Giving Heroin to Drug Addicts: Medicine or Insanity?

A growing coalition of drug-policy experts says giving pharmaceutical heroin to addicts beats established treatment. Such programs, they argue, reduce the harms caused by illicit substance use and serve as a model for liberalizing drug laws. The studies they cite do not justify this radical policy shift.

Drug addiction destroys lives. It leaves children orphaned, wrecks the health of users it doesn't kill and turns the downtowns of major cities into homeless encampments. Because it yields such devastating consequences, we should discourage substance use: health care providers should treat addicts with the intention of helping them quit; policies that enable public drug use should be rescinded and replaced with laws that protect public health and safety. 

These strike me as common-sense public health measures—and they were widely viewed that way for decades—but they seem to diverge from an increasingly popular perspective among some drug policy experts and addiction researchers. Rather than treating addiction as an ill to be eliminated, this harm-reduction coalition views it as a habit to manage: give people a sanctioned place to use, and in some cases give them the drugs. Several major cities in the US and Canada market these programs as practical responses to inevitable substance use. As The Atlantic reported in July: 

In New York City, which established two injection sites in 2021, health officials and academics point to the perceived success of Vancouver as inspiration. Rhode Island, where an injection center opened in Providence in 2024, also holds up Vancouver as a model. The Washington State legislature appointed a working group that in 2025 recommended establishing a safe supply of narcotics for addicts, and officials repeatedly cited the Vancouver program.

Medicalizing recreational drug use is often the first step in a broader case for legalizing all substance use. [1] It's usually couched in rhetoric about the need for empathy and pragmatism in medicine; appeals to individual liberty are never far behind. But to make legalization seem even plausible to the public, harm reduction advocates have to show that easing restrictions on drug use yields significant public health benefits. 

This is something they can't do, because even the most favorable research turns up critical flaws in this approach to drug policy.