The D'Alliance: Personal Views on Drug Policy

Can Heroin-Assisted Treatment Happen Here?

Thursday, January 21, 2010

Those of us in the drug policy reform movement have learned time and again that the most effective solution to a drug-related social problem is often counterintuitive.

One clear example of this trend is heroin-assisted treatment (HAT), an approach to helping otherwise treatment-resistant heroin addicts using well-monitored doses of the drug itself. HAT programs provide a safe place to inject for those users most at risk of contracting a disease or suffering an overdose.

I got to learn more about this harm reduction strategy last night at a DPA-sponsored panel on HAT at George Washington University in Washington, DC. The event featured an international panel of health professionals, researchers, and advocates familiar with the topic.

Donald MacPherson, former Drug Policy Coordinator for the City of Vancouver, spoke about the heroin-assisted treatment program he oversaw in his city. Dr. David Marsh shared his experiences as one of the lead researchers in the North American Opiate Medication Initiative (NAOMI) trial of prescription heroin in Canada. Peter Reuter, a University of Maryland professor and leading scholar on heroin maintenance, discussed treatment programs in Switzerland and the Netherlands. And DPA Executive Director Ethan Nadelmann spoke about the prospect of implementing a heroin-assisted treatment program or trial in the United States.

DC's Ward 6 councilmember, Tommy Wells, also spoke, and it was heartening to see a DC politician there in support of HAT, as DPA's DC Metro program has been investigating whether creating a HAT pilot program in the District is feasible. Washington, DC has one of the highest rates of HIV/AIDS in the country, and many contracted the disease through injection drug use.

I came away from the panel with an understanding that the most important step we can take to make heroin-assisted treatment a reality in the United States is to change perceptions about the people these programs would help.

Why have other countries been able to institute heroin-assisted treatment programs or trials while the prospect of doing so here in the U.S. still seems so far off? Because in the United States drug users are too often characterized as criminals and unworthy of help. The stigma associated with heroin use in the United States is the main reason HAT is not widely accepted in the U.S. as a viable treatment option.

The key to gaining acceptance for this kind of treatment is combating this stigma and convincing people that saving a life, under any circumstances, is more important than projecting a "tough on crime" image. As David Marsh put it, speaking of his two young grandchildren, "I would never want to say to them that I had the chance to stop people from dying, but I didn't do it because I was afraid it would send them the wrong message."

Read more on heroin-assisted treatment.