Maintenance programs for cocaine and heroin users isn’t so different than giving meth to hyper-active children
Source: Vancouver Sun
Editorial Page, Wednesday, January 24, 2007
Vancouver Mayor Sam Sullivan’s plan to set up an alternative drug-treatment plan for 700 cocaine and crystal methamphetamine addicts might never come to fruition, but it’s something that should be seriously considered.
The plan might not see the light of day because the federal government has made it clear that it opposes any treatment or harm reduction programs that involve providing addicts with drugs. Last year, for example, the Conservatives refused to extend the life of the supervised injection site for another 31/2 years, despite the recommendations of scientists and Health Canada bureaucrats.
The science therefore might not sway the government to accede to Sullivan’s request that the program be exempt from Canada’s drug laws, but it should. Although the science is limited — and that is another reason to conduct a large-scale trial in Vancouver — the evidence we do have suggests that stimulant maintenance can have a positive effect on the lives of at least some addicts.
Trials have already been conducted in a number of jurisdictions, including Great Britain, which has been providing stimulants to addicts since 1988, Australia, South America, and surprisingly, the United States, and even more surprisingly, Texas. This means that, unlike the supervised injection facility, a maintenance program in Vancouver would not be the first of its kind in North America.
In fact, University of Texas psychiatry professor John Grabowski, who has conducted maintenance trials involving the provision of methamphetamine and dextroamphetamine, has said that interest in such programs has been growing across the United States on the strength of the results he has seen.
Grabowski has found that heavy stimulant users reduce their consumption while on maintenance, and also report fewer signs of depression and behavioural disturbances. This improved biological and behavioural stability has allowed addicts to get on with their lives and focus on such things as behaviour-control counselling: A 2001 trial in Sydney, Australia, found that dextroamphetamine therapy increased the likelihood of addicts remaining in counselling.
Further, since many stimulant addicts currently inject their drugs — and do so many times a day, unlike heroin users who inject once or twice daily — they are at greatly heightened risk of contracting blood-borne diseases such as HIV and hepatitis C, and of suffering from skin problems.
But as Simon Fraser University’s Bruce Alexander and Jonathan Tsou noted in a 2001 paper in Addiction Research and Theory, maintenance programs could help addicts replace injections with oral medication and avoid all the risks associated with injection drug use.
Stimulant maintenance, therefore, shows considerable promise and it’s worth conducting a trial in Vancouver to see if the results from other studies are replicated.
The one thing standing in the way, it seems, is an ideology that says we must never provide drugs like heroin or methamphetamines to people. Yet we’re already providing heroin to heroin addicts through the North American Opiate Medication Initiative, and preliminary results from those trials appear positive. We’ve also provided, for many years, methamphetamines to children with attention deficit hyperactivity disorder.
We ought, then, to have no ideological objection to providing methamphetamines or similar drugs to cocaine and meth addicts. With these ideological concerns swept aside, we should welcome a stimulant maintenance trial in Vancouver to see if it can improve the quality of life for users, and by extension, for us all.
