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Today’s policy boner

So I have a shameful secret to divulge: I get viscerally, enthusiastically, quasi-orgasmically happy about evidence-based policy. Some people get a little thrill in their nether regions when their favourite celebrity is on TV, or when their sports team wins an important game, or when their favourite band announces a new album. All of those, to me, pale in comparison to the rock-hard excitement I get when someone does something really cool in policy research.

So (and he knows me personally, so please don’t repeat this or it’ll get weird) Dr. Aslam Anis, you’ve given me a boner:

Prescribing heroin instead of methadone is more effective and less costly in treating street drug addiction relapses, a new analysis suggests. It was a collaboration with UBC, the University of Montreal and the Northern Ontario School of Medicine.

“We gave them option of trying methadone or diacetylmorphine [heroin] under medically supervised conditions, and we found people who were getting diacetylmorphine were retained in treatment much, much longer, so they had a much better outcome,” said study head Dr. Aslam Anis, director of the Centre for Health Evaluation and Outcome Sciences at St. Paul’s Hospital in Vancouver.

(snip)

“Our model indicated that diacetylmorphine would decrease societal costs, largely by reducing costs associated with crime, and would increase both the duration and quality of life of treatment recipients,” the study’s authors concluded. While the clinical trial was based on a year’s worth of data, the researchers considered different timeframes — such as one year, five years and over a lifetime— in their analysis.

Now my writing about this article flirts dangerously with talking about my work life, but I feel like it’s remarkable enough to warrant a slight blurring of the lines. We’ve talked about Vancouver’s drug policy before, in the context of using the evidence rather than the memetic approach preferred by governments (and particularly by this one). It’s therefore entirely possible that we may see this piece of data make its way into policy.

Of course, there is a petty element to my joy. Obviously I want to see the promotion of whatever option is the most effective at helping people to kick their substance addiction. Whatever the evidence says is the best, let’s do that. However, this finding is also a nice thumb in the eye of the “drugs iz bayud” crowd – drug use is not a moral imperative that must be condemned on its face. Drugs are only harmful insofar as they are often accompanied by negative consequences like addiction or health problem – removing or mitigating those consequences eliminates the ‘bad’ of drugs. The only remaining objection then becomes “I don’t like drugs”. Okay, cool. Neither do I. Doesn’t mean they must be made illegal.

And, as paradoxical as it may seem, this analysis suggests that drugs may be the best tool to reduce drug dependency. Yes, it sounds silly, but the evidence is fairly clear (and reproduced in other jurisdictions) – heroin works better than a heroin substitute in helping people to wean themselves off of heroin. There’s also, believe it or not, a cost ‘savings’ associated with using the real drug rather than the substitute – not because the purchase point is lower, but as a byproduct of the downstream effectiveness of keeping people in rehab programs for a longer period of time.

It should be noted that this isn’t policy yet, and there may be a conservative anti-science backlash against “giving addicts more drugs” or something similarly free of nuance. However, if the widespread public support for Insite – couched as it was in deference to evidence over ideology – is any indication of Vancouver’s attitude toward policies that lie outside the political mainstream, we may see an exciting (and evidence-based) new direction for my home town.

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