Heroin Maintenance Comes to North America
June 14, 2010 8:31 AM   Subscribe

Heroin Maintenance Comes to North America
In which we talk about the prospects for heroin assisted drug treatment in America with the policy experts who are pushing for it and a couple methadone maintenance drop outs who could have benefitted from it.
posted by The Straightener (5 comments total) 1 user marked this as a favorite

Well, the scope of North America (as in, Canada included) is a different beast politically than the US specifically. I think the PR consequences of accommodating heroin make this a no-go in the US. The results of Dutch & Swiss evaluations won't matter much, I'm afraid.

Do you plan to host this discussion at a more sticky and expansive venue? I think the comments section of an ezine article tends to "decay" faster, both in terms of quantity and quality.
posted by daksya at 5:07 AM on June 15, 2010

I never read the comments on the Daily Beast. I actually never read the Daily Beast, except when I have something on it.
posted by The Straightener at 5:27 AM on June 15, 2010

Actually, that post was unnecessarily glib. There's not much I can do in terms of fomenting discussion on Mefi other than posting the piece here in Projects. I did do a more extensive commentary locally but one that addresses the harsh reality in the field right now and how that presents added obstacles to these programs becoming actually useful to practitioners, including the political realities at the municipal level of a highly dysfunctional city like Philadelphia where a program like this could be implemented.

There are different standards for the "success" of such a program and how you see it depends on where in the system you are coming from. A NAOMI sized program in even one American city would be seen as a huge victory obviously to the Drug Policy Alliance because they've been waging a slow war of attrition against backwards drug policies for decades and a development like that would signal a potential shift in the bigger picture in terms of attitudes towards addiction and treatment and could pave the road to more similar programs. However, even a NAOMI-sized program in Philly wouldn't mean much to me as a practitioner because it's going to be full the first day it takes referrals and the wait list to get into it will likely be years long because we would really need a program 20 times the size of NAOMI to assist all the qualifying addicts we have. So, honestly, the NAOMI stuff doesn't get me excited the way it does a policy/research person because realistically it doesn't offer anything to my clients in the foreseeable future.

The other issue is that we do have opiate maintenance programs built to the scale we need in methadone maintenance but as you can tell by the testimonials from the ex-addicts in the story and even in the descriptions by researchers in the NAOMI study methadone clinics are typically underfunded shitholes full of surly, underpaid, overworked staff and going to one every day is generally considered a miserable experience despite the benefits methadone confers. While the research is appealing on methadone from a purely quantitative standpoint in terms reduced arrests and such the qualitative data from addicts usually centers on how their life quality remains pretty poor overall because of the logistics of being tied to a unpleasant location and undergoing an unpleasant experience first thing every morning in order to get their medication.

So, what do heroin clinics eventually look like in America? I fear they'll wind up being, as Bobby Dukes put it, "a shitty methadone clinic you have to go to 4 times a day instead of once." Which is not to state any opposition to opiate maintenance programs, but to say that there is a crazy amount of work that needs to be done at every level from national policy experts and federal government down to individual practitioners and municipal governments in order to make this resemble anything like the existing programs overseas.
posted by The Straightener at 5:58 AM on June 15, 2010

Thanks for bringing this to our attention, Straightener. I confess I've had the wrong idea about your efforts at times previous to this. Heroin maintenance has seen success in places like Switzerland and the UK and it's no surprise that Germany is taking the hint. I found it interesting that in my city council meeting tonight (Oakland, CA) there was great gnashing of teeth at the budgetary realities of having to cut police services. But as your Phawker piece points out, drug addiction services were the first to be cut when the budgets tightened. How long 'til people connect the two, the need for police and the exorbitant luxury of having heroin be illegal? Unfortunately, like daksya, in this decade as the last, I have a hard time seeing a light at the prohibition tunnel.
posted by telstar at 8:47 PM on June 15, 2010

I confess I've had the wrong idea about your efforts at times previous to this.

I deal with the systems I have to work inside, man, I'm not making any rules or structuring any programming. I try to gravitate towards programs that use evidence based models. I have done harm reduction based housing first work in homeless services where all of my clients were high on crack, resistant to treatment, unmedicated, cycling in and out of psych units and jail, and we met them where they were at and provided services to them regardless of what their status was in terms of abstinence or treatment engagement. Currently I work for the drug court, which is abstinence oriented though the program I work for considers methadone prescribed medication like any other and clients are permitted to take prescribed medication in the program. Clients in our program, even over the age of 21, cannot drink and if they test positive for alcohol the judge will sanction them. Do I agree with that? Not entirely, but the terms of the program were explained in great detail to the client by the public defender at point of plea entry and this is what they agreed to. The alternative is usually incarceration, typically in the range of 4-7 years. The program I work for has graduated thousands of participants over the past 12 years, each of whom had their felony drug charges dropped and expunged and without drug court they would have most likely done hard time and definitely would have a felony record. There is a body of evidence supporting the drug court model as an effective intervention, I would direct you to Doug Marlowe's work with the Treatment Research Institute. It's a matter of not letting the perfect be the enemy of the good. This is what we have, based on the oppositions in the criminal justice system and politics at large towards more progressive programs that policy experts and advocates who support harm reduction have yet overcome. So this is the work I do. As soon as a harm reduction based program comes along that has gained the power to divert people caught up in the drug war away from incarceration and have their felony drug charges dropped I'll work for that program but that program doesn't exist right now and I'm not waiting around for it to do something in the meantime. I sometimes think that people read what I write in terms of comments on this site and see advocacy where there is none. I report what the systems are like, how they work, what my role in them is. I am rarely saying that the way things are is perfect, or even right, or even just, and I frequently try to convey how deeply broken the entire system is and how difficult it can be to navigate it even as an experienced professional.
posted by The Straightener at 7:35 AM on June 16, 2010

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