Expand Heroin Maintenance in Vancouver?

[Duckfeet]

Look, I tend to see myself as hardnosed, cynical. You be a heroin addict this long and you can't avoid it. Your heart will get broken by everything, everybody... But for those of us who are in this for the long haul, have given up hope of being like "normal people", and who are totally unhappy and unsuccessful on methadone or buprenorphine maintenance, it can often seem hopeless. I have followed the attempts by some western countries--England best example--to actually show compassion, and let incorrigible longterm junkies get on heroin (diamorphine) maintenance. It's no cure all. It doesn't make you "happy" all the time. The thrill wears off, and it's just another thing. Even legal, it's not some "happiness drug," not when you do it every day.

But still, I'm one who would get on it, if I had a chance.

Anyway, as many of you know, up in Vancouver, Canada they started the NAOMI trials a while back. Putting addicts who had been unsuccessful on methadone maintenance on heroin maintenance. You had to live withing a mile of the legal injection site, and a bunch of other requirements, and you might be one of the unlucky bastards who got on the control group, of methadone maintenance.

By any serious account, this has been successful. Some of the people are even completing the program, which brings up *two* positive issues.

*One* is that *if* a trial medicine is successful--think cancer--there is an ethical obligation to keep the patients on the medicine, *particularly* if they have failed at earlier treatments (in this case, methadone maintenance). So, now, where the end of the study looms for some of the participants, what to do with them has become a serious issue. If you put them on continued diamorphine maintenance, then *that* door has been opened. If you put them back on methadone maintnance...well, they already have shown *that* doesn't work for them. So this--to me--is huge. Unfortunately, the more conservative--lock junkies up--types *also* know it is huge, and are doing everything they can to *not* let even the successful program participants switch to permanent diamorphine maintenance.

The *second* issue is that Mayor Sullivan--in our corner, by most accounts--wants to expand the NAOMI project. For simple pragmatic reasons: the project takes and cleans up hopeless junkies and takes them off the streets . It works. Putting aside all the chickenshit calvinist morality that even pervades up there, he knows it is better for everbody *else* if we are able to inject ourselves daily.

Here's one quote:

"Probably my next choice is a very robust maintenance program of drug maintenance." Sullivan wants to expand on NAOMI, the controversial experiment that provides free heroin to addicts. "It's a little bit sensitive right now, so I don't want to dwell on it, but I can tell you that will be a big, big part of my agenda," Sullivan said. "I actually feel it will be probably one of the most important elements of the Civil City Project."


So against all my grim experience, it's hard not to get a little hopeful, that ray of light may someday shine on us...

Anyway, I hate Christmas, it's all bad memories for me...not a lot of 55 year old junkies still alive, free, able to take care of ourselves, so I feel lucky to have found you all, know I got at least one place I'm understood and accepted for what I am.

Be safe today, see y'all when I get back from Mom's...

Duckfeet

[nick]

you're right bro,there's always hope.They're talking about expanding diamorphine prescribing here as well,but they've been saying that for a long time.Of all the reasons to get it back on the agenda it took a seriel killer praying on addict prostitutes to get the ball rolling.Shame they had to die for any kind of change.
I suspect the Naomi trials will end up in court,but in good conscience I can't see how they'll be able to cut off people on diamorphine.Of course they'll try and they're trying to shut the INSITE safe injecting room despite it saving over 500 lives in od prevention on site alone.I wrote to Clement protesting this as many others did and it's got a stay of execution.
The Canadian's own commision says there's only two ways to go in the war on drugs legalsation or total war.Sounds ominous.

[MikeyFlowers]

It's just bizarre to me that the OP's argument MAKES SO MUCH SENSE and yet so few people can understand it. I live in the states and here we still have places where you can't even get clean needles. I just can't see how people don't understand that if a medical program is shown to work and has been shown to be safer than alternatives why not do it. I believe that addiction is something that is impossible to really understand by somebody who has never been an addict, I think this is the problem with getting treatment. They've got the problem misunderstood so the solution doesn't work out the way they think it should.

[Duckfeet]

Right: if it were just a matter of "reason" I believe it would have been legalized for registered addicts a long time ago. Among other things, it would take away the outlaw appeal to young people...similar to me the way the methadone clinic does.

But again, I fear that reason won't prevail: Nick has seen the battles in England thoughout his lifetime. There is just a deep current of religiosity in the West--in the world, really--that just doesn't like seeing other people be happy. Just doesn't seem right. To me it goes back to puritanism, combined with idea that government is there to protect us from our "sinful" nature. On a national level it'll always be fought, but mayors and even cops often know that it would take away a lot of their difficulties.

We'll see. If courts allow even minimum diamorphine maintenance, and these guys don't commit any heinous crimes, the door will be cracked open a little more.

[KiloByte]

I don't understand how putting addicts on legalized heroin make it easier for them to quit? Is it the rush of copping the shit/doing something illegal that might be involved with the addictivness?

[nick]

Sadly Kilobite you are totally wrong I got legal H for 16 years and trust me I was very addicted.The point of diamorphine prescribing is to give a life to hardcore addicts.It is seen as a last resort.They do not give diamorphine away free with the cornflakes.
It costs about a 1/4 of the price of locking someone up in jail and it's a hell of a lot cheap than ARV's.

[devilsdrug]

and i dont believe the point is to make it easier to quit

[SuperJunky]

ARV's? Whats that?

[nick]

ARVS=Anti rero virals.Medication for HIV/AIDS like interferon.I'm not sure if this is the usual acronym,but it's the one I use.

[Duckfeet]

I just got thru talking to the NAOMI guy, where the clinical trials for heroin maintenance were being held.

First, I have to always be fighting off the junky tendency to "pretend". One of the pretenses is that "if I could get legal heroin I'd just hop on a plane and go there." That's bullshit. Most of us have ties to where we live, and financial constraints, and other hoops we'd have to get over. My first post on this website was a post asking if there was *anywhere* that a boy like me could go and and get on legal heroin maintenance. I could--and probably should--have had my post slapped down for stupidity by DD--but anyway, I got some responses and help which was appreciated. Mostly I had to look at myself and my life in an honest way, could I *really* leave town, did I have a mobile trade or enough money to support myself, all that, was I aware that after first few days of *legal dope!!* the thrill would be gone, and the ties to a clinic would be even more severe than methadone maintenance: I'd get well, then get sick, brag to other junkies I was on dope, but spend a lifetime hooked tighty to regulatory system that goes against every bone in my libertarian bod...

The second thing is to just be reasonable. Any western country that tries to start and maintain *any* kind of program that involves an illegal or highly controlled substance like heroin, has enormous hoops they have to go thru. *One* of the hoops is making sure it has *medical* crediblity. No program like this would ever get started--or succeed--if any junky with a yearning to get high could hop on a greyhound bus out of Seattle and get loaded in Vancouver a few hrs later. Not going to happen.

So the man at NAOMI was patient and polite and seemed to understand my dilemma. I fit every criteria any of those programs are looking for: length of time on opiates, criminal history, failure with methadone and other legal maintenance drugs.

In this case--to prevent fiends like me from flocking to Vancouver--you had to live within a mile of the clinic for the past year. To save me embarassment, he ran down quickly the ways americans have tried to get in the program thru deceit. "Been livin in my car there a year, dude, got *witnesses*!" Like any good heroin addict I was prepared to lie, but he spared me the attempt. We talked a bit. Sadly, not for me. Always a chance NAOMI'll get renewed, and if I moved up there now, and lived up there, maybe, who knows, but again, that's falling into wishful thinking again...

[Chipper]

Nick, a question or two ... How do Heroin Maint. programs handle the dosage issue? Wouldn't you be tempted to always up the dosage and is there a maximum they allow? Can you also take methadone for the days you don't want to shoot?

[nick]

Dosage depends on the particular doc.There is in theory no maximum dose,but people tend to stabilise at around 400-500mgs.I got up to 150mgs plus benzos and was very happy.I didn't see the point in asking for more.
There are a few people on split treatment methadone one day diamorphine the next,but the gig is you only take what is prescibed by the doc and nothing else.The deal I did with my doc was no other hard drugs and no crime.The rest was up to me.

[flipside]

Duck I just now notices the wasted and wounded moniker under your name. Oh sweetie, I feel your pain, you and I have goten so close over the last couple of monhst. I hope you are not still feeling this bad and not sharing with me because you don't want to burden me. We have a unique freinship one of equal give and take..please let me do my part in supporting you the way you have been there for me. I love you brother and I hope there will be a ray of light for you soon. Love, Flip