Free heroin and its analogs
I’ve gradually become obsessed with the North American Opiate Medication Initiative (NAOMI). In their own words, the project is designed to
test whether heroin-assisted therapy benefits people suffering from chronic opiate addictions who have not benefited from other treatments.
The idea is that heroin addicts are administered regular doses of the drug in order that they may be free from the overwhelming preoccupation with obtaining heroin in the hopes that they may carry on normal activities such as work. Basically just work, as opposed to crime. The idea seems to be to get heroin addicts independent enough of their addictions so that they can focus on supporting themselves and putting their lives together. The project is currently available to heroin addicts in Vancouver and Montreal. While programs to administer methadone have been around for years, and heroin therapy has been carried out in Europe for some time, this is the first time heroin therapy has been carried out in North America, getting it a lot more coverage than it perhaps deserves. This in turn brought it to my attention and set my mind to work on it.
According to findings published in the New England Journal of Medicine the project has somewhat greater success rates than methadone treatment. Slate states
Schecter found that 88 percent of the heroin maintenance group stayed on their course of treatment, versus 54 percent in the methadone group. Illegal activity in the heroin group was reduced 67 percent, versus 47.7 percent in the methadone group. Out of 89,000 injections, there were only 10 overdoses and no fatalities.
I wasn’t able to figure out how ten overdoses occurred when the injections were supposed to be administered to the addicts, but there is obviously something I don’t know going on there.
The idea of administering heroin to heroin addicts throws my mind in perhaps a bad direction. My understanding of drug addiction is that the drug to which an individual is addicted installs itself in that person as a particularly insistent need. For cigarettes addiction, a person is willing to subject themself to the bitter cold of winter in order to smoke in front of a non-smoking building. For something like heroin addiction the addiction takes a place superior even to food, shelter and respectability. I understand this to be a relatively uncontroversial definition of what addiction is: a self-imposed need.
Now of course the problem is that human beings come pre-loaded with a substantial number of needs. Any undergraduate liberal arts kiddo will nod in at least vague recognition at mention of Maslow’s hierarchy thereof. Needs are hindrances, necessarily. One cannot achieve one’s aims when saddled with needs. It’s hard to do things when you’re hungry. This is, I assume, the reason that music stars are provided catered meals, drinks and groupies backstage: in order to clear their mind of all desire so they may perform their job as well as they can. (Naturally this tends to make them too satisfied to be creative, but that’s a topic for another time).
Heroin and methadone programs are not unique in their methodology. There are a number of times at which societies obviate an individual’s need in order to achieve some greater goal. The first one that came to my mind is scholarships and grants. The MacArthur Fellowship exists so that geniuses can turn their attention away from the workaday business of maintaining themselves so that they can attend to their gift. The second case of a society taking away need for a higher purpose that occurred to me was that of the comfort women, or in fact any system designed to let a concentrated group of men (sailors, soldiers, oil workers and what have you) get their rocks off so they can attend to the business at hand. Obviously dining halls attend to a more pressing need to stave off hunger so people can be productive. I doubt that the MacArthur Fellows Program would appreciate being likened to a camptown cathouse but in function at least the two are analogous
My point is that there is nothing qualitatively different about this heroin program and any other attempt to remove one need to attend to a loftier one. Priests are supported by the church so they can focus on the business of the church. My company gives us free coffee and juice to stave off our bodies’ twin needs for caffeine and glucose. Nothing new going on here.
But as I alluded to earlier with my example of the music star who’s so well taken care of that he’s lost the passion required to create new music, there is an important question to be asked, and it’s one that I have no answer to. How much need and desire should be gotten rid of? A Brave New World provides an image of a world where sex and drugs are administered to people to keep them essentially free of desire. The result appears to be geared completely towards social order. They are not freed to enjoy other pursuits such as learning or philosophy or the arts, they are just free from discontent, period. That to me appears to be the biggest difference between the Macarthur Fellowship and the rest of the above. Geniuses aren’t going to commit street crimes if their thirst for research isn’t satisfied. Groups of young frustrated men with military training, hungry men and fiending drug addicts are likely to commit rapes, thefts and robberies if not otherwise quelled.
The whole question of quenching people’s desires always brings me back to the Radiohead song ‘Big Ideas (Don’t Get Any)’, which is an early version of the song ‘Nude’.
The earlier version contains the following lyrics, which I always found particularly affecting
She stands stark naked and she beckons you to bed
Don’t go you’ll only want to come back again
The idea that you should not get involved in something that will only become a new need or additional desire struck me when I first heard this song. In time it has been mixed together with a lot of similar ideas in my head. He seems to be saying that going to bed would be an easy but ultimately empty way of satisfying an inner dissatisfaction, shooting morphine to escape the pain of a broken bone without setting the bone. That in the end is what is going on in NAOMI I think. They are essentially coming clean about the ineffectiveness of drug treatment programs and saying ‘Here’s your fix, just don’t rob people too much.’ Without regard for any questions of right and wrong, NAOMI provides at least one piece of evidence in favor of the program that we can all get behind
An untreated heroin addict costs the state $45,000 a year in legal and medical bills; heroin maintenance costs $7,000.