Fighting Heroin with ... Heroin

Sometimes the poison that kills you can save you. At least that's the hope of Canadian researchers about to begin a one-year, $6.5 million clinical trial that will provide pharmaceutical-grade heroin under controlled conditions to nearly 90 addicts (a similar number will be given methadone). The study, which begins in Vancouver this week and then expands to Montreal and Toronto for similar trials, aims to end the most desperate addicts' dependence on prostitution and crime to pay for their habit. "We hypothesize they can stabilize their lives and get onto a better path," says Dr. Martin Schechter. The hope is that they will then be more ready to enter a program to wean themselves off the drug.

Some think it's the plan that needs a fix. Among them is the White House Office of National Drug Control Policy (ONDCP), already rankled by a small supervised heroin-injection site in Vancouver and by Canada's plans to decriminalize possession of small amounts of marijuana. ONDCP policy analyst David Murray calls the prescription-heroin study a mistake. "There's a large moral-hazard question here about a government undertaking to become the official dispenser of addictive substances," Murray says. Even proponents of such schemes note the ethical land mines. "I don't think anyone is arguing that heroin maintenance is in itself a wonderful thing," says George Bigelow of the Johns Hopkins School of Medicine. "It's only good in relation to the options." --By Steven Frank. With reporting by Deborah Jones