Want Fewer Heroin Deaths And Users? Give Addicts Heroin For Free

Heroin graffiti

Well, for free under very controlled circumstances. From a blog post by “M.S.” on The Economist:

But we do have a good idea of how to stop more people from destroying themselves specifically with heroin injection, which has a higher fatality rate than most controlled substances. As with most drug problems, the solutions involve decriminalisation and universal access to treatment programmes, including alternative blocking drugs like methadone and buprenorphine. In the case of heroin, there is also another proven way to reduce harm: setting up safe injection rooms monitored by healthcare staff, and—for registered addicts who cannot or will not comply with treatment regimes—providing heroin itself for free.

Switzerland and the Netherlands pioneered this “Heroin Assisted Treatment” (HAT) approach in the 1990s, and both countries adopted it as national policy in the 2000s. Heroin use has steadily declined since; by the 2000s the Dutch incidence of new heroin users had fallen to essentially zero, and the aging population of addicts from the ’70s and ’80s continues to shrink. The average age of Dutch heroin users rose from 34 in 1997 to 45 in 2009.

Decriminalisation of marijuana use has also played a role in shrinking Dutch heroin use, since it separates the use of cannabis from the use of harder, more restricted drugs. HAT trials have since been run in Spain, Britain, Germany and Canada. The evidence consistently shows that HAT drastically reduces heroin-related crime, since addicts don’t need to steal to get money for their fix, and it slashes heroin-related deaths and HIV infection, since addicts are shooting up under medical supervision.

More interestingly, HAT is also correlated with lower overall heroin use. This is in part because free government heroin tends to drive out private-sector providers. Most addicts will end up shooting up in safe rooms monitored by public-health staff, where they will be encouraged to enroll in a treatment programme or, if they fail or refuse treatment, simply receive free heroin. This gradually erodes the market for dealing heroin for profit; as they say in the tech world, you can’t compete with free. The result is what you see in the Netherlands: the slow disappearance of heroin use.

As I understand it, the idea is not to make heroin legal in the sense that anyone can walk into their friendly neighborhood heroin shop and buy some, but a legal drug that addicts can acquire from designated places with a prescription.

In comments, M.S. added:

Heroin use rose across Europe while it fell in the Netherlands and Switzerland. There’s essentially no policy disagreement among drug experts that harm reduction saves many lives and vast amounts of money without increasing usage. The initial application of HAT is this: once you’ve provided universal free treatment and gotten all the addicts pulled into the system through safe injection sites, what do you do with those last recalcitrant users who can’t or won’t quit and are underwriting the private heroin market? You give them free heroin. It doesn’t increase usage because people have to go through the wringer before they start getting the free stuff, and it likely reduces it by putting dealers out of business.

Meanwhile, you clearly have your own pre-existing, unjustified prejudices if you demand that HAT reduces usage before you’ll consider it. Many people, *clearly including Philip Seymour Hoffman*, are able to live reasonably happy, productive lives while regularly using heroin. The harm they do by using is 1. epidemiological, 2. financing illegal drug trade, and 3. the risk they will unintentionally die, hurting themselves and their loved ones. Giving these people free heroin at controlled sites fixes their problems even if it doesn’t reduce usage at all; unless you can prove it *increases* usage, which runs against all the available data in every trial run so far, I can’t see what the argument against it is. The amount of money HAT saves society is generally estimated in the range of $5k-$10k per patient per year.

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17 Responses to Want Fewer Heroin Deaths And Users? Give Addicts Heroin For Free

  1. 1
    JutGory says:

    Ignoring the merits or wisdom of the program in general, why does it have to be “free”?

    Hoffman was paying for it before, presumably.

    Why couldn’t he pay for it through this system? it should not be “free,” and not just in the sense that nothing is “free.” Users, particularly well-to-do users, should pay for it.

    You could even do some sort of sliding scale so that people who would steal to get money for their fix could get it for “free or reduced price” and people like Hoffman would essentially subsidize their use (and the other costs of the program) and still get his fix at a lower price (potentially).

    Of course, I have not worked out a budget for the program, but there is no reason why someone like Hoffman should get “free” heroin, when he could be (and had been) paying for it.


  2. 2
    RonF says:

    Works for me. The WOSD basically puts money in the pocket of people who will use it to kill their competitors.

  3. 3
    JutGory says:

    I do not see that the World Organization of Scuba Divers has yet weighed in on this debate.

  4. 4
    RonF says:

    There’s an organization of scuba divers who are putting out hits on their competitors? Sounds like they’re ready for the Olympics.

  5. 5
    Sebastian says:

    As an active member of PADI, I’m really concerned about such hits. I guess now I am starting to understand why some of my diving buddies carry knives that could double as a brush clearing tools. And here I was, thinking they were compensating for something.

    Kidding aside, WOSD is really not deserving of the name. Even in Europe they are hardly even a blip on the radar. PADI may have more members even in the Netherlands.

  6. 6
    lkeke35 says:

    I like this but I’m very pessimistic about a program like this being instituted in the U.S, no matter how logical it sounds. In the U.S, the idea seems to be punishment of drug users. I don’t see that attitude changing anytime soon.

  7. 7
    Denise says:


    It’s free to stop users from buying heroin on the streets. This means they will have safer heroin, and heroin becomes dramatically less profitable for dealers.

    If you make it something other than free, then there’s going to be a bunch of addicts who will consider street heroin a better deal, considering the fact that they apparently have to jump through hoops to get the legal stuff.

  8. 8
    rimonim says:

    I would love to see programs like this in the US. I live in New Mexico, where we are in a full-blown heroin epidemic (and meth epidemic, to a somewhat lesser extent). The current treatment options are a disgrace.

  9. 9
    RonF says:

    I’m in favor of legal drugs because a) I favor individual responsibility over government “nannyism” and b) it would probably save lives in a few ways:

    People buying legal drugs are more likely to get clean stuff of a known quality and quantity and won’t accidentally OD or get hepatitis, etc.
    People with the opportunity to get free/affordable drugs are less likely to commit crimes to fund their drug habit
    The criminal infrastructure that is comprised of heavily armed people killing both their peers and innocent people in order to defend and expand market share becomes instantly defunded and far less relevant.

  10. 10
    Yvain says:

    This definitely works and is a good idea, but the methadone clinics that already exist are also pretty good. An even better choice than either heroin or methadone is suboxone, a newish drug which satisfies opiate cravings while still being safe and non-addictive enough that users can be sent home with a month’s supply. Removing their dependence on daily access to the heroin/methadone clinic is very liberating for users and gets rid of a lot of the stigma.

    Economist won’t let me read their stuff today so apologies if the article already mentions this.

  11. 11
    Ben Lehman says:

    I think that talking about treatment as if it were the end goal is kind of missing the point? Treatment is great! New treatment methods are great! But, as a society, you can’t actually treat your way out of a drug problem.

    The reason that new addiction rates have dropped, effectively, to zero, is that the government has undercut the revenue stream of the drug cartels by providing free heroin to addicts. Like all businesses, drug cartels need to spend money to bring in new users, and that money comes from long-term users. If you take away the profit stream, cartels can’t afford to stay in the heroin business, and since the government isn’t interested in selling, you don’t have people out there selling heroin to new users. If all the government provided was recovery and treatment options, you would be driving the regular users, and their cash flow, back into the arms of the cartels.

    This is exactly the sort of destructive market interference that conservatives like to talk about, but applied to drug cartels (a business that almost no one wants around.)

    For such a program to work, it must provide heroin, and that heroin must be free, because it must serve the community of addicts that do not want to stop.


  12. 12
    brian says:

    Making it “free” to take the profit out of selling it makes some sense, as without the black market mark up, a pound of heroin (or a synthetic opiate that does the same thing) would cost as much as a pound of aspirin. The savings in court costs, jails, police reports etc. would more than cover the expense.

    BUT just to play devil’s advocate, addiction to anything ruins lives whether it is opiates, alcohol, gambling or buying crap you don’t need and can’t afford on credit you shouldn’t even have. It seems a bit social Darwinist to just turn people loose on an all you can eat buffet of things that will kill them in order to do it in a way to save society a little money.

    If you’re going to do THAT you may as well just put 25 cent suicide booths on every corner and decrease the surplus population. Perhaps society SHOULD be about socializing people, training civilized behavior to keep the civilization going.

  13. 13
    gin-and-whiskey says:

    And that’s the goal:

    1) Deter new users by reducing the price of the drug and thereby removing incentives for dealers to create new addicts.

    2) Ideally, deter new users by making it less appealing generally, even if you have a high rate of use among existing addicts. That can mean providing safer drugs which satisfy addiction (if you are already addicted) but which are not nearly as likely to create addiction (since they offer less of a “high.”)

    3) Keep the existing addicts at a relatively normal state by giving them sufficient drugs. *(after you use dopamine agonists long enough, you need to use them to achieve “normal” at all.) Not incidentally this tends to reduce (not necessarily eliminate) their incentives to commit crime to score drugs.

    4) Wait for the existing addicts to die off. This isn’t really as unpleasant as it sounds. We can’t really cure them, so the idea is to keep them reasonably stable and reasonably happy, and to prevent them from creating new addicts or damaging third parties.

    Of course, humans have a devilish tendency to simply seek out new drugs which offer their own highs. So unless we make all drugs legal (which entails some complex social adjustment if we include drugs that really alter one’s state) then this is only a partial solution.

  14. 14
    Sebastian says:

    Brian, did you miss the part where new heroin users have stopped emerging? It seems that, for some reason, the approach above managed to prevent new lives from being ruined. Speaking for myself, I have no idea why this happened, but that does not prevent me from being happy about the results.

    Furthermore, being the selfish bastard that I am, “new lives not being ruined” is only a side effect for me. The real benefit of these kind of programs is that they destroy the business of drug cartels, they prevent a number of people from joining the trade, and they allow addicts to get their fix without exorbitant expenses that may push them to crime. Thus: all of us are safer.

    Considering how much money is being spent in the US fighting drugs, and how unsafe some neighborhoods still are, I’d say that this would not be a bad idea to try. Of course, as even this thread proves, the approach really does not appeal to the American mindset.

  15. 15
    Abbe Faria says:

    Heroin isn’t particularly “addictive”, only a minority of users have any sort of clinical problem. Dependency isn’t incurable, and most people who become drug dependent recover spontaneously without any treatment at all. The solution to the heroin problem is to stop criminalising it so it isn’t cut, offer treatment, and to educate people on responsible use. It isn’t to jail or force perfectly healthy people into “treatment” for diseases they don’t have.

    I’m not a fan of language policing; but addict has not been a clinical term for substance disorders in the ICD or DSM for a long time, because it’s pejorative and stigmatising and an instrument of political propaganda. Drug users are unequivocally a persecuted minority, and if you want to stop all that I’m not sure its use is constructive.

  16. 16
    Sebastian says:

    Abbe, I admit that ‘addict’ is pejorative. But here and now, because of the way the war on drugs is fought, drug users are often dangerous. And given that many of them had some choice in becoming a drug user, I think that it is pushing it a bit too far to postulate that one should not refer to them negatively.

    Even heroin. My best friend has a history of addictive behavior in his family. He knows about it, he usually stays away from anything but alcohol (and he should stay well away from that, too!) But twice I have seen him give in: once to heroin, when his college ex-girlfriend got into trouble he could not get her out of, and once to alcohol when his best friend from the old country got killed. When he was looking for his next fix, he was a scary creature, and it was not because he could not afford it.

    I felt bad about him, and both times, we took him out of it, and both time getting him to baseline took some scuffling. But the fact remains, both times he made the choice to go for the drug. And who cares whether the substances are truly addictive, and even who cares what truly addictive means? The addict want to be in the place where the fix puts him, and nothing and nobody else seems to matter to him.

  17. 17
    anonymous says:

    Better off being a heroin addict then person in chronic pain. At least Drug addict can go to methadone clinic and get medication without attitude or judgment but as a person suffering with chronic pain and at end of rope now that all doctors have been busted or forced to quit treating anyone for pain, I walk in E.R. with hundred pages of medical records, tests and proof of numerous serious medical problems, damages causing never ending agony and refused treatment. I request another doctor and threatened to have cops called. So I would like to know who the hell is affected by the war on doctors except people in chronic pain. Think I’ll create some fake track marks and try the methadone clinic where I can show up every morning and get a daily pill for pain.