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• W1507151946 abstract "Sir—Clinical and basic research into the molecular biology, pathology, natural history and treatment of drug dependence is essential if we are to deal successfully with this major public health problem. I was therefore delighted to read the Editorial that appeared recently in this journal (Hall, Carter, & Morley 2003). While I agree with many of the authors’ points, I must take issue with their equating my views (Cohen 2000a) with those of Charland (2002). Specifically, I do not agree with the editorial's statement that my arguments lead inevitably to the conclusion that ‘no experimental research will be permitted in which drug-dependent people receive their drug of dependence’. The essence of my thesis (Cohen 2000a) was that ‘the nature and pathology of untreated substance dependence make the condition inherently incompatible with a rationally, internally uncoerced and informed consent on the part of those volunteering to receive addictive drugs in a non-therapeutic research setting’ (p. 74, my emphasis). Furthermore, my proposed prohibition applied only when the addictive drug was administered in doses capable of producing a psychological effect: ‘the administration of addictive drugs to either addicts or nonaddicts in such minute quantities as to be devoid of any pharmacologic, physiologic, or psychotropic action (e.g. minute doses of radio-labeled tracers) requires an ethical analysis similar to that performed in any other human study not involving addictive drugs’ (p. 75). Therefore, I differ strongly with Charland (2002) and see no ‘dilemma’ in the research he analyzed. Rather than proposing that all experimental research be forbidden if it involves drug-dependent individuals receiving their drug of choice, I supported emphatically the administration of heroin to heroin-dependent individuals—the direct purpose of the study scrutinized by Charland was to develop a therapy that would ameliorate some, but not all, of the problems associated with heroin dependence. My ethical analysis is evident from a précis of my response to Charland (Cohen 2002b): ‘Heroin prescription’ may not be the ideal approach to therapy, but it is not without benefit . . . This modality of treatment does not change the addict's compulsion and craving but directs them into forms that are more acceptable both to the public health community and, perhaps, society as a whole . . . [W]hen contemplating treatment addicts may very well be capable of distinguishing between and analyzing the relative risks of ‘street heroin’ vs. ‘prescription heroin.’ . . . Heroin addicts who wish to continue to use the drug and can distinguish between the risks of ‘clean’ and ‘dirty’ heroin meet [ethical] criteria for competence to consent to treatment. The success of needle exchange programs provides ample demonstration of this fact. As with needle exchange, the object of ‘heroin prescription’ is harm reduction, not abstinence. Therefore, I propose, contra Charland, that [research is ethically permissible when] . . . addicts who can distinguish between the risks of ‘street’ and ‘prescription’ heroin (even though they cannot abandon heroin's use entirely) wish to be treated with ‘prescription heroin.’ They are able to make a competent and voluntary decision about whether or not to undertake this mode of treatment, thereby solving ‘Peter's Dilemma’. In conclusion, I believe that studies involving administration of addictive drugs to drug-dependent individuals in concentrations likely to produce psychotropic effects are both necessary and ethical except in a limited subset of the population: drug-dependent individuals who are neither being treated nor who desire to be treated. While this hypothesis is certainly not accepted by all, it is necessary that it be delineated accurately in order that the ethical and research community may engage in useful discussion and debate." @default.
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• W1507151946 date "2004-02-01" @default.
• W1507151946 modified "2023-10-16" @default.
• W1507151946 title "CORRECTING THE RECORD: A COMMENT ON HALLET AL.2003" @default.
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• W1507151946 doi "https://doi.org/10.1111/j.1360-0443.2004.00638.x" @default.
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