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November 14, 2007 - News & Observer (NC)

OpEd: Making Addiction Less Deadly

By Arthur Benavie

Return to Drug War News: Don't Miss Archive

CHAPEL HILL - Last month San Francisco health officials met with groups that supported the idea of opening a "safe injection" center -- the first in the United States. It would be funded by the city and be limited to intravenous users of heroin, cocaine and other drugs. Addicts would bring their own drugs, receive clean needles and inject themselves under medical supervision instead of shooting up in the streets.

Advocates of the proposal believe that the creation of such a facility would reduce fatal drug overdoses and curtail the spread of HIV and hepatitis C caused by the sharing of needles.

Formidable obstacles stand in the way of this proposal: The facility would violate federal law that criminalizes the possession of such drugs, and it is certain to run into a political firestorm. So far, not one San Francisco politician publicly supports the idea. The meeting between city health officials and the groups advocating the site had hardly ended when a spokesman for U.S. drug czar John Walters blasted the notion as "poor public policy" and "a form of giving up" on curing drug addiction. Yet there are numerous safe-injection sites in Europe, and studies have found them to be effective.

Consider Switzerland's experience. In 1994, persuaded by favorable results of a drug maintenance program in Liverpool, England, Switzerland launched the largest and most scientifically designed trials ever attempted.

Over 1,000 volunteers were selected -- hard-core heroin addicts, who were at least 20, were afflicted with serious health problems and had repeatedly failed other programs. They were offered heroin, morphine or methadone and initially opted for heroin. Addicts were allowed to adjust their own doses. They self-injected with equipment prepared by the staff, who also provided advice and supervision.

In the final report issued in July 1997 the Swiss government stated: Within a month the patients had settled on stable and relatively low dosage levels that allowed them to dramatically improve their health and their economic and social functioning.

No overdoses occurred, and no heroin was reported to have leaked into the illegal market. The percentage of addicts with stable jobs increased from 14 to 32. After a year and a half, 92 patients switched to methadone, and 83 chose a rehab program that would help them give up heroin altogether.

The government report noted that the probability of switching to an abstinence program increased the longer the individual remained in the program. Law enforcement and health officials in Switzerland declared the program a success. So did voters. In a nationwide referendum in September 1997, over 70 percent opposed an initiative that would have ended the trials.

In October 1998 parliament voted overwhelmingly to make the program permanent and agreed to have it evaluated by the World Health Organization, which concluded that heroin maintenance was feasible and would bring about improvements in health and social functioning.

The official U.S. reaction was hostile, and proposals to undertake similar experiments here were met with outrage. For example, in 1998 professor David Vlahov of the Johns Hopkins School of Public Health suggested undertaking similar trials in Baltimore. Maryland's Democratic governor said, "It doesn't make any sense. It sends totally the wrong message."

Impressed by reports from Europe, Vancouver, B.C., set up an injection drug center four years ago -- the only one in North America. After facing much initial skepticism the facility has won the support of the mayor, the police chief, merchants and a majority of the public. A rigorous study by a team of researchers headed by Dr. Thomas Kerr found that the Vancouver center has prevented overdose deaths, helped prevent the spread of disease and led to a decrease in abandoned syringes, needle-sharing and drug-related crime. The research also credited the facility with increasing the number of addicts seeking drug treatment.

U.S. drug czar Walters reacted angrily to Vancouver's safe-injection center. He said "The very name is a lie. There are not safe injection sites. It can't be made safe."

Dr. Kerr disagrees. He sums up the evidence this way: "It's really been studied to death -- it's time to move on. It's obvious this is something that works."

I agree. What a shame that America's anti-drug fervor blinds us to overwhelming evidence that medically supervised injection sites for addicts would bring enormous benefits to our society. The health and social functioning of addicts would improve; they would commit fewer crimes to get a fix; and their connection with health professionals would help many kick the habit.

In addition, safe injection sites would diminish the spread of AIDS, since, according to the Centers for Disease Control, about 30 percent of the AIDS cases in the United States -- and a majority involving children! -- are caused by dirty needles.

(Arthur Benavie is professor of economics, emeritus, at UNC-Chapel Hill. His book "Drugs: America's Holy War" is forthcoming.)

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