This article originally appeared on VICE Germany.
It's a bright Friday morning in the Düsseldorf-based practice of Dr. Christian Plattner. The light floods into the white-walled waiting room, with its white chairs and white-clothed receptionists sat behind a white counter. On the walls are images of white sandy beaches and blue seas, and the air smells of coffee.
The receptionist greets everyone with a smile, making small talk about the weather. Next door, eight patients are shooting up heroin. There are pictures of palm trees in that room, too.
Dr. Plattner and his colleagues are treating heroin addicts with controlled doses of diamorphine – the purest form of heroin. The aim is to help severely addicted patients live a normal life by giving them a small, monitored dose of the drug, which will hopefully discourage them from getting their fix off the street.
In Germany – where there are only ten such practices that offer diamorphine as a form of treatment – the drug can only legally be given to the most severely addicted people. These are addicts that are older than 23 and have been addicted to heroin for at least five years. Before someone can come to him, they first have to be diagnosed with a serous physical or psychological condition, and have already attempted two withdrawal treatments before they can receive a course of diamorphine.
In the UK, there are around 50 clinics licensed to offer diamorphine where other opiates have failed, but the practice remains rare. "It would make a lot more sense to treat all patients with diamorphine," Dr. Plattner tells me. Instead, the vast majority of addicts are treated with methadone – a treatment that, according to Dr. Plattner, has been shown to be ineffective and leads to high rates of relapsing.
I spoke to Dr. Plattner to find out why he thinks heroin is the best treatment for heroin addicts, and why so many doctors are unwilling to prescribe it.
VICE: Why do you believe opiates like methadone are not effective for the majority of patients?
Christian Plattner: Methadone protects against the physical withdrawal symptoms, but only for about a week. The reality is that addiction is not just physical. If a user has been addicted for decades, and has already accepted being excluded from society, then they're not easily going to give up that high because they've avoided a week's worth of pain. Anyone who thinks they will doesn't understand what addiction is or where it comes from.
So what are the main causes of addiction?
Addiction tends to take hold in people with dysfunctional lives – a way of life that often involves emotional and physical violence, neglect and long periods of incarceration. So when that person eventually runs out of other physical attachment options, like a family support system or a job that can secure a livelihood, they can suffer from a severe feeling of loneliness that will lead to an addiction. Not every trauma turns into an addiction, but almost every addict is the product of trauma. Some of our patients have lived through terrible things.
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At what point did you decide to switch from conventional treatments to pure heroin?
When we started this practice, our only goal was to provide a safe, clean environment for people to get treatment. But over time, we saw so many of our patients that were treated with methadone relapse to street heroin – even after long periods of staying clean. So we slowly realised that we needed to find an alternative treatment solution.
Is it no longer your goal to get people off the drug completely?
For some of our patients, complete recovery is a realistic goal. But for others, it's unrealistic. You have to look at it like this: dependence only become a problem when someone can't get the medicine they need. A diabetic needs to inject insulin, without which they would eventually die. So what's the difference between that, and a patient who injects diamorphine? Of course I realise it's a different type of dependence – but they're both illnesses.
What is the difference between diamorphine and street heroin?
The stuff you get on the street is unpredictable, so you have no idea what's in it and how strong it is. On average, it only contains about 4 percent heroin. In addition, users on the street share needles, spreading infections like HIV and Hepatitis C.
Some people assume that what we give our users makes them so high they just lie in a corner for hours. But that impression is wrong – the high off diamorphine only lasts a few minutes, but the sedation effects lasts for up to six hours. Our patients use it so they can go about their day with less fear and more confidence. The reality is that if we don't provide the heroin, they will get it from somewhere else.
So why are there only ten practices in Germany offering diamorphine?
The barriers to prescribing diamorphine are high. It's expensive, and there are a lot of safety precautions that need to be taken. For example, the safe where we keep our stock has thicker walls than one in a bank.
Would psychotherapy not help?
Up until 2017, patients were required to undergo psychological therapy alongside a substitution programme. The requirement was dropped when it became obvious that psychotherapy only went so far.
There are certain experiences and traumas that I don't think can be fixed with therapy alone. One of our patients was prostituted out by her mother when she was just eight years old. She tells me all the time that if it wasn't for heroin, she wouldn't be alive. Now, thanks to our treatment, she can live her life.
Do you think we will one day see heroin in pharmacies?
Heroin was an approved drug up until the 1920s. One thing I know for sure is that if pharmaceutical companies were allowed to manufacture it and put it on the market in small doses, we would see superb effects, especially in people dealing with depression and personality disorders. The product would be really pure, unlike the dangerous stuff we see on the streets.
What would you like to see in the future?
For now, that we get diamorphine in new forms, like in tablets and nasal sprays. There are many patients who have veins that are too blocked to inject. Long term, I want to see the safe, controlled legalisation of heroin. We must not deprive sick people of their medicine. A public health system should involve everyone, not just those with illnesses we agree with.