Pubdate: Tue, 22 Mar 2005
Source: Vancouver Sun (CN BC)
Copyright: 2005 The Vancouver Sun
Contact:  http://www.canada.com/vancouver/vancouversun/
Details: http://www.mapinc.org/media/477
Author: Perry Kendall
Note: Perry Kendall is the provincial health officer of B.C.
Bookmark: http://www.mapinc.org/find?131 (Heroin Maintenance)
Bookmark: http://www.mapinc.org/hr.htm (Harm Reduction)
Referenced: http://www.mapinc.org/drugnews/v05/n474/a01.html?37158

'HARM REDUCTION' WORKS IN EUROPE

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relapses when the program was withdrawn.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.
- ---
MAP posted-by: Jay Bergstrom