Time for legalized distribution of illegal drugs? CMAJ 1997;157:1345 Re: "Needle exchange: Panacea or problem?" (CMAJ 1997;157[3]:275-7 [full text / résumé]), by Dr. C. Hankins In response to: T. Johnstone I agree with Dr. Johnstone that it is time to consider alternative opioid-substitution programs. Among 90 recommendations in the national action plan drawn up by the National Task Force on HIV and Injection Drug Use and published this year1 are recommendations for the investigation of alternative drug therapies beyond methadone, such as buprenorphine, naltrexone and levomethadyl, and for the conduct of clinical trials of prescription morphine, heroin and cocaine. More than 1200 heroin users in Switzerland are participating in a prescription program through which they inject up to 3 times a day under medical supervision at 1 of 18 participating treatment centres. The program, which commenced in 1994, recruits IDUs who have been dependent on heroin for more than 2 years, have failed several treatment attempts, and have impaired health status or social functioning. Results so far demonstrate declines in illegal drug use, improvements in physical and mental health, decreased criminality and income from illegal sources, fewer overdoses, and positive changes in social functioning.2 Public support for the program's continuation was evident in a referendum held in Switzerland in late September. In the face of the increasing epidemic of blood-borne viral infections among Canadian IDUs, it is time for bold, creative thinking and action on opioid substitution in Canada. Catherine Hankins, MD, MSc Consultant Physician Montreal Regional Public Health Department Associate Director McGill University AIDS Centre Montreal, Que. References Canadian Centre on Substance Abuse and Canadian Public Health Association. HIV, AIDS and injection drug use: a national action plan. Ottawa: Health Canada; 1997. Uchtenhagen A. Résumé du rapport de synthèse. In: Uchtenhagen A, Gutzwiller F, Dobler-Mikola A, editors. Essais de prescription médicale de stupéfiants. Rapport final des mandataires de la recherche. Zurich: Office fédéral de la santé publique; 1997. Send a letter to the editor responding to this letter Envoyez une lettre à la rédaction au sujet de cette lettre | CMAJ November 15, 1997 (vol 157, no 10) / JAMC le 15 novembre 1997 (vol 157, no 10) |