[KarlKode]

I think a astronomically better example would be programs in the Netherlands, Denmark or Switzerland, where people heavily addicted to heroine can get into programs that will provide them with pharmaceutical heroine. Still prescribed by doctors (although specialized ones), but not just for pulling a wisdom tooth with huge margins for the Sacklers...

[Aurornis]

The last time I looked up the Swiss program it was only servicing a small number of people. Around 1500 in a country if 9 million. It also wasn’t prescribed like a typical medication but part of a program where they received other treatment as well. There was some exception where some people could get 2 days of it at a time to take home, but it wasn’t a free for all prescription where they could just talk to a doctor and get their monthly desired supply from a pharmacy.

Many countries, including the US, use methadone for maintenance. As I understand it it’s not as enjoyable as some people’s opioids of choice but it’s still an extremely powerful opioid depending on the dose (easily fatal).

So it’s not only the countries you mentioned that provide pharmaceutical opioids as maintenance treatment. The US does too, though the form is different.

[thrownthatway]

> a small number of people. Around 1500 in a country of 9 million.

What is this supposed to mean?

That’s a completely nonsense statement to make because you’ve provided no data on problem opioid use in Switzerland.

Is 1500 a lot? Not many? Average? Should all nine million be on the program?

[consp]

I'd say it is about what you expect for a country with voluntary programs. In the Netherlands the original program like the Swiss, resulted in heroïne becoming a medication for heavily addicted people usable under supervision. In the Netherlands there are about 4000 people with medical prescriptions for heroine on a 18M population.

Note that it is free, supervised and voluntary so ymmv in other countries. The conclusions of the original program with methadone in the 80s was that it resulted in hardly any reduction amongst heavy and problematic users and they were likely to go back to using heroine with all the associated problems, the heroine distribution program worked but needed some tweaking, thus the program was fully legalised and put into law resulting in supervised consumption (at the distribution point) with dosage control and medical checkups and far less issues.

[thrownthatway]

I’ve used heroin maybe 80 times.

I can understand why methadone is ineffective as a treatment.

[AlexeyBelov]

Wow. Can you speak more about this experience?

[thrownthatway]

Something like 25% of people who “try it once” will go on to be problem users. So don’t.

I had to call an ambulance for one friend cos he stopped breathing in front of me.

I woke up on my kitchen floor 45 minutes after a shot. I had time to cap the needle before I passed out and had no idea I was about to go down.

Another mate died because she used at home alone while her partner was at work.

Other than that, it’s a pretty nice high :)

[vintermann]

A problem LAR programs have had since the start is that although methadone is less attractive as a drug than heroin, it's still attractive, and basically the only way to figure out how much a heroin addict needs is to ask them. Leading to users asking for extra, selling the excess (to users who were not in the LAR program) and buying other drugs with the profits. For some years, more people died from methadone overdose in Norway than heroin.

Sure, you could demand injection on site to reduce this problem. But that just makes the program less appealing. You could also just hand out the users' drug of choice directly (heroin) rather than the less harmful substitute, but at some point that starts counting as physician-assisted suicide, really.

[scragz]

methadone is not a less harmful substitute, it's just the one that makes official people money. the withdrawals are worse.

[pseudohadamard]

Don't Spain and Portugal also have fairly progressive policies/programs for drug harm reduction? I remember reading about it a while back, but it was a US source and they were trying really, really hard not to have to say "you know, this might actually be a good way to handle it".