Further Reading

Do you know of any harm reduction programs in place for cocaine?

Dear Stanton:

Are there any programs for cocaine maintenance in the world. If so, do they work as well as methadone? Can IV users of stimulants find or get an acceptable oral alternative.

This question has been asked of me by several people (one in the same batch of e-mail containing your letter). Obviously, it is on many people's minds. Patricia Erickson, a leading expert on cocaine use patterns, recently sent me a paper which is to appear in the International Journal of Drug Policy on harm reduction for cocaine users, and which explores the range of potential cocaine HR techniques. But, in our correspondence, we both remarked on the paucity of such programs. For example, we discussed the Swiss heroin maintenance program, which has explicitly ruled out cocaine. I asked one of the managers of this program why not include cocaine, and he said that acute reactions to the drug are too dangerous. But, of course, given that people are using the drug, its dangers are not a reason for excluding it from safety programs, but rather are a reason for including it.

So, I know of no such programs. Perhaps cocaine has historically been thought of as less dangerous than heroin, and this explains why so little concern has been directed towards reducing its harms. One always thinks of needle exchange programs, for instance, in terms of heroin addicts.

Please let me know what you discover.