Drug Substitution & Maintenance Approaches
At Issue:
Drug substitution and maintenance approaches have a long history. These mostly involve providing drug addicts with legal access to drugs that would otherwise be obtained in black markets. The basic rationale is that of harm reduction: if some people are unable to quit using drugs, both users and society at large benefit if these users, i.e., addicts, are able to switch from "black market" drugs of indeterminate quality, purity and potency to legal drugs, of known purity and potency, obtained from physicians, pharmacies and other legal channels. The risks of overdoses and other medical complications decline; the motivation and need for addicts to commit crimes to support their habits drop; addicts are more likely to maintain contact with drug treatment and other services, and more able and likely to stabilize their lives and become productive citizens.
In the United States, morphine maintenance clinics proliferated during the first two decades of this century, before being closed under pressure by law enforcement authorities. Some also prescribed heroin and other drugs. In Asia, government outlets allowed addicts to register and obtain legal access to opium. Some of these outlets continued in operation until recent decades. In Great Britain, doctors have long retained the power to prescribe whatever drugs they deem appropriate; this has included the prescription of heroin, cocaine, amphetamine and other drugs for the purpose of maintaining drug addicts. The history of morphine maintenance treatment for those addicted to opiates extends to many countries in Europe, including quite recent experiences in Italy and the Netherlands. In Germany, where methadone maintenance was prohibited until the late 1980s, many opiate adicts were maintained on codeine.
The most dramatic development in drug substitution and maintenance is now underway in Switzerland. On July 10, 1997, the government announced the results of a three-year experiment in which 800 heroin addicts were maintained on legal prescriptions of heroin, and a much smaller number on injectable morphine and methadone. A summary of the Swiss report, which found dramatic reductions in crime and not just heroin but also illegal cocaine use, is available on this Web site. The Dutch government has decided to initiate a similar experiment in the Netherlands. In Germany, numerous local and state governments have appealed to the central goverment, and the courts, for permission to start their own heroin prescription program; in February 1997, Der Spiegel reported that a majority of big city policy chiefs would favor such programs in their own cities. In Australia two phases of a proposal to initiate a heroin prescription experiment in the Austrlian Capital Territory (Canberra) were approved in late July, 1997, but face strong opposition from some members of the government.