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We should be very clear that the role of harm reduction as part of a broad strategy in addressing substance abuse is thoroughly documented in the peer-reviewed literature. That this literature and its conclusions are routinely ignored, misrepresented or selectively mis-quoted by senior U.S. drug policy advisers is equally well documented and Kevin Sabet provides a good example of this in his comments on heroin maintenance (Why 'harm reduction' won't work, March 20.) The Swiss heroin trial was indeed critiqued by scientists and others on the grounds that it was not a randomized study. This is a valid critique, but equally applicable to all of the U.S.-based drug treatment court evaluations, a program that Sabet clearly supports. It has not stopped their expansion and indeed there is some evidence that for some people they may be beneficial. That is, addicts who graduate from the court program, (exactly like participants in the Swiss program) "experienced improvements in health and wellbeing and less criminal behaviour." More serious is his egregious omission from his review of the subsequent randomized trial of prescription heroin by Dutch investigators. This trial, which met the strictest scientific criteria, also found that previously treatment-refractory, long-term, hard-core heroin addicts experienced substantial improvements in health, social functioning and lessened criminal activity when they were in the program. They also suffered relapses when the program was withdrawn. In both the Swiss and Dutch programs, some heroin addicts did become abstinent and others transitioned to methadone, facts that Sabet overlooks. The science, contrary to Sabet's contention, clearly and unequivocally supports a role for heroin maintenance in Switzerland and in Holland. Will it here? That is what the NAOMI trial seeks to establish. The supervised injection site and the prescription heroin trials fill gaps in our present system where we need to face the fact that not all illicit drugs can be kept off the street, not all drug use can be prevented, not all drug users are susceptible to our present treatment options and no amount of wishing it were otherwise will make it so. |
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We are careful not to duplicate the efforts of other organizations, and as a grassroots coalition of prisoners and social reformers, our resources (time and money) are limited. The vast expertise and scope of the various drug reform organizations will enable you to stay informed on the ever-changing, many-faceted aspects of the movement. Our colleagues in reform also give the latest drug war news. Please check their websites often. |
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