A new study done for Baltimore's Abell Foundation concludes that programs that give heroin to hard-core addicts can reduce crime and improve public health - findings some hope will spur renewed debate about whether such an effort could help combat the city's unrelenting drug problem.
Peter Reuter, a drug policy expert at the University of Maryland, College Park, analyzed heroin maintenance programs in Switzerland, the Netherlands, Germany and Vancouver, Canada. He found some positive results. In Germany, for instance, participants were less likely to commit crimes, and in Switzerland, many addicts moved from the heroin distribution program to drug treatment aimed at helping them kick their habit.
While Reuter notes there are drawbacks as well - including high costs and low rates of participation - he says public health officials and city leaders should at least discuss the concept.
"It is a sensible innovation to consider," he said. "I am not a passionate advocate for it, but I do think someone should try it in the U.S. It has enough plausibility that it's worth trying."
But the issue raises thorny moral and legal questions and is politically contentious. Baltimore officials call the report unconvincing and say they would not consider the option, especially when proven treatments go underfunded.
"I think it would be a mistake to pursue an expensive and unproven idea when we need more resources for effective drug treatment," said Dr. Joshua M. Sharfstein, the city health commissioner. "There's nothing that persuades me to invest in something that is so expensive and without evidence."
Heroin maintenance programs seek to lure addicts into treatment, not act as a replacement for it, Reuter said. Some researchers believe that once addicts are removed from the drug lifestyle, they can realize the need for help.
Medical professionals treat addicts like patients, distributing doses of heroin in a sterile, clinical setting. In the Netherlands, where the drug is largely smoked, heroin is distributed in small groups. Users remain at the centers while intoxicated but must leave once they have recovered from their dose. In Switzerland, drug users must have failed several treatment options to be accepted into a heroin maintenance program. They also receive weekly counseling sessions and help finding jobs and housing.
