Drugs: Why free heroin is not the answerby Dr Joe SantamariaNews Weekly
, June 3, 2000
Dr Joe Santamaria explains that the free distribution of heroin compounds rather than relieves the drug problem.
Some years ago, I was consulted by a married couple of middle age. The appointment was at nine o’clock in the morning. The wife opened the discussion by expressing concern that her husband had less ability to handle alcohol than he did in the past. Previously when he came home, he would consume a bottle of beer with little overt effect but, in recent weeks on this dose, he would exhibit features of intoxication and would drop off to sleep within half an hour. On close questioning of the husband, it appeared that he had been a heavy drinker for years. During the working week, he would limit his daily intake to about 2-3 bottles of beer, but at weekends he drank more heavily. This pattern had gone on for some years.
The husband was quite subdued but cooperative and seemed concerned about his alcohol problem. He had driven from their home to keep the appointment. He stated that he had drunk no alcoholic beverage since 11 pm the previous night.
After completing the history and examination, I took a blood alcohol reading with a hand held breathalyser. To my amazement, the result was 0.14. The whole picture fell into place.
Here was a man who over the years had developed a strong tolerance for alcohol and now rarely had a negative reading, probably coasting along with a blood alcohol level of between 0.06 and 0.10 or more, topping off at night. This probably resulted in a level exceeding 0.20. His tolerance allowed him to perform some routine tasks during the day but he quickly became visibly intoxicated and drowsy when he pushed the alcohol concentration to a much higher level.
As it turned out, his work performance had also fallen away and he was subject to absence from work, especially on Mondays. I advised his wife to drive home and organised for his admission to hospital to be detoxified. This took took five days. Thereafter he underwent prolonged counselling and joined Alcoholics Anonymous.
Over the succeeding weeks, his general health improved, he was eating better, his mind began to clear and he returned to work with more enthusiasm. It took many weeks for his mental faculties to return to normal but with the help of his family and new friends, he realised that the answer to his drinking problem was, in the first instance, abstinence from the mind-altering and addictive drug, alcohol.
No one in his his right mind would have advocated maintenance doses of alcohol to prevent withdrawal symptoms and to accommodate to the preferences of the addicted alcoholic. The object of detoxification is to allow the brain to function properly and for the general state of health to improve. The brain takes weeks to unscramble itself and rehabilitation must proceed free of the destabilising effect of the addictive drug. This is an inescapable fact of prime importance and it is even more so for those whose addiction has consolidated over years.
The same applies to the heroin addict — even more so — for his life has become chaotic and he has lost most of the social support systems. To assert that prescribed heroin should be the first line of intervention is to deepen the addictive state and to prolong the disruption of the mental faculties. It maintains the habit of the intravenous injection of drugs and does not eliminate the sharing of injecting equipment and the repeated exposure to sudden death and blood-borne infections, with their grave prognoses over future years. It does nothing to eliminate the use of other psychotropic substances such as alcohol, cannabis, cocaine, benzodiazepines, ecstasy and amphetamines.
The heroin doses are high due to the state of tolerance, but the effects on cognition, work and driving performance remain unchanged. The frequency of injections and the dependence on the system of drug maintenance to prevent accidental death limit social reintegration and maintain a marginalised lifestyle.
The message to the community is that we must tolerate such drug use and encourage casual heroin users to continue their use of a dangerous mind-altering drug. As the costs of such services escalate, the more reputable rehabilitation centres lose their funding as the addicts opt to continue injecting their drugs and avoid any responsibility to refocus their lives. The experience in Switzerland and the Netherlands reveals that very few stop their use of these drugs, even if some turn to smoking the opiates.
The sanction on the use of the mind-altering drugs should be an opportunity for an early diversion to treatment centres which have a target of abstinence in the short-term and long-term programmes of rehabilitation to a drug-free state and social reintegration.
Heroin trials are a blind alley, for they are in reality heroin programmes. Of course the distribution of heroin will attract heroin addicts but it will also increase the number of chronic users and set a lifestyle of chronic dependency on the system and an increasing burden on the welfare budget.
We do a grave disservice to the drug addicts of today. We do not have enough effective programmes of early intervention and we have been lacklustre in our prevention strategies, largely due to the vagaries of the national policy of Harm Minimisation, which has run for the last 15 years. We need to discourage the use of such drugs and seek to resolve the factors which create an at risk population.
We cannot afford to condone the proposition that the use of mind-altering drugs should become an acceptable pattern of life in our culture. We should not pretend that all we can offer those who are now strongly addicted to such drugs is to maintain them in a state of chronic intoxication when we know that there are several successful models of abstinence-oriented programmes in Australia and other parts of the world.
Our interventions should be more compassionate than what is currently proposed — injecting rooms or prescribed heroin. And we should be more appreciative of the scientific studies which reveal that injecting rooms and free needles and syringes are misfiring. We should learn from our experience with alcohol and tobacco that you do not maintain the use of the addictive substance if you wish the patient to make a full and fruitful recovery.