BERGEN, Norway: Norwegian heroin addict, Kim Arnetvedt, a member of the campaign group Association for a Humane Drug Policy, stands on a corner in Bergen. —AP photos

but is highly suspicious of a health system that he says is too close to the police and makes “every day of addiction miserable.” He is treated with methadone and antidepressants, but says he can’t imagine ever shaking his addiction to heroin.

CASE

Outside the needle exchange there is a more-or-less open drug market. Dozens of users and dealers cut deals unmolested by police. Last year a crack-down on heroin users in the notorious Nygaards Park in the center of town drove them into the tourist-heavy city-center. Straxhuset leader Hugo Torjussen says the unofficial policy is to allow them to congregate here instead. The proximity of health professionals makes it safer in case of overdose, and the new local government has cut through political deadlock to sanction a safe injecting room for users to shoot up their own gear inside. Even so, a small number of addicts are either too suspicious or immune to the methadone to start treatment at all.

Ola Joesendal, deputy director of Bergen’s Haukeland Hospital, said more than 90 percent of the city’s heroin addicts receive methadone treatment. “But for a very small amount of addicted people it is not possible to establish contact through the (methadone) maintenance program,” he said. “If we have the opportunity to reach them through heroin, then they can be reached.” Otherwise, their isolation from health professionals means they are the users most likely to die, he says.

Some are skeptical. Anti-drug campaigner Mina Gerhardsen says free heroin therapy would put too much strain on many of the vulnerable users it is intended to reach. “They won’t be able to use this because you need to show up at the same place and time several times a day,” she said. “Many of these people are not capable of that.” Gerhardsen also said the publicly-funded medical heroin programs would be too expensive. The cost of the treatment can reach some $22,000 per year, compared with an upper level of $3,800 per year for methadone, according to the EU drugs watchdog.

First synthesized from opium poppies in 1898, and marketed as “Heroin” by the German pharmaceuticals giant Bayer, diamorphine was initially prescribed as pain relief. Later evidence showed its addictive qualities and it was banned in most countries, but continued to be manufactured and made available in Britain, primarily for end of life care. It also survived as a street drug where it is mixed with other toxins and its purity varies dangerously. In 1991, Switzerland established a small scale trial, using diamorphine to treat heroin addicts unresponsive to other treatments such as methadone. Later trials in Denmark, the Netherlands and Germany all showed that supervised injectable heroin can be effective for targeting this marginal group, according to the EU watchdog.

Major reductions

It said the therapy creates “major reductions” in their continued use of illicit street heroin, “major disengagement from criminal activities” and “marked improvements in social functioning.” Joesendal says this type of harm reduction is at the heart of the proposed policy. The drug is still available in these countries in small-scale quantities and strictly controlled conditions. However, wary of encouraging use rather than rehabilitation, in 2013 Norway’s Conservative-led national government rejected Joesendal’s application for a medical heroin trial.

Cecilie Brein-Karlsen, deputy health minister for the junior ruling coalition partner, the Progress Party, says the change in local government to Labor in September will not force the Department of Health to change its mind. “It is not an option from the government’s point of view,” she said. “We think we should prioritize other measures.” The government’s overdose prevention strategy advocates persuading users to switch to smoking, which is far safer than injecting. Yet it will not allow addicts to use Oslo and Bergen’s injecting rooms to smoke the drug. — AP