Fall 1983 – Issue 30 - Stanford Lawyer - Stanford University

the addict to possess heroin, exceptinside a secure clinic. If the addictwere required to shoot his heroin onthe premises, relatively little supervisionwould be needed to preventthe massive diversion entailed in aprescription system.The on-the-premises system, however,raises other difficulties, most ofwhich stem from the brute pharmacologicalfact that heroin is a shortactingdru'g. Since its effects last foronly about four to six hours, the addictin maintenance would be forcedto appear for his shot three or fourtimes a day. The interruptions requiredby such a schedule wouldmake a normal working life difficult,if not impossible, and the inconvenienceof so many trips to the clinicmight well make this kind of heroinmaintenance no more attractive tomost addicts than are their presentalternatives: abstinence, methadonemaintenance, or continuing life onthe street.Obviously, to make an on-thepremisesheroin maintenance systemwork, we would have to lowerthe addict's traveling time considerably.We would need far more clinicsto dispense heroin than presentlydispense methadone. There are severalserious costs in doing this,however.The Problem of DiversionNot only would the clinics, the centralheroin warehouses, and thevehicles delivering the drug fromone place to another all be targets forrobbery and theft, but the greaterthe number of clinics, the greater thesecurity problems of preventingdiversion by employees corruptedby the profits to be made in sellingheroin. Although diversion by addictsof their allotments could bemade very difficult by an on-thepremisessystem, the same cannotbe said concerning the employees ofthe system.Sale of heroin legitimately cominginto police possessio!! has been anagging problem of heroin enforcement;dealers arrested for sellingheroin have been given back thedrug supply seized from them andpermitted to continue their business-withpolicemen as senior partners.And we know even of caseswhere confiscated heroin has foundits way from guarded police propertyrooms onto the street.There is certainly no reason tothink that the profits of heroin dealingwould prove less tempting tothose working for the maintenancesystem; and the problems of designinga security system would be fargreater. The police, at least, are notexpected to distribute heroin at all.Once one allows distribution on anyscale, diversion becomes mucheasier. It becomes possible to keepnonexistent addicts on the rolls,diverting their allotment of heroin tothe illegal market, or to shortweighthe dosage addicts receive and sellthe difference. And, of course, "unexplained"inventory shrinkages canresult from simple, crude theft.It is no doubt possible to designmethods of combating each of theseproblems. The difficulty is that asthe number of clinics goes up, sodo-more than proportionally-thecosts of supervision, the likelihood ofcorruption somewhere in the system,and the difficulty of simplykeeping track of both heroin andaddicts.Attractiveness to AddictsAn on-the-premises system wouldbe much less attractive to the addictthan a prescription system. Hewould have to contend with all the inconvenienceof traveling and waitingaround for the inevitable bureaucraticprocedures within the clinic.He could not shoot up in his homesurroundings or, presumably, withhis friends, and it is hard to believethat the institutional setting of aheroin maintenance clinic would be apleasant, attractive place for him.Finally, the time and energy thattreatment in such a clinic requireswould prevent the addict from enjoyingmany of the exciting satisfactionsof his former life style.It is likely, therefore, that asubstantial percentage of addictswould not sign up for this kind ofheroin maintenance. To the extentthat the price of heroin remainedhigh, but more addicts remained onthe street, the situation wouldresemble our present heroin prohibition.The fact that some addictswould be attracted into the systemmight lower some of the social coststhey impose upon us - but only at theprice of adding other costs.Location of the ClinicsAny sizable increase in the numberof maintenance clinics would notonly be more expensive financially;it would cause major political problems.The location of methadoneclinics has caused considerable oppositionfrom the surrounding neighborhoods,and heroin clinics wouldbe likely to generate much strongerresentment. The amount of trafficper addict generated by a heroinclinic would be much greater becauseof the larger number of visitsnecessary, and the short time betweeninjections would tend to inducethose addicts who had nothingelse to do to congregate in the area,either nodding from their last shot orwaiting around for the next.This would raise community objectionson a host of grounds; manywould protest on the ground that thecongregation of addicts near theclinic might become a magnet to theyouth of the area or the focus for alocal drug culture. In addition, if pastexperience is any guide, the areaswhere the addicts gathered wouldsoon become prolific sources of bothpetty crime and unsightly litter.Moreover, the small area servedby each heroin clinic would make itimpossible to locate all outside of theresidential areas. Many would haveto be located within the ghetto ratherFall 1983 Stanford Lawyer63