Angry about (t)HAT.

I can’t help being angry about “HAT.”  HAT is the acronym for ‘heroin assisted treatment.’ A vocal minority is currently pushing for the legal prescription of heroin. Yes, you read that correctly. Before your head spins on it’s axis, consider that the aim is a noble one: ending death by overdose. Lives should be saved because the prescribed heroin would be pharmaceutical grade; not tainted by fentanyl, carfentanil, or any of the dozens of additives and poisons that can make up a street purchase.

HAT isn’t the brainchild of businesses trying to cash in on a future market (like WeedMaps, a California based online marijuana dispensary which is funding pro-marijuana lobbying groups in Massachusetts). Nor is it coming from those seeking lost tax revenues or the end of illegal street dealing and the crime that accompanies it. Instead it is voiced by those whose opinion should be highly valued: former addicts.  And by addiction counselors whose only motivation is saving the lives of their clients.

Disagreeing with such individuals gives me great discomfort.
But I feel strongly that HAT would be a mistake.

Prescribing heroin to an addict feels like giving up on them. (Would we prescribe bottles of vodka to an alcoholic so they wouldn’t drink antifreeze?)  These substances are KILLING them.  The ugly fact is that those who suffer from addiction are not going to quit until their life becomes unmanageable. Unmanageable may never come if we hand them their poison. The counterargument would be that HAT is successful in the Netherlands, Germany, Canada and Portugal. But they measure success by the decrease in deaths by overdose. You may have less death, but you may also have less recovery.  Isn’t recovery the goal?

Besides the ethical implications, there are practical ones, What sane physician would prescribe heroin? I can hear the counterargument: doctors have been happily prescribing oxycontin for decades so why stop now? While it is true that some willfully ignorant doctors bear partial responsibility for the opioid epidemic, most were deliberately duped by Big Pharma’s false claim that oxycontin was non-habit forming. Then, as an added blow to responsible prescribing, insurance companies tied doctor compensation to patient pain management (thanks again to Big Pharma’s funding of fake focus groups). But the past is the past and I can’t imagine finding a nation of doctors willing to prescribe what they should not have been prescribing in the first place.

HAT will have its supporters if the movement gets off the ground. One of them is certain to be the insurance industry. Did you know that heroin costs $5 a bag? On the other hand Vivitrol, a medication which blocks the effectiveness of heroin, costs $1000 a month. Which do you think your insurance company would rather cover?

I bet Big Pharma will also sign on for HAT. Why not get the green light to repackage oxycontin as heroin and continue to profit from the misery of others? I feel like smashing my t.v. on a daily basis when I see Purdue Pharmaceutical marketing their new pill Symproic to help opioid constipation. The joke is most certainly on us.

Possibly the biggest obstacle to prescribing heroin may be the addict themselves. As my daughter confessed “enough is never enough.” Will we have to continually increase the amount of heroin we prescribe as their tolerance increases? And if we do not will they trade their prescription for fentanyl laced street dope? My child told me that many addicts seek out fentanyl for the higher high. Let that sink in.

There is a saying that “if we could ‘love’ our addicts to health there would be no addicts.” There are so many of us out here, right now, seeking a quicker, better, safer solution. I know of a parent who drove their child to purchase heroin, waited in their car fitfully until they returned, and then watched them inject it because they needed to test positive for detox admission. Can you imagine being that parent? No one, no one, wants to be that parent.

Legally prescribing heroin….it feels like being that parent.