Prescription shouldn’t we? While the idea of providing

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Prescription Heroin

By Jillian Bauer-Reese


The trolls were out in full force last week to battle with misinformation and zero data the City’s announced support of Comprehensive User Engagement Sites (CUES).

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On news sites and social media, I saw it all: “When will the city make a child molestation safe zone?” one person joked; “Not with my tax dollars!” cried others; a cop cited season three of The Wire like it was peer-freaking-reviewed evidence.


And not all hid behind their screens. On Good Day Philadelphia, radio personality Dom Giordano expressed a popular sentiment in an attempt to prove that Philadelphia has taken this too far: “Why don’t we provide the heroin then?” he asked, facetiously.


I laughed out loud. Prescription heroin? Sure. Let’s do it. After all, why shouldn’t we?


While the idea of providing individuals who use substances with a safe space to use them might sound radical, globally, the United States is behind the curve of evidence-based addiction solutions. Portugal decriminalized all drugs in 2001, and now annually, they lose only 5.8 per one-million adult citizens to overdose, compared to America’s nearly 200. And several other countries, including Canada, Switzerland, the UK, Germany, and the Netherlands, provide individuals for whom other treatments have failed with a prescription for medical-grade heroin.


Though medication-assisted recovery, which is the use of FDA-approved medications such as methadone, buprenorphine, and extended-release naltrexone (combined with psychosocial therapy), is irrefutably the most effective treatment for opioid use disorder, for the 40 percent ofindividuals for whom it is ineffective, heroin-assisted treatment is a viable, second-line option.


Every study on the use of diamorphine (pharmaceutical heroin) to treat heroin addiction under medical supervision has demonstrated positive outcomes. In the various countries where it’s provided, it’s created a sharp reduction in illicit drug use, crime, disease, and overdose. It’s also improved individuals’ overall health and wellbeing and helped them reintegrate into society by securing stable housing and employment. Oh, and it improves the chances that individuals receiving it will stay in treatment.


So why does this solution sound so radical to us?


We humans – and all animals, really – are creatures driven to catch a buzz. Dr. Ronald K. Siegel, who spent more than 20 years collecting evidence that humans are not, in fact, the only species that seek out substances to use recreationally, wrote extensively about this in his book Intoxication: The Universal Drive for Mind-Altering Substances. Through Siegel’s book, and also in his interviews with journalist Johann Hari in Hari’s book Chasing the Scream, Siegel explains that people who use drugs aren’t bad; they’re just human.


Unfortunately, though, for 10 percent of us here in the United States, that little buzz we’re all seeking isn’t enough. One in 10 people who try drugs or alcohol – me included – develop a substance use disorder, the most severe case of which we commonly refer to as addiction. So given that we’re all wired to seek mind-altering substances, but some of us have a negative reaction to them when we use them, addiction is hardly the choice it’s often believed to be.


Yet still, our society treats people with addiction as though they don’t deserve the same tax dollars, empathy, and humane, evidence-based services as individuals with other disorders and diseases. Ask anyone who’s needed treatment for substance use disorder and cancer, and I promise you they’ll affirm this.


So why then, if more than 1,200 individuals died of cancer in Philadelphia last year, and our city proposed a location for them to receive a death-reversal antidote and medical treatment when they need it, would there not be the controversy and outrage that exists today over such a facility for people with substance use disorder? And why, if someone with cancer needed a medication called diamorphine to keep them alive and improve their life, would people not deny them that treatment? After all, research has shown that most people who use drugs – even those with addiction – eventually grow out of it if they don’t die of an overdose first.  


The answer to this is simple: Because our country has illegalized drugs and turned those who use them into criminals. It’s dragged the globe along in its 100-year-old racist, failed drug war, in which it’s painted through the media a demonized picture of substances. Some researchers even have a name for the public fear of medicinal heroin – it’s called diamorphophobia. 


Now, this is where most Americans – pickled with anti-drug messaging – clap back: “But drugs are so strong that anyone will become addicted after trying them. Look at what happened with the opioid epidemic, caused by Big Pharma!”


While we should certainly hold Big Pharma accountable for its deceptive marketing practices, it’s much more complicated than it’s been presented by the media. Environmental factors such as trauma, loneliness, isolation, and unemployment are not to be ignored, and those hit hardest by the greatest economic collapse since the Great Depression experienced all of the above. It’s also worth noting that the problems we associate with addiction – like crime, disease, and overdose – start when the substances are taken away. The spike in overdoses since the government’s crackdown on Big Pharma support this.


So before you dive into the argument against Comprehensive User Engagement Sites, ask yourself this: Why are these substances illicit and these behaviors illegal in the first place? Do a little research. Think philosophically about our drug policy. Because the evidence-based solutions presented here are hardly as radical as America’s draconian drug policy would have you believe. 

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