The proposal to carry out in Canberra a trial in which some registered dependent users would be prescribed heroin at maintenance levels to be taken under controlled conditions has caused much controversy. After being approved by a meeting of Commonwealth and State Ministers of Health, it was vetoed by the Commonwealth Government. The objective of this paper is to examine the case for and against the trial from a Christian perspective. Christians have been vocal both in support of the trial and opposing it. This paper provides a Christian perspective. There are other Christian perspectives. Currently the options available to dependent users of heroin are to discontinue taking the drug using what help is available for rehabilitation, to become part of a replacement program in which methadone is provided if such a program is available, or to continue to take heroin and rely on the illegal supply of uncertain strength and purity at very high cost, and with consequent health risks. Controlled maintenance provision of heroin would offer another alternative for those who, for whatever reason, do not want to discontinue and do not find methadone a satisfactory replacement.

The views expressed in this paper have evolved as a result of a series of discussions held by two overlapping groups of members of East Belconnen Parish of the Uniting Church in the ACT. The group concluded that, for reasons spelled out below, a trial of the effects of providing this additional option to dependent users of heroin should be approved.

Background

A brief history

For most of the nineteenth century recreational use of opium was seen as a
Chinese problem and efforts to curb its use were largely focused on China. The Chinese Government prohibited trafficking in opium in the 1830s, but Britain took exception to this because it threatened the profitable trade in opium between British India and China. Two opium wars were fought between Britain and China (1839-42 and 1856-58) before the Tientsin treaties forced China to legalise the trade in opium. The same treaties also required China to open its doors to Christian missionaries!

Following this treaty there was much public pressure in Britain to curb the opium trade, linked to efforts to curb the use of alcohol. For many years the movement to prohibit the use of alcohol (which was in force in the United States for some years in the 1920s) was a much more active than the movement to curb the use of drugs derived from opium, and the use of laudanum and patent medicines containing opium was not questioned. The first international opium conference in Shanghai in 1909 passed resolutions to curb or regulate the use of opium for other than medicinal purposes and to control trade in opium. At this conference, and in the follow-up meetings in the ensuing years, the opium manufacturing and trading countries, especially Britain, Germany and France, opposed trade limitations. The US supported them at least in part because it wanted to reduce the advantage that the opium trade gave to Britain in trade with China.

The measures that followed the Shanghai conference and a number of follow up conferences, ratified as part of the Treaty of Versailles, were relatively effective in curbing the trade in opiates that went through legal channels. A major problem that remained was that the legal producers in Europe, especially in Germany and Switzerland, sold their products to illegal traders. This was curbed by the Limitation Convention of 1933 which effectively controlled legal production, but as a result, production also was driven underground where it was much more difficult to control or monitor. Much of the subsequent production occurred in illegal factories close to the producing areas in the Middle East, Southeast Asia and Latin America. The 1953 Opium Protocol in New York limited to seven countries the legitimate production of opium for export, and adopted other stringent provisions. The subsequent 1961 Single Convention on Narcotic Drugs effectively introduced prohibition.

In Australia, according to Bronitt, drug consumption was largely unregulated and self prescription common until the turn of the century at which time the States and the Commonwealth enacted legislation to suppress opium smoking, largely in response to public concern about its use within the migrant Chinese population. It was part of a general panic about “Chinese vice”. The importation, supply and possession of opium were prohibited. From the turn of the century to the end of the second world war these controls were gradually extended to heroin, morphine, cocaine and other “dangerous drugs”. This expansion seems to have been the result, not of any concern about a drug problem in Australia, but because Australia had signed several international treaties. As Bronitt puts it, the passing of this legislation itself made drug users into criminals.

Notwithstanding these measures, the use of medically prescribed heroin in Australia remained relatively high until, fearing an international backlash, the Commonwealth prohibited the importation of heroin in 1953 and the States and Territories followed by prohibiting its use by 1955. These laws were seldom invoked until the 1960s when drug use became an increasing problem and since then penalties, especially for trafficking, have been increased.

Methadone

The use of methadone as treatment for heroin dependence was developed by

Drs Vincent Dole and Marie Nyswander in New York in the 1960s. They viewed

heroin dependence as a deficiency disease akin to diabetes and methadone as

akin to insulin - a medication which would have to be taken for the rest of

the person's life to allow them to function normally. Replacing illegal, short-acting, injectable heroin with legal, long-acting, oral methadone has allowed many people previously dependent on heroin to stabilise their lives with consequent improvement in health, well-being and social stability, and a reduction in crime and illicit drug use. Although the drug is addictive, methadone maintenance treatment is one of the best researched treatment options for opioid-dependent individuals.

Methadone maintenance treatment has traditionally been provided through

publicly funded specialist clinics. In New South Wales the first private

practitioner was allowed to prescribe methadone in 1984 and there has subsequently been a move to integrate methadone maintenance treatment into general medical and pharmacy practice. This is most advanced in Victoria where 95% of methadone maintenance clients have their medication prescribed by general practitioners and dispensed at community pharmacies. These practitioners and clients are supported by four specialist methadone services.

Methadone is a liquid which needs to be taken once daily to avoid withdrawal

symptoms, reduce craving for heroin and to provide stabilisation. Admission

to a methadone program requires demonstration of a history of heroin

dependence. Most methadone clients are required to swallow methadone under

observation by the pharmacist or other clinic staff. When a history of

stability has been demonstrated, limited take-away doses may be available;

take-away policy varies from state to state.

In June 1994, 15,000 people were receiving methadone maintenance treatment,

the most common drug treatment in Australia. The annual census of treatment agencies shows that in March 1995 there were around 2,000 people each in therapeutic communities and receiving outpatient counselling. These figures are not strictly comparable to those in methadone treatment as the census figures

included people who had problems with alcohol and/or other illicit drugs as well as those with problems with opioids.

The Proposed Trial

Beginning in 1971 there has been a series of some ten reports of commissions and committees on drugs and drug use in Australia or in individual states. Most recommended an anti-drug campaign combined in some cases with maintenance treatment using methadone. They all recognised that prohibition had failed, but argued that greater efforts might still succeed. Reflecting increasing concern about the spread of HIV among intravenous drug injectors, the most recent report, of the 1989 Joint Parliamentary Committee on the NCA, drugs, crime and society, (the Cleeland Report) gave more attention than earlier reports to harm minimisation. It recognised the adverse effects of prohibition and considered the possibility of some relaxation of prohibition, but recommended that it be considered only if more strict law enforcement failed to reduce drug use.

In 1989 also the Legislative Assembly of the ACT established a Select Committee to inquire into and report on HIV, illegal drugs and prostitution. One of its three reports examined the feasibility of the controlled availability of opioids, of which heroin is the most important. At the request of the Select Committee after it reported, the National Centre for Epidemiology and Population Health at ANU agreed to undertake a two-stage study of the feasibility of the controlled provision of heroin, and in particular a trial of such provision. The Australian Institute of Criminology agreed to collaborate. The first stage considered the scientific feasibility of such a trial and the second its logistic feasibility. The results of both of these stages were positive, and the Report and Recommendations from Stage 2 were then considered by a broadly representative Heroin Pilot Study Task Force of 19 members established by the ACT Government which reported in January 1996. The Task Force included representatives of the police commissioners, the police association, the courts, social welfare agencies and government departments. The Task force recommended that the trial proceed with the only dissent from that recommendation being by the representative of the Australian Federal Police Association.

The trial aims to provide information about whether an alternative approach might have better results. Much of the support for the trial, especially from the Australian Medical Association, is based on the fact that it would be carried out in a scientific manner and that it is a “controlled randomised trial” of the effects of “controlled maintenance provision” against the best known alternative treatment, which is the provision of methadone as replacement therapy. A controlled randomised trial is one in which participants are randomly assigned to one treatment or the other and all other conditions are, as far as possible, the same for both groups. Controlled maintenance provision is a situation in which the amount of the drug provided and the conditions under which it is provided are under the control of relevant authorities and are designed to maintain the dependent user rather than meeting demands for increasing amounts over time.

What the trial is designed to find out is whether some of the dependent users who are unwilling to enter a methadone program would take part over an extended period in one which provides heroin itself under controlled conditions, and whether some who drop out of a methadone program would remain in a trial that provided maintenance amounts of heroin. Success of the trial would be judged on the extent to which participants remain in it, the extent to which they can manage with a dosage which does not increase over time, and their ability to hold down a job and remain in normal family and social relationships, and not engage in criminal activity. They see the trial as providing necessary information before any decision can be made about whether or not the provision of prescribed heroin under such controlled conditions should be adopted as a general policy. They stress that neither the trial nor any change of policy which might occur as a result of the trial imply legalisation. Both supply and use of heroin outside the controlled conditions would still be prohibited, but of course the use of prescribed heroin within the controlled maintenance provision would not be illegal.

The arguments for and against

The argument for a trial program of controlled maintenance provision of heroin to registered addicts are that:

• prohibition policies have failed in Australia and elsewhere to reduce, let alone eliminate, the use of the drug or to reduce the number of people dependent on it. Indeed the numbers of dependent users has increased even though huge resources have been thrown into the so called War Against Drugs;

• because of prohibition, and the resultant price of the drug being much higher than the cost of supplying it through legal channels, many addicts have to commit crime to support their addiction. They are discriminated against and marginalised and become part of a drug culture and cannot keep jobs or maintain family relationships. They endanger their health and their lives because the supply of the drug is of variable quality, and because self injection, and especially sharing of needles, bring with them the risk of other diseases including HIV and hepatitis, and of death;

• prohibition has resulted in dealing becoming very profitable, though also risky. One result is that there are huge financial incentives to maintain the drug trade and in particular to maintain it under the conditions of “prohibition” that yield very high profits. Another is that some police and prison officers responsible for enforcing the prohibition have become corrupted by illicit dealers using those profits;

• of itself the taking of heroin is one of the “victimless crimes” because it harms no-one but the person who decides to take it. But, especially when they are prohibited, the indirect effect on their families, unborn children (through the transmission of HIV), on taxpayers and on the victims of drug-related crime are enormous;

• notwithstanding considerable efforts put into drug education and rehabilitation programs, including replacement therapy using methadone, there are still increasing numbers of long term dependent users;

• experience with a Swiss trial suggests that some of the problems experienced by addicts and others can be substantially reduced if maintenance heroin is made available under controlled conditions; and

• in order to deal with medico-social problems such as those associated with the use or heroin we need information about the possible effects of different policy alternatives, and this can best be gained from a controlled trial.

The arguments against the trial are that

• it would be better to put our efforts and resources into further improving education programs to discourage people from taking drugs and into rehabilitation programs to help drug users to adopt and maintain a drug-free life style and return to the mainstream society;

• even controlled maintenance provision gives the message that society condones the use of addictive drugs and heroin in particular. As a result such a program would encourage more people to use heroin because it would be cheaper and more readily available and its use would entail fewer risks and less social disapproval (this argument is not necessarily weakened by the fact that other addictive drugs including tobacco and alcohol are legally available);

• a common belief, including among Christians, is that people need to be protected from the temptations of drugs of addiction by laws that prevent them from being available. Potential users cannot assess in advance the possible effects on them of taking the drug; and

• the damage that drug addiction causes to other people, including family members and victims of heroin-related crime, and the cost to taxpayers are sufficient reasons for maintaining the ban on use of drugs.

If there is an area of agreement, it is that the present policies are not working. Because they draw different conclusions from that agreement, some of the arguments for and against the trial are at cross purposes with one another. For example, the proponents believe that the present policies are inherently flawed while the opponents believe that it is only necessary to try harder. The opponents equate treatment with cure and see abstinence as the only useful objective. (For the same reason many of them have opposed the methadone program.) The proponents focus their attention more broadly on minimisation of harm to the addicts and others in the community, and see rehabilitation as an important, but not the only means of achieving this objective. They want to find out through the trial whether controlled provision could be useful to people for whom detoxification and/or methadone replacement therapy are not effective. They see stabilisation and a reduction in other problems as worthwhile in themselves, and also believe that achieving these objectives may in the long term lead to fewer dependent users.

Most of the opponents are not interested in the trial from a scientific point of view or in the information it would provide. They take a black-and-white view of drugs of addiction and see the trial as wasteful because, no matter what the results, they would never accept a policy of controlled maintenance provision. They believe that the only way to deal with drugs of addiction is a policy of complete abstinence for the individual and prohibition for society. Some of them, such as Brian Watters of the Salvation Army (letter in the Canberra Times , 13 September, 1997) are consistent in that they take the same attitude to other drugs of addiction such as alcohol. He and others would argue that just because we endure the health and other problems that result from the legal availability of these drugs, is not a reason for adding to the problems by making another drug legally available, even under controlled conditions. Many, ignoring the history of Australia and many other countries prior to prohibition, see heroin as a much more powerful and dangerous drug than the other two. For these critics, the danger of the trial itself is that it is the thin end of the wedge. It gives messages, especially to children, that taking drugs of addiction is acceptable. The trial, and even more so the policy if it were to be adopted, would be likely to increase the number of users and reduce the incentives for users to quit.

In reply Nick Crofts, one of the supporters of the trials, argues in the Medical Journal of Australia (MJA) that “[t]he morality that rejects a place for opiates in this society because they are dangerous, when the danger demonstrably comes more from their illegality than from the drugs themselves, is fundamentally flawed.” He goes on to claim that “[i]t is a strange morality which argues for so many deaths [from heroin] to prevent the use of a drug that is relatively harmless under controlled conditions ...”

This statement highlights one of the important differences between participants in the drugs debate. Opponents of the trial believe that it is the taking of the drug which is the main or the only cause of the huge damage caused to users, their families and society in general. Proponents of the trial, appealing to history and to the situation in respect of other drugs of addiction, believe that much or most of the damage is a result of prohibition. They see the trial as a partial test of whether this view is correct by removing most of the effects of prohibition (high price, uncertain purity and strength of supplies and risks of infection during injection) for some dependent users and carefully assessing the results. They point out that current policies such as needle exchanges and methadone treatment have similar harm-reduction objectives. The trial should be seen as an extension of the choices available to dependent users; not as a replacement. They point out also that the cost of the trial is very small relative to the current cost of keeping in prison those found guilty of drug related crimes.

A third view should be mentioned. Hawks has argued, also in the MJA, that an attack on the drug problem should attack the underlying causes “which breed a disillusionment with the future and a sense of hopelessness about the present ...” He identifies these as poverty, family dislocation, and long term unemployment, the loss of the individual’s sense of worth, sense of commitment to society and sense of contributing something that society judges to be worthwhile. It is, of course, highly desirable to tackle all of those problems and it is likely to reduce the number of dependent users. But it is unlikely to remove the problem because dependence on heroin appears to occur in good times as well as in depression, and among people who have good and secure jobs as well as among the unemployed. And we cannot wait until those problems are solved to tackle the problems of dependency.

A fourth, described as a Christian point of view, is that acceptance of Christ as saviour is the best way to deal with dependence. But that flies in the face of the evidence. People who become Christians may well find it easier to stop taking the drug. But many have done so who are not Christians, and it is scarcely a Christian point of view to deny help to those who do not accept our beliefs.

A Christian View

Christians can be found among those favouring and those opposing the trial. Following Christ’s injunction to love one’s neighbour can in good conscience be interpreted in different ways. Certainly, some who believe passionately that prohibition must be maintained are in the forefront in ministering to individual addicts and their families.

There is no real argument here about the facts -- nobody believes that the present situation is satisfactory. Christians differ, however, on how Christian love manifests itself: through limiting exposure to temptation or through helping people to make their own choice about what kind of life they want to live in a world of temptations.

Our inclination is to affirm that the world is God’s creation, and to seek to maximise people’s freedom and dignity. This is consistent with Jesus’ emphasis on loving God and one’s neighbour as the fulfilment of the law. We are not, however, talking in absolutes, or proposing that floodgates be thrown open. This is just a trial which aims to test a change of policy that might contribute to the goal of full lives, hampered as little as possible by drug dependence.

Accordingly we, as Christians, are in favour of the trial going ahead for the following reasons.

1. Freedom to choose.

We accept that the proposed trial is a test of the effect of an extension of the choices open to dependent users. The currently available options are detoxification, use of methadone (a choice that is not open to all because places are limited) which itself is addictive, and continued reliance on illegal supply. Without wishing in any way to support the use of any drugs of addiction, we believe that the creator God gave his people the freedom to choose how to live. The story of the garden of Eden is an allegory about choice. As a matter of experience, only those who freely choose to give up heroin are likely to do so. We can and should help those who want to give it up, but attempting through prohibition to force those who are not yet ready to quit is unlikely to be effective. Some present treatment projects focus on stabilising the lifestyle of dependent users so that their motivation and capacity to change can develop. Controlled maintenance provision of heroin could make it easier for some users to decide to quit.

We note that the use of heroin in Australia has been prohibited only since 1953. Before that time registered addicts could be prescribed supplies to meet their needs. In the UK that has been the situation until relatively recently, and heroin remains more readily available for medicinal uses than it is in Australia. The evidence does not suggest that prior to the 1950s the use of heroin was as serious a problem in Australia as it is now, or that it is more of a problem in the UK than in countries which ban its use completely.

There is no proposal either in the trial, or in any policy change that might follow were it successful, that heroin should be legalised in the sense of being freely available through retail outlets. Rather it is a trial of the effects of the decriminalisation of prescribed use under controlled conditions. As in Australia prior to prohibition, heroin could be prescribed in the trial for registered users. The conditions under which it would be provided would be more strictly controlled than prior to the 1950s in that it would be available only at specified places and, because it could be administered only in those places, it could not be sold. These conditions would ensure also hygienic administration of a strictly controlled dose. The risks of death or contraction of other diseases should be largely removed.

2. Being beside people in need

Christians believe deeply that it is their responsibility to stand beside people in need. Heroin addicts are in great need, indeed they are in much greater need because of the effects of prohibition described above. The Report of the Heroin Pilot Task Force points out that “[t]he nature of the emphasis on the negative aspects of heroin use has tended to discriminate against, and marginalise, all people who use heroin.” There is little sympathy for dependent users and they tend to be segregated because of their self inflicted addiction. Because of their addiction they are discriminated against, especially in the provision of health services. They are forced to live a life of deception if they are to avoid stigmatisation. We do not treat dependent users of nicotine or alcohol in this way though these addictions are at least as harmful as addiction to heroin in its pure form.

Jesus unconditionally identified with outcasts in his society. He did not tell Zaccheus that he would come to dinner with him if he ceased to collect taxes for the hated Roman oppressors; he went freely to eat with him. Nor did he put conditions on forgiveness of the woman who was about to be stoned for adultery. He did not, of course, condone their actions. But he did not ostracise them nor offer his love only on condition that they change their ways. Their contact with him opened up new possibilities for them to change and challenged them to make a decision about their lives.

Similarly we should stand with those who are in need, even if their need is of their own making. People dependent on drugs are children of God; they are our neighbours and Jesus’ second commandment applies to them. We can offer to help them if they want to give up their addiction, and we can sympathise with them because of all of the problems that arise from being addicted, but we should help them even if they decide to continue to take heroin. We should recognise that present policies of prohibition are responsible for many of the problems they experience.

Education, encouragement of addicts to give up their addiction and help with rehabilitation are not alternatives to controlled maintenance provision. We should do all of these things. The results of the Swiss trial, which was based to a significant extent on the Canberra proposal, suggest that controlled maintenance does not increase the rate of rehabilitation, but nor does it decrease it. A person who has to resort to crime to support an addiction and whose family breaks up may find it more difficult to decide to give it up than a person who is able to lead a relatively normal life with controlled maintenance. The Swiss experience suggests that this effect may be as strong as the incentive that prohibition, with all of its damaging effects, provides to giving up the addiction.

3. Protecting non-addicts who are adversely affected

Under prohibition it is not only the addicts who suffer but also their families, the victims of drug-related crime, and all members of society through the cost of attempting to control its use, the loss of the productive work of the dependent users, and the corruption of law enforcement agencies. It is estimated that there are roughly two recreational users to each dependent user and the Task Force was informed of a hidden population of dependent users who maintain full time employment. “Recreational users” is the term used to describe users who are not dependent, are able to limit their consumption and are generally able to hold a job and have a normal family life. Many have relatively high incomes. Some eventually become dependent but others remain recreational users until they decide to give it up.

Controlled maintenance provision would allow more dependent users to sustain a normal family life because it would greatly reduce the necessity for criminal activity to pay for the drug. Some of the submissions to the Task Force suggested that a positive effect of the proposed trial may be to reduce domestic violence. The reduced stigmatisation of dependent users, which opponents of the trial fear may attract more users, would also permit dependent users to have a higher quality of life. It would similarly be expected to permit more dependent users to hold full time jobs that could support their families and enable the users to continue to operate as members of mainstream society.

The trial would be expected to reduce the amount of drug related crime for reasons mentioned above. The Swiss trial of prescribed provision of heroin under controlled conditions found that those who participated in the trial were involved in much less crime than they had been before trial. As a result there are benefits to those who might otherwise be victims of drug related crime and to the community from reducing the costs of police and prison services. If heroin can be supplied under controlled conditions at a price that reflects the cost of legal production and distribution there will be less profits to be made from trading in it and therefore less money available for corruption of the law enforcement agencies. The trial itself is unlikely to be large enough to have a major impact in this respect, but if controlled maintenance provision were to be adopted as a policy the effect would be expected to be large. Police commissioners have been among the strongest supporters of the trial because they recognise the corrosive effect on their forces of drug related corruption, as reported by Commissioner J R T Wood in the 1995 NSW Royal Commission into the NSW Police Force.

4. Confronting those with a vested interests in continuation of prohibition

It has been estimated that illicit drugs, of which heroin is perhaps the most important, are now the largest item in international trade. The people who most obviously gain from prohibition of the use of heroin are the growers, processors and traders in the drug. At both ends of the chains that lead from the poppy fields of Latin America, the Middle East or Southeast Asia there are unfortunate people who make a meagre livelihood. At one end are peasants whose standards of living are raised slightly by a cash crop that can be easily grown on poor soils. At the other end are dependent users for whom pushing the drug is one way of making enough money to support their addiction.

In between are a large number of wealthy traders who are criminals as a result of prohibition. Their profits are immensely inflated because of prohibition. Legally produced heroin can be supplied at a small fraction of what it costs on the illegal market because of the high penalties if illegal traders are caught. The profits to be made are so high that corruption of governments occurs in all of the major producing countries. The large scale “drug lords” often run a state within a state and have their own private armies, or buy protection from the armed forces of the state itself.

Prohibition also supports a huge bureaucracy, especially in the United States, which has taken on (unsuccessfully) the role of watchdog for the world. The US Drug Enforcement Administration carries out a “war on drugs” throughout the world. In this respect it is assisted by the International Narcotics Control Board. In most western and many other countries law enforcement agencies are heavily involved in attempting to enforce prohibition. Despite their manifest failure and despite the corrosive effects of prohibition in the form of corruption, many of these forces continue to support prohibition. It is one of the major reasons justifying, if not their existence, then the volume of resources they can command. It is to the credit of the commissioners of Australian police forces that they support the trial. But it would not be surprising if many individual officers saw the possible end to prohibition as a threat to their jobs.

While the fears of all of the people whose livelihoods depend to a greater or lesser extent on the continuation of prohibition are understandable, these fears should not blind us to the huge costs of prohibition to dependent users and to other members of the community.

Not all of the groups that have an influence on the drug trade act to support prohibition. While the US Drug Enforcement Agency and other agencies concerned with the drug trade have pursued prohibition through the war against drugs, other parts of the US Government have aided and abetted the drug trade. McCoy claims that the drug business in Southeast Asia was intimately linked with the cold war crusade of the United States. In Laos, he alleges that the CIA supplied money and guns to Meo guerillas to counter communist wars of national liberation, thus supporting their production of opium. Similarly in Burma the CIA-financed remnants of the nationalist Chinese army facilitated and took part in the trade in opiates.

5. Recognition of the possible adverse effects on young people

The strongest argument against the trial is that, compared with unqualified prohibition, it may be seen as sending out a message to young people that the use of heroin is more socially acceptable, or less socially unacceptable. Prohibition gives a number of messages. By making use of the drug illegal it shows the strength of society’s disapproval. But it also makes it even more attractive to some potential users who see its use as a way of rebelling against authority. This is scarcely a new phenomenon: Genesis records that Adam and Eve were unable to resist eating the one forbidden fruit.

One of the disadvantages of prohibition is that it demonises the drug. It gives the impression that a single shot will turn the user into an instant addict. But it does not, any more than one cigarette makes the smoker addicted to nicotine or a single glass of alcohol makes the drinker an alcoholic. Young people and others need accurate information about all drugs of addiction. The dangers inherent in using them need to be emphasised, but it is likely that there will be less dependency if it is clear that all people need to take responsibility for their own behaviour in this as well as other ways.

Conclusions

It is our firm view that considering the proposed trial from a Christian perspective leads us to support it. At the most pragmatic level this is because prohibition has failed and has produced many, indeed most of the problems that arise from the use of heroin. We do not accept that the only legitimate aim of heroin programs is rehabilitation. As Christians we believe we have a responsibility also to those who, for whatever reason, continue to take the drug. At least we can lessen the dangers to them of death and disease from taking heroin, as we do now to a limited extent through the needle exchange program.

We do not see a controlled maintenance program as an alternative to programs that aim to reduce the use of heroin through education and rehabilitation. Some would see them as competing in that the availability of controlled maintenance provision will lessen the incentives of dependent users to quit. In our view it is at least as likely that they will complement one another. Dependent users on a maintenance program who are not forced into crime to support their addiction and who can hold down jobs may be better able to make rational decisions about whether or not to continue to use the drug.