Cost utility analysis of co-prescribed heroin compared with methadone maintenance treatment in heroin addicts in two randomised trials

Last year, I submitted a letter to BMJ titled; "Losing faith in
health research". Since that time, I have come upon a number of studies
published through BMJ that have improved my opinion on the state of health
research considerably, and "Cost utility analysis of co-prescribed heroin
compared with methadone maintenance treatment in heroin addicts in two
randomised trials" definitely rates high as one of those studies.

I was particularly impressed by the inclusion of this unspun,
objective, reality-based assessment of a "bottom line" to the health as
well as social and economic impact of heroin addiction;

"Heroin addiction is a chronic relapsing disorder with a fluctuating
(on-off) course. Addicts can function as long as they receive the drugs as
needed, while they deteriorate the moment the drug supply is interrupted."

In my opinion, the public purse could be spared a great deal of
unnecessary expense in relation to funding health research, if more
studies were grounded in this kind of dispassionate, ideology-free
rationalism and less studies were guided by apparent determination to
generate "evidence" supporting some ideology or public policy agenda held
by the researchers or their sources of funding.

Regretably, some of the replies to this study didn't similarly
bolster my faith in the state of health research discussions. Dr. Adil Y.
Kadri's reply includes the old refrain, sincerely held by many if not
most professionals and non-professionals alike, that I have been listening
to for over forty years - essentially: substance use must be aggressively
"fought" by all sectors of society and especially through tough anti-drug
laws, harsh penalties and severe sentences for offenders. Other
approaches may be tolerated, but only if they lead to "treating and
rehabilating addicts" - with the ultimate goal of eliminating substance
use entirely.

The problem with that, is that I HAVE been hearing it for forty years
and, despite the expenditure of hundreds of billions of dollars worldwide
on this prohibitionist approach over that period, and the incarceration of
literally 10s of millions of persons, substance use and substance use
related problems remain at much the same levels or are growing.

I hope that Dr. Kadri will spend some time seriously contemplating
this essential truth and it's implications; "Addicts can function as long
as they receive [can access] the drugs as needed, while they deteriorate
the moment the drug supply is interrupted."

David J McCartney's reply brought back memories of some circular,
self-serving arguments about tobacco usage and smoker's alleged desire to
become permanent non-smokers. The "McKeganey et al" study McCartney
references, itself raises some profound doubts about it's own limited
methodology and the probability of insincere answers from respondents; "It
is possible that drug users may have been providing what they thought
would be the most socially acceptable response to the question about
desired changes in drug use rather than the response which most accurately
reflected their actual expectations for change, thus over-prioritizing
abstinence."

It would be interesting to expand the range of questions in the
"McKeganey et al" study, and ask things like - would you seek treatment
here at all, if you could access a sufficient supply of your drug without
having to prostitute yourself, commit crimes, fear imprisonment or be
treated like social scum by the self-righteous majority? (In other words,
would you even need to seek treatment, if the prohibitionist's "war on
drugs" wasn't artificially trapping you in this "chronic relapsing
disorder with a fluctuating (on-off) course" - ?)

Competing interests:
None declared