Sir, - Fintan O'Toole's thoughtful article on the need to at least seriously consider State prescribing of heroin to addicts makes for depressing reading (The Irish Times, June 3rd). In one critical regard it is also flawed.
The phenomenon of cellular tolerance - the increasing dose required for effect as sensitivity diminishes - means that there is no ceiling on the amount of heroin that will eventually be required by the addict. If, as with every other drug, the medical establishment implements a therapeutic ceiling, we are back in the situation of a black-market demand for the drug.
Even with methadone, a prescribed drug where physiological stability can be achieved, after three decades of widespread use and research there is still no universal agreement over low- to medium- to high-dose prescribing. The argument remains that too little of the drug will lead to "top-up" drug use, while too much will see black-market selling of the "surplus". The consequence, beyond the battle of wile and wit between patient and therapist, is methadone diversion, and an increasing number of methadone-related deaths.
To consider that such a high price in health and crime consequences can be avoided with heroin prescribing, where physiological stabilisation is not a realistic option, must be, in Wilde's words, a case of the triumph of hope over experience. - Yours, etc.,
Lorne Patterson, RMN, Senior Addiction Clinician, NeuroElectric Therapy, Marian Avenue, Edgeworthstown, Co Longford.