We had a fantastic q and a session with the inspiring and knowledgeable Dr. Nelda de Grave, as well as a nurse and client of the heroin prescription program. They were boundlessly generous with their time and willingness to answer even the most difficult and personal of questions. We were also able to see the Service's safe injection and use areas, and to learn how the government vets participants in the methadone and heroin prescription programs. Patients must attempt methadone maintenance for five years before being eligible for heroin prescriptions. All use is closely supervised and bound by an extensive set of rules. As we were told, these are the patients that for one reason or another have been determined to be unlikely to ever successfully be weaned from heroin; therefore they are given ways to use that are safer and less likely to spread disease and crime.
Dr. de Grave told us, after years in the public health service, that 'methadone is cheap; heroin is more expensive but far cheaper than the costs of all the trouble [crime and secondary health problems] of obtaining heroin on the streets.'
The treatment center we visited was in a southeastern suburb, very different from the city centre where we are spending most of our time. There's a large immigrant population and the area has little pedestrian traffic, being far more industrial than the city centre where we have spent most of our time thus far.