Canada's Cautious First Step

The northern North Americans in Canada are taking another cautious step for drug policy reform. NAOMI, the North American Opiate Maintenance Project, will shortly begin providing maintenance doses of heroin to addicts in Vancouver, moving later in the year to Toronto and Montreal as well. Drug warriors in the U.S. and Canada alike are likely to characterize the project as reckless or wrongheaded. In reality it is a cautious first step only, but an urgently needed one.

In Vancouver's Downtown East Side, where many of the city's hard drug users congregate, the addicted each day face unnecessary levels of risk from overdose, spread of infectious diseases such as hepatitis or HIV, marginalization from society and the health system, a wearing and time-consuming search for money to pay for expensive street drugs, general destabilization of their lives, and all the obstacles to survival, recovery or prosperity these conditions present.

Prescription heroin is not a panacea capable of instantly transforming every addict into a happy, productive, model citizen. But the experience of countries such as Switzerland, The Netherlands, Great Britain, even the early 20th-century United States, show that legal access to the drug of choice enables many such people to accomplish that for themselves. The consequences of prohibition are defining and harsh. Counterintuitive though it may seem to some, without prohibition, heroin and even heroin addiction would be markedly less destructive than they are today.

One famous advocate of prescription heroin was Danny Sugerman, long-time manager for the music group the Doors and coauthor of the famous Jim Morrison biography, No One Here Gets Out Alive. Danny, who sadly passed away last month from cancer, also wrote an amazing book, Wonderland Avenue: Tales of Glamour and Excess, telling the story of his descent into serious heroin addiction while living the fast life in West Hollywood. It's the kind of book that you don't want to put down until you've finished it.

Wonderland Avenue made crystal clear that Danny held no illusions about heroin. He keenly understood its dangers – he almost died from them, many close to him did – but he also comprehended the impact of prohibition on addicted drug users. In an interview four years ago, Danny said, "If you prescribed heroin to current addicts, you'd save an entire generation." Those words were spoken from hard experience and deep thought combined.

In the context of that idea, saving generations of addicts, the NAOMI trial seems much too little – a few or several hundred participants, people who have already tried other therapies unsuccessfully, followed by a weaning off with the potential for a return to the street once the study's done, absent changes in drug policy to permit continuation. Canada has tens of thousands of active heroin users. Doubtless it has to start this way; even in Canada – even in Vancouver – heroin maintenance is a radical step forward, in political terms. But we know heroin maintenance works, if carried out in a sound fashion, and the record from other places and times, the people from those places, are there to offer insight and aid. So amid my satisfaction at this historic step, I cannot forget the uncertainty the future and present alike hold for many, many people who could be saved now.

Still, Canada deserves congratulations – a lot of them – for this cautious but major first step. With favorable results, unceasing pressure, and maybe a little luck, more and larger steps can follow.

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