How to Prevent Opioid Overdoses? Provide Hard-Core Addicts Free Pharmaceutical Heroin

With Ohio beset by a massive public health crisis around opioid use and overdoses -- more than 4,000 Ohioans died of opioid overdoses in 2016 -- the Cleveland Plain Dealer sent travel editor Susan Glaser to Amsterdam in search of innovative approaches to the problem. While there, she rediscovered Holland's longstanding, radical, and highly-effective response to heroin addiction and properly asked whether it might be applied to good effect here.

The difference in drug-related death rates between the two countries is staggering. In the US, the drug overdose death rate is 245 per million, nearly twice the rate of its nearest competitor, Sweden, which came in second with 124 per million. But in Holland, the number is a vanishingly small 11 per million. In other words, Americans are more than 20 times more likely to die of drug overdoses than Dutch.

For Plain Dealer readers, the figures that really hit home are the number of state overdose deaths compared to Holland. Ohio, with just under 12 million people, saw 4,050 drug overdose deaths in 2016; the Netherlands, with 17 million people, saw only 235.

What's the difference? The Dutch government provides free heroin to several score hardcore heroin addicts and has been doing so for the past 20 years. Public health experts there say that in addition to lowering crime rates and improving the quality of life for users, the program is one reason overdose death rates there are so low. And the model could be applied here, said Amsterdam heroin clinic operator Ellen van den Hoogen.

"It's been an enormous success. I think it would work elsewhere," she told Glaser.

It already has. The Dutch program was modeled on a similar effort in Switzerland, which has also proven successful. Germany and Canada are among the several other countries with similar programs.

The Dutch approach is an example of the country's policy of gedogen (pragmatic tolerance), the same principle that led the Dutch to pioneer quasi-legal access to marijuana in the 1980s. It is also rooted in the notion that, for some, drug addiction is a chronic disorder, not a condition to be "cured," and one that can be treated with supervised drug use under clinical supervision. And the complete cessation of drug use need not be the ultimate goal; rather, the Dutch look for reductions in criminal activity and increases in the health and well-being of the drug users.

"It's not a program that is meant to help you stop," acknowledged van den Hoogen. "It keeps you addicted."

That's not a sentiment sits well with American moralizers, such as George W. Bush's drug czar, John Walters, whom Glaser consulted for the story. He suggested that providing addicts with drugs was immoral and not "real treatment," but he also resorted to lies about what the Dutch are doing.

He claimed the Dutch are "keeping people addicted for the purpose of controlling them" and that the Dutch have created "a colony of state-supported, locked-up addicts."

Actually, the Dutch are dealing with older, hardcore addicts who have repeatedly failed to quit after repeated stints in treatment, including methadone maintenance therapy, and they are neither "controlling them" or locking them up. Instead, the people in the program show up at the clinic twice a day, get their fix, then go about their business. This heroin-assisted treatment (HAT) allows those hardcore users to live less chaotic and more productive lives.

And heroin-assisted treatment is "real treatment," said Peter Blanken, a senior researcher with the Parnassia Addiction Research Centre in Rotterdam. He pointed out that one-quarter of program participants make a "complete recovery," including better health and quitting illegal drugs and excessive drinking. Many others continue to use heroin, but do so with better outcomes, he said.

There is also a real safety benefit to using state-supplied pharmaceutical heroin. It's potent, but it's a known quantity. Users face no risk of adulteration with more dangerous drugs, such as fentanyl, which is deeply implicated in the current US overdose crisis.

In the current political atmosphere in the United States, providing heroin to hardcore addicts is a hard sell indeed. Other, lesser, harm reduction interventions, such as needle exchanges remain controversial, and the country has yet to see its first officially sanctioned safe injection site. And drug decriminalization, which has led to a dramatic reduction in heroin addiction and overdose deaths in Portugal, remains off the table here, too. But with an annual drug overdose death toll of more than 50,000 people a year, it may time to start asking how many more Americans we are willing to sacrifice on the altar of moralistic drug prohibition.

Permission to Reprint: This article is licensed under a modified Creative Commons Attribution license.
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This seems like a duh ... how could anyone not agree?

I've been preaching this for years, including to Senator Grassley's (R - IA) lackey and Congresman Blum's (R-IA) lackey today.

Of course I wish the Dutch would just legalize OTC heroin and we could all go back to the safe days of 1923 ... before 'addict' became the secular equivalent of 'atheist.'

 

LEAP_Speaker's picture

Opioids and Pain Patients

Lets work on getting opioid pain medications to ligitamate pain patients committing suicide for lack mof pain control before worrying about those who abuse opioids.

register to vote NOW!

If American democracy means anything, it means the people decide.

In November, the people --- every American citizen who votes -- will decide many things.

Be one of them.  Register to vote.  Do it NOW.  Later may be too late.  Do not assume you are already registered.  REGISTER.  Make sure there can be no mistake on election day.  Get your voter registration card.  Do it NOW.

On or before election day, decide who you trust. Here's how:

(1) Ignore *all* advertising.  It's just money talking.  You are not money.  You are an American citizen.  You are not for sale.

(2) Consult *diverse* professional and personal sources.  Make sure they disagree with each other, or you will not get the whole story.  Ask the hardest questions you can ask, and criticize the answers, even if you do it only in your own head, and silently.

Then VOTE on election day (or earlier only if you won't be able to).  Vote for the best candidates on the ballot.  There will be no perfect candidates, but don't allow that to discourage you.  Who's going to do the best job, and do it for all of us?

P.S. Your vote is more powerful than any weapon.  Use it or lose it.

P.P.S. The more people who vote, the more our leaders will worry about what you think.  It's more important that you vote, than that you vote "correctly", whatever that means.  You won't ever know whether your votes were "right".  That doesn't matter.  That's democracy. 

'conservative' christianity,

'conservative' christianity, america's unofficial religion, posits a dogmatic, puritanical, judgmental, and infinitely punitive god who must be believed in and worshipped. until americans stop believing in and worshipping such a god, we/they shall remain mired in policies that are faith based, not fact based, policies that are cruel, corrupt, ineffective, and just plain stupid!

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