Injecting heroin with a doctor

Slate has two articles on an innovative but controversial service in Vancouver, Canada, that provides injecting drug users with a place to safely inject drugs with clean equipment and medical staff on hand.

The project, ‘Insite’, is based on a ‘harm reduction‘ approach which is driven by the idea that users should be encouraged to take drugs in the safest way possible.

This is partly an admission that addiction treatment is not very successful on its own, but partly a public health measure in that injecting drug users have much higher rates of diseases such as HIV and hepatitis and are more likely to pass them on to other people.

It is also the case that one of the biggest dangers from injecting drugs is the actual practice of injecting, as unsanitary conditions, ad-hoc ‘cooking up’ and unpredictable street dope as become much more risky when the final product is injected into the bloodstream.

These services can be controversial in some places as they can be seen to be condoning drug use, although some countries are now going further and actually prescribing heroin to addicts.

One of the biggest impacts on society is not the fact that a tiny minority of people are damaging themselves with smack, but that they tend to commit crimes to feed their habit and support a violent criminal network of dealers.

Methadone is a heroin substitute that has been prescribed for years and we know that it can stabilise the lives of users and increase their chance of kicking the habit.

But it is often not what users want. It stops the withdrawals, as it’s another form of opioid drug, but it doesn’t feel the same and still has the danger of overdose. One common problem is known euphemistically in the medical literature ‘methadone diversion‘ where users sell their methadone to buy street drugs.

Several countries have trialled the prescription of heroin itself, with, it turns out, a great deal of success – including better health, a reduction in criminal activity and a higher chance of actually kicking the habit.

This may seem counter-intuitive, but one of the advantages of these projects is that the user is constantly in contact with health professionals who can provide addiction treatment.

The political and local opposition to harm reduction services is usually immense, however. Politicians want to be seen to be ‘tough on drugs’ and no-one, and I mean no-one, wants one of these clinics near where they live.

The Slate articles looks into the day-to-day running and talks to some of the clients of the Vancouver programme, and provides an insight into the challenges such services face. There’s also a gallery of photos that captures the project in action.

Link to Slate article ‘Welcome to Insite’.
Link to Slate article ‘Upstairs, Downstairs’.
Link to photos of the Insite project.

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