Fall 1983 – Issue 30 - Stanford Lawyer - Stanford University

than on its edges, thus increasing thepolitical opposition to the clinics andexacerbating their abrasions of thesurrounding community.These are not merely public relationsdifficulties. The opposition ofthe clinics' neighbors would mostlikely be based on a genuine loweringof the quality of their lives-andone which would be differentially imposedon those least able to afford it.The Problemof the AutomobileAs if this were not enough, wemust consider the problem of theautomobile. Although, in the mostcrowded inner cities, it is likely thatmost addicts do not drive cars, thereare many, perhaps a majority inplaces such as California, who do.The difficulty here is that many addictson heroin are not in goodenough condition to drive safely.Heroin, in this respect, is quiteunlike methadone, where the long- Ier-acting nature of the drug and thefact that it is taken orally make itsonset far more gentle.Even those addicts who are takingstable doses of heroin will not be ingood enough condition to drive justafter their injection, and should theybe delayed in traffic on the wayto theclinic, the beginnings of withdrawalmay make them a danger then. Entirelyapart from any legal liabilitythe clinic may incur, there is themoral problem of creating a risk tothose on the streets, and this dangerwill be most concentrated nearestthe clinic.The more one thinks about thisproblem, the more intractable it Ibecomes. We might be able to makean on-the-premises system workonly by providing convenient transportationfor addicts and by locatinglarge numbers of clinics throughoutour areas of heroin addiction. Thecosts of this kind of service, however,may simply price the wholeprogram out of the market.Financial Costof the On-the-PremisesSystemIndeed, the financial cost of theprogram would probably raise themost serious obstacle to an on-thepremisesheroin maintenance system.For a host of reasons, includingthe fact that it must be staffed dayand night, an on-the-premises heroinmaintenance system is considerablymore expensive than a prescriptionheroin scheme or one using methadone.It is likely that an on-thepremisesheroin maintenance systemwould cost some $15,000 per addictper year.Arguably this expenditure wouldstill be worthwhile, since the yearlysocial cost imposed by many addictsunder heroin prohibition is wellabove $15,000. The wisdom of suchexpenditures is by no means clear,however, for several reasons. Thoseaddicts who would stay in this kindof treatment would probably tend tobe the less criminal and more stableaddicts, who impose less than$15,000 a year costs upon us. Andsome of the criminalistic addicts whodid enter the maintenance programwould continue their former lifestyle with its attendant depredationsupon society, while absorbing thecost of maintenance, as well.In addition, the $15,000 figuredoes not include the indirect costs ofthe on-the-premises system. It doesnot include the social cost of theinevitable diversion from the system,the political and symbolic costsof locating the clinics, and thewelfare costs caused simply by thefact that for many, attending an onthe-premisessystem would be sotime-consuming that it preventedgainful employment. Finally, anykind of heroin maintenance system,regardless of whether a prescriptionor an on-the-premises system, involvescertain inherent costs whichmust be considered along with thosealready mentioned.The Costs of Any HeroinMaintenance SystemAmong the costs of all maintenanceschemes, we must consider the politicaldisadvantages of any government-controlledsystem which distributesaddictive drugs. We have \already heard charges that methadonemaintenance is a type ofgenocide and an effort to manipulatelarge numbers of minority groupmembers through government tranquilization.Even if one rejects thesecharges as extreme and unbalanced,there is legitimate cause for concern.Anyone interested in limiting governmentalpower over the individualshould worry about programs thatwould keep sizable numbers of citizensdependent upon the goodwill ofofficialdom to avoid being deprivedof their supply of an addicting drug.The Addict's HealthThe fact that the very nature of. heroin maintenance involves givingheroin to addicts raises anotherissue. In the long term, heroin use,especially through intravenous injection,is not good for the addict'shealth. British addicts, when theywere receiving legal heroin, had adeath rate even higher than that ofAmerican street addicts. So long asthey continue intravenous administration,addicts will risk collapsedveins, hepatitis, and a whole series ofphysical ailments. Moreover, eventhough heroin seems relatively nontoxic,at least as compared to alcohol,we do not yet know the longtermphysical effects of heroin addiction,even on a stabilized dosage andapart from the method of administration.The physical effects of heroin areby no means the only health problem.It is likely that many of thosemaintained on heroin will not be ableto stabilize their doses, despite theefforts of the maintenance clinics. As64 .Stanford Lawyer Fall 1983