Medically Supervised Injection Sites have been particularly successful in Canada. I for one would like to personally visit a program in Vancouver and assess for myself how they operate.

Shooting-up an addict is treatment? Am I missing something?

Are you serious? I would like to know how they monitored the participants to gather the data and stats on crime. How do you know they weren't still using outside of the "safe and supervised setting". Herion is a quick high and quicker drop. Were the participants able to come any time they needed a fix? How ehtical was/is this study? In the words of my teenager, "child please", Use your grant money wisely.

I agree with the experiment. I think that it would benifit society in many ways. For addicts to use in a controled invironment would eliminate some of the hazzards of heroin use. It produces a safe inviornment to use the drug, there would be a dose as opposed to street drugs, clean needles, doctors present to avoid overdose, less chance of contracting disease, less commission of crime to obtain the drug, and counseling to help those who need help with dis-continueing use.

Sad story. With all the research we have today that supports addiction as a treatable disease, it seems unethical to "write people off" this way as a way to save costs. What other treatment for illness takes this approach? Mike Schiks, MS Executive Director www.projectturnabout.org

This is what those of us working at the street level on harm reduction know to be true. Maintaining/treating addicts with their drug of choice is not only cheaper and more effective, it reduces the overall costs to the community substantially.

This makes too much sense. The US will never go for this with the mentality most politicians have, let alone how some of the old guard clinicians are going to repond.I read the article; they said the treatment is expensive at $22,000 a year. Working in the field, that number is not that expensive. We pay $16,000 for 28 days of hospital based tx. I would look at this as another tool to use for clients I served. NA meetings are not the end all answer for every person I see. There is not a "one size fits all" tx. The US has to decide if they want to help people or keep doing the same thing over and over, getting the same results. I tell my clients doing that is called insanity.

I have credentials for substance abuse counseling in NY State. I worked for an abstinent based outpatient facility. I had no idea what Harm Reduction therapy was until I attended a training conducted by a Risk-Management/Harm Reduction facility. At that time I learned there are other methods of recovery that may be more suitable for individuals than abstinence. It has conflicted my thoughts since I learned about it. This is based on Harm Reduction methods and it is understandable why it is effective. Professionals need to remain open-minded to the possibility treatment such as this is effective. You take a drug away from an addict and they have several options...they will find a way to obtain it...illegally, they will suffer needlessly until they relapse or they become a fatality statistic...success rates in recovery through abstinent based programs are not the greatest. I'm not saying it doesn't happen, but the statistics are stacked against an addict.

The only thing missing, Scott, is whose pockets receive the $22K per year. If there are any investigative journalists left in the world unafraid to delve into the trail of money and perks doled out by the manufacturers of "legal heroin" this is over-ripe for disclosure to the public. In the interim this issue is covered on The Prescription Addiction Radio Show hosted by pharmacist/host Larry Golbom with archives at www.prescriptionaddictionradio.com Paula Davies Scimeca, RN, MS

Paula Davies Scimeca has hit the bull’s eye regarding this topic. Who will profit from this approach? Why would any heroin addict ever want to quit using if they never hit a bottom and suffer consequences? Hitting a bottom hopefully prior to losing the capacity to think with an undamaged brain is the easier softer way to freedom. This “treatment” sounds to me like a heroin addicts dream come true. A dream only those seeking to live an unconscious life would aspire to. I say go back to the drawing board on this one.

Is this harm reduction? Suboxone might be but free IV heroin? I think not. How was the outcome of 75% decided? Unless there were daily lab tests performed on the test group or the test group was sequestered (which invalidates the study) there is no way to know for sure. Bah Humbug.

The other option that is being utilized is doling out suboxen like it's candy...let's do the cost comparison on that one. I know heroine addicts (especially those on Medicaid) are taking full advantage of the free high they get from Suboxen vs heroine...hey as long as Medicaid covers it...why not use it instead of going to the streets for heroine...Not saying all heroine addicts abuse Suboxen...but there are a lot more out there than professionals know about. So that's not really working all that well either...any other suggestions?

Did any of you watch the videos and read the article before you commented? I had heroin clients that were coming in every 2-3 months for detox and sometimes rehab, some even more often. Then we opened a methadone clinic and our frequent flyers got admitted and we no longer see them. Last year we had only 4 over dose deaths, a drop from the previous year's 12. This past fiscal year we had none. Yet these people who are now working, taking care of what needs to be done get crucified if they go to a meeting and share about being on a presecribed medication. Let me see, a hard to treat heroin addict committing crimes, not taking care of his/her family, going to prison vs a heroin addict getting prescribed heroin and attending IOP, doing what needs to be done? Real hard choice! Don't worry people, we won't run out of clients to treat.

The comments reacting to this article demonstrate that there are two deeply conflicting drug treatment and policy camps among those working on many various drug policy issues; objective and compassionate public health advocates versus abstinence-only quit-or-die prohibitionists. From what I've read, seen and heard about experiences in Canada and Europe, providing heroin addicts with untainted premeasured doses of heroin for use at safe injection sites is far better for many addicts and for the public than repeated arrests, fines, incarcerations, mandatory abstinence-only treatments, and multiple relapses. The tobacco control movement has similarly split into similar distinctly different factions over harm reduction products and policies.

It is very sad that addiction is still being treated as a moral lapse rather than the illness that we now know it to be. Giving heroin or methadone to an opiate dependant person is akin to giving insulin to a diabetic. Neither treatment is a cure, merely a way to stabilize the patient while encouraging lifestyle changes and working with the patient to resolve the underlying issues and reason for the substance abuse (diet in some forms of diabetes and possible early trauma in addiction). I apologize for the simplification but space is limited here. The only difference in these treatment modalities is moralizing! If we really want to treat addiction we really need to drop the moralizing and concentrate on the science. Michael

Some of the comments are totally off the mark. First of all, it is not possible to get high from suboxone unless the user is not an addict and has no history with opiates, and even then they would only get a buzz. Suboxone blocks the receptors, so opiates cannot enter, and the patient would not get high even if they used heroin. Not only does he not get high, suboxone stops 99% of the cravings. The maximum dose of 34 mg is sufficient for all but long-term heroin addicts, who might need to supplement it with up to 150 mg of methadone in order to control cravings. Giving heroin to addicts even just 10 years ago might have made sense because we didn't have a substantially better alternative (methadone has its own set of problems). However, given that we now have what amounts to a cure, why would we want to give heroin to addicts at all? This is NOT about morality or who gets the money (pharmaceuticals would get the money in either case); it is about efficacious tx. Although supervised injection sites may reduce crime and the risk for associated diseases, they do NOT cure anything.

This sends a mixed message to potential users and people at high risk for substance abuse. The fear of becoming addicted to Heroin and the associated lifestyles that companion drug use are no longer going to deter some people from using while they have a way out such as this. Basically this says go ahead and give heroin a shot, but if you decide that you want to stop and can't then try this way out. There got to be a better way out for treatment resistant clients. Keep looking please.

"It is very sad that addiction is still being treated as a moral lapse" . . . That says it all. Suboxone works for some, not everyone. To leave treatment for heroin addiction with heroin maintenance off the table is foolish. As to cure, well, with all our modern addiction methodology and "zero tolerance" for drugs, the percentage of drug addiction in the full population is virtually the same as it was before the Harrison Act (and the billions spent on interdiction and control since them).

Diane: If suboxone were a cure, then we wouldn't have large numbers of people struggling with opiate addiction. They'd just show up at the clinic and get their prescription and they'd be cured. Obviously, that hasn't happened. According to the article, the heroin maintenance treatment was given to those who had failed at other kinds of treatment. Presumably, for some of these addicts this must have included suboxone. Heroin maintenance therapy is one alternative that can be used for some people.

First of all; there is NO cure for addiction. It is a chronic disease and rquires treatment as such. That said: HARM REDUCTION and MOTIVATIONAL INTERVIEWING are the keys. It is old school to think an addict needs to hit bottom. One can enhance motivaiton for change with brief interventions. People may come in for heroin, but they will be exposed to tratment in the form of staff at this location who, I would hope, are trained in Motivational Interviewing. Methadone, suboxone and abstinence don't work for everyone. As a professional with 21 years in the field, 11 at a methadone program, I am all for trying whatever we can to end the suffering of active addicts and reduce the likelihood of overdose deaths which leave ZERO chance for recovery!!!

I agree the number of comments about this subject certainly shows this is a hot button topic. I have recently began an internship in the field and I see how harm reduction models do work. Clients need to find a way to live a healthy,happy, productive life as they define it-not society or treatment providers. If this works-why not.

bleeding heart harm reductionsists. having worked in a gas and go methadone program it was the norm for the "patients" to use both alochol and other drugs with thier meth (if they weren't selling it that is). So, yes crime "might" be down, jail costs "might" be reduced, but meth addicts were still addicted. So what IS THE POINT?

Gradualism is an approach to treatment that seeks to draw on the best of the harm reduction and abstinence-oriented treatment approaches. It also addresses some of the issues that have been brought up here. You can get more information on this at: www.gradualismandaddiction.org

Has anyone heard of tolerance? As a former heroin addict, I know that if you give me a bag today then sometimes soon it will take 2 bags then 3 then 4 and so on. So the $22,000 may seem like a good idea to some, it is indeed a trap. Come on people lets not forget all that we know about addictions.

I am a recovering Heroin addict and I highly respect this study. I know what it takes to get off of heroin and it is not easy. Besides what do you think "methadone treatment " is? To those of you who do not deal with heroin addiction on a very personal basis you can't undestand why this study is accurate and should be used. I was told by a doctor at the age of 19 that I would never be free of my opiate dependency and that is not unusual for for an opiate addict.

I just wanted to add one thing. I have also been on suboxone and to the individual who called it a cure that couldn't be farther from the truth. It may be very well designed and do it's job quite well, but seriously when i tried to get off of it i lost it and went on the worst binge of my addictiona and ended up in prison for 3 years. So please to all that have a black and white version to this study, open your minds and really try to stand in someone else's shoes.

Thank you Scott and Virginia; Why would you take ANYTHING off the table that helps reduce suffering and makes lives better? Someone else's recovery may NEVER look like some of you old school folks think it should, but it people are helped, public safety enhanced, disease lessened why would you judge them? And Scott Kellogg, thanks for the Grandualism link, great information and articles....!