

Jesper, great comments. I was a user and can see this kind of program not only helping addicts for all the humane reasons you stated, but having a safe place with understanding professionals will help many to cease using, like i did.

Why not use?

Why not use diamorphine or diacetyl-morphine? You will get the same result and avoid using "heroin". That means that the specific name of the drug be used, all of the time. Especially, when talking to the press and government agencies. It would give identical results! Isn't that a good thing? No more "heroin". I have grown to hate that name!

Malkavian's picture

I hear you

Yeah, the word "heroin" has ceased long ago to be a neutral word. Now it's loaded with all sorts of crap, including an implicit stigma of being somehow related to crime.

Clearly it may make some people stop to think when using other words like diamorphine. I frequently use that term to pull the discussion away from the whole "drug war" rhetoric.

"Heroin", however, is just convenient, because if you start out by saying diamorphine you'll have to explain yourself every single time, and when you get to "heroin" eventually you have to explain anyway. Besides, women - once considered pretty much next of kin to the Devil - got rehabilitated without making up a new name for the gender :o)

Personally I think lots and lots of people should be forced to say "heroin" over and over until they reach a point of familiarity with the word so that it becomes stripped of the emotional baggage :P

move

Wouldn't it be less expensive to hop on a plane from the U.S. and go to these other countries that offer treatment for drug users than it would be to try and find a doctor {good luck} or rehab and spend a fortune on treatment and or go underground for heroin and still not get any counseling or human treatment that is unavailable here in the police states? Not to mention the risks involved going underground to get a supply because of our out dated laws? I know many, many friends that would benefit from the move. Just how long must you live in a country that offers this medical help before you can get it? Is it like waiting for a green card here? If so, again, {good luck!}

Malkavian's picture

Unfortunately not so easy

Had it owned my country, personally I'd love to have every single opiod user in the US around, cause I'd just give them the damn stuff if it's really all that important to them. So cheap no one would even notice, and I bet no one would notice those people either once they're on the only medicine that really seems to work for them.

However, the barriers to entry are still very high at this time. Very few users are actually admitted. It's pretty much only those with a foot in the grave and maybe even the first shoveling of dirt on their face that's being admitted. And the demands for skills on the human resource front is sky high still.

So, unfortunately I doubt we'd just let foreigners into the program. Immigration laws these days are harsh.

Malkavian's picture

Update

I did a little more research, because just yesterday the city council in the second largest city in Denmark, Aarhus, voted on rx heroin and according to the local newspaper this actually means heroin maintenanance is a reality in most of the largest cities in Denmark (except Aalborg that voted it down)..

This should mean that Copenhagen, Aarhus, Odense and Esbjerg now have decided to set up shop. Even though the absolute number of eligible patients are deliberately kept at a bare minimum it's actually quite impressive that so many have followed suit so fast.

I sure couldn't keep up :o)

legalisation diacetylmorphine Denmark

It's cost effective (cheap) societally also. To wit: UK can't pour pounds down a blackhole of "treatment". Legalised heroin and cocaine in the mid 1960's. Result- police don't carry guns or have drug swat teams.The programme is a cultural mix of the good, the bad, and the onery. USA designates the British programme as a failed policy ( translation Yankee dollars have influenced British sovreignity. Same old same old). What can one expect from a country like America that tries to have its medical professionals ( I am one- licensed, too) designate cigarettes with nicotine as a "gateway drug"? What can one say- this is the nation that legislated the Volstead Act (prohibition).

It boils down to money. Of which America doesn't have as it starts its decline on a slippery slope to free fall. USA has no industrial base except drugs, sex, rock n' roll, & Disneyland. A large portion of its citiens gets pay checks from legal jurisprudence, law enforcement, institutionalisations (jail), etc. Legalise heroin and they'll have to criminalise something like not sitting up straight at the table. Whatever. America doesn't have the resources or is it in its strategic interests to be the Holy Inquisitor re.: drugs. Once upon a time, the USA was BFF's w/ the Talibani for eradicating opium. Subsequently- U.S. citizens prescribed pain killers faced artificially induced shortages when they went to get pain meds after chemo, etc. Whatever. Sign me up for Denmark's programme. Denmark seems to be a country unheard when it comes to the economics of the Great Recession.

I find this to be a good

I find this to be a good start. I know so many people that this would help. I really hope this grows and we can see other countries follow. I live in the u.s. and cant ever see us doing it, hell just having methadone and suboxone availible is almost illegal.

Good medicine

I am in the US and have been on methadone for 10 years. I have done fairly well with only a few short relapses here and there. I am currently working to get off of it and am down to 38mg from 100mg. I wish such an option were available here. In my current situation I would prefer to switch to heroin now so that when i finally go from 1mg to nothing I have an easier time. From everyone I've seen the side effects of coming off the methadone last 4-12x times as long as a heroin habit. Of course in a perfect world why not just left us have an unlimited take home supply of as much heroin as we want at an affordable price? The reasons I used to begin with were all to self medicate mental illness. Chronic depression, anxiety, OCD and now PTSD. Using helped, not hindered, my ability to get up in the morning, shower, shave and go to work and pay my taxes.

Well i hope you made it off

Well i hope you made it off the meth. It took years to feel better after grtting off the meth .i. started useing again after my combat tour in afgainstan i came home with. Ptsd. And im tjhinking about moveing to europe and get on the hwin program if posibal. I done. Everthing to quit .i tried rehabs. Meth subutex. And in ny the street. Is a hard road. Triying not to get caught. It wpuld never happen hear what is going on in. Denmark but it would be a good thing if thay had that program hear. I think that. If you want to live your life that way. You should have that choice and it would stop the drug wars im looking into moveing to europe i have bin struggling for 20. Years and i. Dont want to stop useing . So mabe i can have that choice now

Not here, sadly.

I'll never know what it would be like.  Not in the US, birthplace of the failed 'War on Drugs.'  I've been basically an addict since 1970, on my second tour in Vietnam, another failed war which we tried to justify.

Some days I get so bitter at our own unwillingness to at least try something other than punishment.  Oh yes, we claim to care, to want to 'help' the addicts.  So now we send them to treatment and then AA or some other program for a while, then lock them up anyway, just takes a little longer in the 'liberal' states.

And methadone?  God I"m so sick of methadone. It's not cure, it's just a total addiction to an opiate that provides no pleasure, none at all.

God for Denmark and compassionate countries trying to actually provide some solution to the madness.  We?  We just build bigger prisons.

USA Policy Will Only Continue to Fail

I can only echo the sentiments about the USA that have already been mentioned. There are so many reasons why the USA continues down a path of warring against drugs. It mostly comes down to two things: law enforcement jobs and military veterans. You see, if we had heroin clinics and actually participated in harm reduction instead of this draconian gladiatorial prison system then we might make progress, but you see unlike Denmark or any country really- the U.S. takes on the mantle of world savior and so we spend all our money-trillions- on defense one way or the other. You see Denmark and other Nordic style democracies don't have to worry about safety because everyone knows the U.S. will bankrupt itself building bombs, guns and prisons. Then after all these troops fight these ridiculous wars, they become veterans and as veterans in the US they have no real job skills except for...you guessed it....law enforcement. If you talk to cops here (may you never have the distinct pleasure of dealing with a close shaved egomaniacal nightmare tyrant who only could prove he was worth something through artificial marine corps training-most cops are veterans) you will discover that 85% or more of ALL law enforcement (and boy does the U.S. have a lot of law enforcement. Countless local and federal law enforcement agencies where 85% of their direct or indirect job is....the war on drugs!!!) were veterans. You see I am an Army veteran who was also an Officer. I was enlisted and an officer for ten years. I'm 33 and only left a little under two years ago. Most men join the military for two simple reasons: self-worth and benefits. This is due in large part to a culture in movies and TV and family that continues to hark on World War II era bravado. You know your dad and grandpa were in the Army/Marines you should be too. That kind of thing. Once the men leave the military there are still no jobs, haven't been in years. And the jobs that do exist require 60 hours a week for a salary that's been the same now for 20 years. And so all these veterans flock to law enforcement agencies and our politicians know this so they keep passing more and more and more and more criminal laws and WILL NEVER STOP THE WAR ON DRUGS. I would submit that if the U.S. stopped throwing cash at our militates and pointless decades long military engagements and instead put it to use for our citizenry for eduction, health, stipends, drug reduction policies, etc., you would see probably the most amazing Nordic model of capitalism tempered by generous social benefits. But the very rich know how to stop that. You can't have the rich not get richer so they create a big lie-that if you're miserable, unhappy and in prison it's all your fault, all your fault and never the fact that we only spend money on war and sending out own men to be sexually and physically assaulted in prison and laugh about it in movies by making prison rape jokes all the time while we also have race wars in prison. Yes, the US is so Godly. Such a Godly country of straight up lying sacks. And most young men know the only place in America where you can earn a decent wage with healthcare fresh out of highschool or hell anymore I saw dozens of men at the upper age limit for enlisting coming in when the recession hit. You see young men at 18 get a load of crap from an older generation that didn't have the same struggles telling them they're a man now and have to support themselves and a family. We have the nonsense in America which young men internalize and yet the reality is that there is hardly any meaningful opportunity unless you have a rich family or you get extremely lucky or you truly are brilliant in something you then luck into at a young age. So most young men feeling less than flock to the military where they will "prove" to everyone they are a man damn it!!! This mode of thinking is outdated and not real but our politicians, movies, actors and pop culture and baby boomers like to act like you should be able to support yourself and a family at 18 years old. Unless you're a woman in which case you should be a mom or a celebrity. It's ridiculous. This results in large "volunteers" to the military. You often see 20 year old men who are married with 2 kids come in and act like its for the country when it's for the benefits and guaranteed paycheck. But God forbid you smoke a joint after deploying to war three times in 10 years because then they try to strip you of everything and call you a failure. It's utter crap-our entire US culture is founded on BS lies. Most of these lies were started after the USA felt it earned the reputation of bad ass post World War II. Many of these outdated machismo models stem from movies about World War II where 3 men fought a division of Germans. You may laugh at my rant but I'm telling you that an honest appraisal will have you agreeing with me. Look, I used to be delusional, after all I joined for money and benefits. Now I see. Which brings this long post to my conclusion- we will never have heroin clinics because young people who may want change almost always, through pop culture and dumb family members, buy into American hype about being self-made and no excuses and you have to work 100 hours a week for pennies to show what you're made of. It's all garbage. All designed so we don't ask too many questions. I laugh every morning at the methadone clinic. Why? Because it's just a fucking comedy of errors and idiots. You would not believe some of the fucking asinine things I hear the doctors and nurses at the methadone clinic say. They are nothing more than programmable robots who spit out a script for wads of cash from the VA where I get it. I watch them do the most punitive measures to some poor guy whose a vet like detoxing him involuntarily because he had weed or coke in his system two weeks ago or stop his weekly take home it took him 6 months to earn because, according to them, "they do it for his safety so he won't overdose." Yep. Even though not a single one of us in the methadone line have ever met a real opiate/heroin addict overdose on methadone after decades of opiate use. Fact is they either know they're lying and just think we are all as dumb as rocks or they simply are too stupid and lazy to ever think "gee, why would I believe my idiot bosses who justify taking take homes over the hundreds of methadone patients who call BS on it?" It's really sad and makes my blood boil. In other words, they punish addicts in methadone clinics but try to hide behind this "overdose" mantra. I've seen dozens of methadone patients/veterans undergo painful surgery and not receive any pain meds due to being on methadone which is funny because most BS Vicodin you can't even feel anyway on methadone. But why do they live in agonizing pain post-op you ask??? Because of the insane war on drugs and the stupid, needless war on pain pills that started about 10 years ago with oxycodone and has resulted in doctors, en masse, cutting off patients-legit patients-from pain pills because all the pharmacists and Drug Enforcement Agents have threatened all the doctors. AND that my friends is where the current heroin situation developed. But that's what we got here. And no one changes here until they get money to think differently. I would trade my US citizenship for a Danish tag any day. It's funny because in America, and we all know this, anytime you criticize how dumb we are, dumb people say dumb things like "well' if you don't like it go to North Korea". Dumb Americans will always say how lucky you are to be an American when you could be in Iran and North Korea. It's like stabbing someone in the eye and when they scream in pain telling them how lucky they are because you could've cut off their balls. So stupid. And since we're so stupid and stupid people come in droves, I fear we will never even dance with a drug policy of harm reduction. And I'm not against AA or treatment but come on, AA has just become too much to deal with and the treatment scam train continues to strip everyone of all their possessions why telling them how lucky they are to be in treatment when they could be in a gladiatorial rape me/assault me prison!!!! Like I said, we are dumb. It's so unfortunate. The treatment scams are just awful with staffing too self-righteous and arrogant to tolerate. Only in AA and treatment do these people with "years" sober expect ticker tape parades. And they all feel compelled to talk about how happy they are when, if you talk to them, they are anything but. So get treatment fine-but for the love of God lets do harm reduction policies. Too bad it makes so much sense. Instead we will continue to build jails, ruin lives, give people absurd criminal records, make opiates cost so much when in reality they're dirt cheap so that addicts are forced to steal. I hate it. If I could leave the cess pool America has become, I would. I mean, we HATE our own citizens. We really do. We laugh at each other's misfortunes and wish ill on each other. Plain stupid.

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