Sunday, September 22, 2013

Legalize It, Control It

One of the most devastating problems that our society faces is that of addiction.  Whether that is to tobacco, alcohol or narcotics - any substance addiction can have long term consequences for the addict, those around them and society at large.

Smoking is known to cause cancers, alcoholics can destroy their families and careers, and drug addicts become pariahs of society.

Tobacco is not illegal in this country, but it is highly regulated and among the most heavily taxed of all products out there.  Over the course of my own lifetime, I have seen smoking go from common and nearly pervasive to being almost rare.  Few people in my circles smoke, and I can go into restaurants and nightclubs without inhaling the equivalent of a pack of cigarettes in second-hand smoke.  Alcohol is similarly regulated, but not illegal.

Then we come to narcotics like heroin.  Heroin is illegal in Canada, and requires special authorization even for medical applications.  Opioid medications are all heavily controlled, and heavily sought after by addicts.

The difference between the three?  Treatment for tobacco addiction or alcoholism is fairly readily accessed and doesn't carry with it the stigma and fear that is associated with seeking treatment for being addicted to narcotics which are (theoretically) illegal and should not be on the streets.

So when Canada's Minister of Health, Rona Ambrose, had a ministerial hissy fit over a handful of heroin addicts participating in a clinical study being granted permission for medically controlled access to heroin, I was a little bit surprised - but for the ideological stripe of the current government.

"This decision is in direct opposition to the government's anti-drug policy and violates the spirit and intent of the special access program," she said in a statement. 
"I am taking immediate action to protect the integrity of the special access program and ensure this does not happen again." 
There are already safe treatments for heroin addiction, such as methadone, Ambrose argued. 
"The special access program was designed to treat unusual cases and medical emergencies; it was not intended as a way to give illicit drugs to drug addicts."
As a columnist over at Global points out, these addicts fall well within the scope of the Special Access program - they are the addicts for whom treatment regimes such as Methadone have already failed.

Let me be clear - I'm not advocating that these drugs should be readily available on the street.  Far from it.  What needs to be taken out of the picture is the criminalization of the addict.  An addict doesn't need to be punished - the addiction is far worse than any punishment the courts may dish out.

The SALOME (Study to Assess Longer-term Opioid Medication Effectiveness) study’s not yet complete. But in the meantime, doctors say they need a viable way to treat participants who’ve completed their 13-month trials and remain very, very dependent on heroin. 
The idea is to administer – in safe doses, in a medical environment and under close observation – an illicit substance these people would otherwise break the law to obtain. Best-case scenario: You stabilize and, eventually, quit. 
Several doctors, including Vancouver Coastal Health’s Chief Medical Officer, submitted 1,000-plus pages of studies and missives as part of an application requesting injectable heroin prescriptions for 35 people.Health Canada approved 16. 
Is it ideal? Hardly. But traditional solutions haven’t worked so far. 
In her indictment of her department’s decision, Ambrose said she plans to “ensure this does not happen again.” 
Giving addicts this heroin, she argued, is “not to treat an underlying medical condition, but simply to allow them to continue to have access to heroin for their addiction even though other safe treatments for heroin addiction, such as methadone, are available.” 
She’s right: Methadone maintenance is one of the most commonly used treatments for serious opioid addiction. In some places across the country, it’s insufficiently accessible – especially now that many of those who need it aren’t addicted to illicit heroin, but to licit (highly addictive, frequently abused or misused) prescription opioids. 
But the addicts getting this heroin were by definition ones methadone wouldn’t help: They’ve already tried.
Instead of the Minister getting up on her high horse and complaining about a small, controlled study, she might want to consider directing Health Canada to start the process of figuring out how to help addicts get off the substances that they are addicted to - without fear of being prosecuted.

Narcotics have legitimate medical uses, and perhaps we have lost sight of that in the drive to use prohibition to restrict these substances.  The underlying discussion should be one of how to help the addicts.  There will always be those who sell these drugs illicitly - those people should be held accountable for their actions, for no other reason than they are ultimately doing grave harm to their customers.  Their customers, on the other hand, need to have access to treatment that enables them to escape the chemical bondage they find themselves held to.

We have experimented with prohibition for too long.  It is a failed strategy, and it is time for us to reassess the effects of the legal frameworks that are in place.  Unfortunately, I don't expect the current government to move one iota towards a constructive approach to these issues - Harper and his ilk seem to think that harsher and harsher punishments are the way to go.

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