Following a meeting last weekend in New York, a cadre of researchers and others involved in drug treatment are skirting treacherous political waters: They want to design the first study in North America of an approach in which heroin addicts are given free heroin.
This approach, called heroin maintenance, is likened by detractors to giving an alcoholic free booze. But supporters say a major study in Switzerland, covering about 1000 heroin abusers, showed that maintenance could improve health and reduce drug consumption. Critics say the study lacked controls and was too loosely conducted to prove anything (Science , 20 March, p. 1839). But the Dutch have been impressed enough to design a 5-year trial, set to start in three cities next week. This is the first such study to have randomized controls, says epidemiologist Ernest Drucker of Montefiore Medical Center in New York.
The conference, convened by the George Soros-funded Lindesmith Foundation in New York City, was held primarily to air the Swiss study. But the next day participants pulled together a task force, headed by David C. Lewis, director of the Brown University Center for Alcohol and Addiction Studies, to design a study for the United States and Canada. It would most likely be launched in Canada, says Martin Schechter, an epidemiologist at the University of British Columbia in Vancouver, where the public has been shocked by a recent "explosive outbreak" of HIV among intravenous drug users. In the U.S., says Lewis, it will be some time before such an experiment is politically palatable.