THE HEROIN SOLUTION

The sizable problem: what new medical, legal, and social approaches might prove productive as regards legal and illegal heroin use in the US? Over the last decade, Trebach has studied the vast differences between British and American narcotics control policies as director of American University's periodic Institute on Drugs, Crime, and Justice, in London. In this massive, thoughtful report, he eschews quick analyses and immediate answers: there can be no ""total, unconditional old-fashioned American-style victory in a War on Heroin."" To help us understand the ""social balance"" that might be achieved between the salutary use of heroin and its abuse, Trebach presents the background as he sees it--and his disagreement with other recent accounts. The increase in the level of heroin addiction since the 1960s, both here and abroad, is real, Trebach says--and not a creation of the Nixon administration, as suggested by Charles Silberman (Criminal Violence, Criminal Justice), Edward Epstein (Agency of Fear) and others. (Doubtless it was exploited, however, for political ends.) And, concurrently, there has been an increase in often-violent crime committed by addicts. Nonetheless, there are legitimate medical uses for heroin: it is an excellent pain killer, with some distinctly beneficial side effects and without some of the harmful side effects common to other pain killers. (Cicely Saunders, founder of the hospice movement, has been excoriated for maintaining this position--but the evidence here is convincing.) For humane reasons, therefore, it must be legalized. Trebach's second, equally controversial point is that the US is fighting a losing battle against heroin addiction. Though the British system of ""legalizing"" addiction is not without flaws, British addicts are largely employed, stable, and productive on maintenance doses of unadulterated heroin; American attempts at methadone maintenance, by contrast, are a shambles. Hard-line law men--notably, long-time narcotics commissioner Harry Anslinger--have saddled us with damaging social policies. (And the counter-movement encouraged by Peter Bourne during the Carter regime, slammed to a halt after Bourne admitted falsifying prescriptions.) Trebach's corrective proposals, predicated on the belief that the solution lies with the medical profession, will not go down well with many. But in view of the dismal record thus far, his solidly grounded, considered arguments demand careful reading and serious thought.