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Heroin Maintenance: Study Suggests Baltimore Could Be Ripe for a Pilot Program

Baltimore is home to one of the nation's most intractable heroin-using populations, and now a study done for the city's Abell Foundation is suggesting it could be time to try something new, at least in this country: heroin maintenance. The idea is not so much to push for such a program now, but to open the door for discussion -- a worthy idea given that decades of repression and, more recently, conventional drug treatment have done little to stem the tide of addicts.

Authored by University of Maryland drug policy expert Peter Reuter, the study, Can Heroin Maintenance Help Baltimore?, examined existing heroin maintenance programs in Switzerland and Germany as well as the now-ended North American Opiate Maintenance Initiative (NAOMI) program in Vancouver, and examined the Baltimore heroin scene. His review of results so far found decreases in criminality, increases in employment, and health improvements for participants.

But Reuter also noted that those existing programs are expensive (more expensive than methadone treatment), serve relatively small numbers, and would be politically controversial in the US setting. In fact, the US National Institute on Drug Abuse, offered a chance to participate in the NAOMI program, declined. In addition, Reuter wrote that significant differences between hard core heroin users in Baltimore and in European cities made predictions of success difficult.

Can heroin maintenance help Baltimore? Here's how Reuter answered his own question:

At best there is a case only for an experiment. There are too many potential differences between Baltimore City and the other sites in which HAT [heroin-assisted therapy] has been tried to allow confident predictions of the outcomes. Visits to facilities in other countries hardly provide an inspiring model. The client population in Baltimore City is highly troubled so even if HAT leads to better outcomes for the group as a whole, many of the clients will remain unemployed, marginalized, and in poor health conditions. There will be some poster children but not many.

The potential for gain, however, is substantial. Even in the aging heroin-addict population, there are many who are heavily involved in crime and return frequently to the criminal justice system. Their continued involvement in street markets imposes a large burden on the community in the form of civil disorder that helps keep investment and jobs out. If heroin maintenance could remove 10 percent of Baltimore's most troubled heroin addicts from the streets, the result could be substantial reductions in crime and various other problems that greatly trouble the city. That is enough to make a debate on the matter worthwhile.

"It is a sensible innovation to consider," Reuter told the Baltimore Sun. "I am not a passionate advocate for it, but I do think someone should try it in the US. It has enough plausibility that it's worth trying."

But Baltimore officials are not convinced. "I think it would be a mistake to pursue an expensive and unproven idea when we need more resources for effective drug treatment," said Dr. Joshua Sharfstein, the city health commissioner, who apparently did not actually read the report. "There's nothing that persuades me to invest in something that is so expensive and without evidence."

Former Baltimore health commissioner Dr. Peter Beilenson worried that the notion was too radical to fly in the US and could undercut more plausible reforms. "It's not like everything has been tried and everything has failed and you just throw up your hands," said Beilenson, who is now Howard County's top health official. "The problem is if you are going to do any reasonable drug policy reform, this heroin thing is such a red flag that it takes all the attention away. It makes it look like anyone who is interested in drug policy reform is crazy." [Ed: Beilenson should know -- he tried it in 1998.]

But some addiction specialists said there should at least be a clinical trial. "Do I think it would be interesting? In a controlled clinical trial setting, yes," said Susan Sherman, an epidemiologist with the Johns Hopkins Bloomberg School of Public Health "To me, it's also important to have a public dialogue, regardless of the outcome. It forces people to deal with really hard issues about drug use and drug users."

"Most studies clearly show they help," said Dr. Christopher Welsh, assistant professor of psychiatry at the University of Maryland medical school. "But using public funds to fund something like this would be a whole other level of politics, especially in this economy."

Permission to Reprint: This article is licensed under a modified Creative Commons Attribution license.
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Can't they at least try?

What I will never understand is why taking care of an addict with a few doses of drug a day will not be cheaper than keeping one in prison for $50,000 a year! It allegedly dropped new heroin addicts by 80% when initiated in Switzerland! But, we know that it will cost at least $50/day to get them $5.00 worth of heroin! That is US government efficiency for you.

But, I guess it is hard to pre-evaluate a program if you don't even take the time to read about it! That doc does not deserve a job! He sounds like a lazy ass-ed prick! But, he was smart enough to know it would fail, without needing to read the report! How stupid can one person be?! One wonders how medical innovations occur in this country, if the doctors, involved, are no better than this! They sound like they are not into "change"! I did not completely understand the second doctor's "red flag" comment anyway. Maybe I am just getting senile! But it really did not seem to apply to the situation.

And everybody all over the country seems to think their situation is different than that of everybody else, and unique to that particular area. I get real tired of experts like that! They seem to be full of excuses for not trying something, other than, their same old failed programs! Sort of reminds me of the "we don't do it that way here" crap, typical of medical politicians.

It is a start

There certainly is a change in attitude which is beginning. There is another article that says the DEA will no longer raid legalized marijuana distributors in California and other places where state legislation has made it legal. Now this is another way to help allow these state to help their citizens. What has been finally recognized is that the brains of opiate users and other type drugs are changed (adapted if you will) after years of use. Abstinence has shown to be a failure in the medical arena. Simply referring people to 12 steps has only helped a very few and their length of recovery is in question. Relapse is part of recovery but for those lucky enough to not relapse think they are special and everyone can do it. I do not know where they get this from except from their inflated egos. They should be grateful instead of egotistic.

Lets try and try anything and everything as what works for some does not for others. Lets get all aspects of treatment out of the legal system and treat it with parity with all other diseases both physical and mental.

Addiction is a horrible disease and we need to quit letting those with no knowledge make the laws regarding treatment.

lots of misconceptions

There are a lot of negatives pointed out in this article that are not the fault of the trials.Low numbers,for example,are nothing short of ridiculous.I received many e mails from addicts all over the world that were willing to come to Vancouver in an instant if there was even the smallest possibility of getting on.I, as an addict of 35 years with an extensive criminal and prison record couldn't get on as I didn't qualify???.When England did their experiment in the early 60's half of Vancouver's addicts tried to get on that program.Many were successful which shows a far more liberal policy in 1965 that when NAOMI was done here.The program here was going to expand and open it's doors to a majority of Vancouver's addicts until Stephen Harper and his born again racist conservatives took power.The doors were closed within months.Heroin addicts are basically the same everywhere you go.The more vicious and extreme the policing,the more violent and extreme the addict.The English were not ready for the kind of addict they got from Vancouver because the addicts here had all been brutalized all their using lives.The police chocking someone unconscious was a daily occurrence and so were beatings.No one ever noticed.If anyone spoke up,the cops identified themselves and that was it.NAOMI was all positive but the feds downplayed the good results and went on with their anti drug policies which as of yesterday became more draconian than ever.Laws passed to deal with gangsters are inevitably applied to the lesser druggies and seldom ever work against the people they were designed to get.One step forward 10 steps back.And so it goes,until this madness is brought down and stomped out forever.

Still learning!

I guess they are never going to learn that the gangs are caused by the obscene profits caused by prohibition. It happened, in the thirties, with alcohol. And, they continue to repeat the same mistakes with the prohibition of drugs! We, down here, thought the Canadians were getting smarter than that. I guess not!

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