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.


4 thoughts on “Angry about (t)HAT.

  1. As the mother of a recovering addict HAT is soooo scary. As the mother of a recovering addict I did not-could not- actually watch my son shoot up, but did however drop him off in a neighborhood where he knew could score heroin.The bargains I made in the name of love and hope were crazy. The deal was so that hopefully… if he remembered his promise to call me, I could then pick him up to take him to a detox and he would test positive. That was only the tip of battle. After dropping at a hospital detox you have to gamble that they will be able to locate a bed in a rehab. Many times they did not. Then you have to pray that the rehab they find is not one that he had been accepted into within the last six months, if it is, then no admittance. Then you have to beg his insurance to cover yet another rehab within such a short period of time. Then you have to pray this is the time he really- really will have the enormous spirit and will power to make it work, change his sad existence. Then… as in my case you have to repeat- repeat- repeat this revolving door routine. Ten years of hell for my son and I. However for me I saw only two choices out of addiction, keep hope for the miracle of found strength, or death. I thank God every breath I take that my son found the strength. In my humble opinion, HAT is NOT a smart choice. I believe increasing the stay period in rehab of a recovering and hopeful addict when they are in the frame of mind to fight the disease and actually want to make a change is the answer. Thank you Annemarie for yet another awesome blog.


    1. You are an amazing mother – thank you for sharing so eloquently (and painfully) again. I am so glad your son is in recovery. My stories feel so unreal sometimes (even to me!) … but the sad fact is that they are not and that many other parents and children have experienced the same. And yes, longer stays are essential! We need more evidence based research, more MAT in hospitals and rehabs, more detox beds and then longer term rehab stays partially funded by the pharmaceutical companies that profited hand over fist from this epidemic. And we need insurers to recognize that this is a disease (do they turn away cancer patients because they were treated in the same hospital a week prior?!) On with the fight!


  2. This is absolutely compelling. I hadn’t heard about this ridiculously dangerous movement. I think this needs to get to NPR!!! You are an absolutely fantastic writer! My Heroine!


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