Controlled Heroin Use

When I read about heroin addiction, it sounds like the epitome of self-destruction.

Often upheld as the worst potential consequence of dabbling in soft drugs, the research seems to back up the stereotype. Compared to other drug users, heroin users have the worst rates of recovery, and lifestyles marked with crime, incarceration, and failure in all areas of life.

When we think about harm reduction for heroin users, approaches like needle exchanges and methadone maintenance programs spring to mind. Rarely do we discuss the possibility of controlled heroin use, the way we do with other substances -- for example, controlled drinking is fast becoming the standard approach for managing alcohol use.

Yet ironically, the whole concept of controlled use was based on Zinberg's work with people who used heroin in a controlled way. It is hard to believe that there are no controlled heroin users out there. Where are they? And more importantly, what can they tell us about understanding and managing heroin addiction in a more complete way?

It is hard to come forward and talk openly about a subject as stigmatized as heroin use. But as long as people are secretive about controlled heroin use, the stereotype of the hopeless, criminal "junkie" will prevail.