In Ashland there have been three deaths by heroin overdose this year (Mail Tribune, Dec. 6). One can attribute those tragedies to the drug, but the real cause is our laws that criminalize its use.
Don't get me wrong. I'm not advocating that anyone use heroin. It's highly addictive, and we should never turn control of our lives and health over to such substances, including the more inherently destructive ones such as alcohol and nicotine. What I am advocating is public policy based on real information.
The dangers heroin poses to life and health are the results of its illegality. One is infection by unsterile needles. The other is uncertainty about the strength of the heroin one buys on the street — that seems to have been the immediate cause of the deaths in Ashland. A third is the need of desperate people to commit crimes to obtain their supply. If heroin were available legally and administered under medical supervision, all these dangers would vanish.
Like all our laws governing recreational drug use, outlawing heroin has done neither the user nor society any good. We have unnecessarily forced addicts into lives of degradation, and turned them into a threat to our own well-being. We have enriched organized criminals, corrupted the police, and utterly failed to halt the flow of banned substances to our streets.
But what, you might ask, about the drug itself? Doesn't it destroy lives? The very word "heroin" causes most of us to shudder. Prepare to be surprised by the facts.
Here are excerpts from The Pharmacological Basis of Therapeutics (4th edition), a standard physicians' desk reference: "The complex relationship between crime and opiate use has been discussed in detail by several commissions (see Task Force on Narcotics and Drug Abuse, 1967). It should be emphasized, however, that the action of the drug itself is to reduce hunger, pain, and aggressive and sexual drives: it is the desire or need for the drug rather than its effects that motivates criminal activity." And later: "The addict who is able to obtain an adequate supply of the drugs through legitimate channels and has adequate funds usually dresses properly, maintains his nutrition, and is able to discharge his social and occupational obligations with reasonable efficiency" (pp. 285-286). And more recently from the online edition of The Merck Manual Home Health Handbook: "Opioids themselves do not cause many long-term complications other than dependence."
So it's clear that the laws criminalizing heroin use, not heroin, are the primary danger to self and others.
What to do? The radical proposal is declare the War on Drugs the catastrophic failure it has been, legalize all recreational drugs, and approach the problem as a medical one. That policy change is worth serious consideration, though it would require another opinion piece to offer it. The proposal I put forth is specific to heroin, and is very simple legislatively: the reclassification of heroin from a Schedule 1 drug (substances with a high potential for abuse and no proven therapeutic value) to a Schedule 2 drug (substances with a high potential for abuse and proven therapeutic value). Class two includes many other opoids, including morphine, which physicians may prescribe.
And what is the therapeutic use of heroin? To maintain heroin addicts as normally functioning human beings. If this sounds foolish, think of insulin. It's used to maintain the body chemistry of diabetics. Insulin doesn't cure their condition — they have to keep taking it — but it keeps them alive. More pointedly, Great Britain has had a program of heroin maintenance for decades, and despite some occasional mismanagement of the program, the proportion of addicts in its population is far less, and the black market in the drug is far smaller, than in the United States.
Before 1920 the U.S. had heroin maintenance clinics. The one in New York City was mismanaged, and puritanical crusaders at the national level used that as an excuse to shut them all down. The police in Shreveport, La., protested the closing of the successful clinic there, but to no avail.
Still more revealing is that in the U.S. it has long been acceptable for physicians to maintain heroin addicts on methadone. Methadone is as addictive as heroin; doses are administered daily. And some addicts say it is harder to kick it than heroin. So why is methadone OK and not heroin? Why, it doesn't give anyone any pleasure. Addiction without pleasure — now that's morally acceptable. That's an approach worth any number of deaths from overdose.
Herbert Rothschild Jr. lives in Phoenix.