Massimo Barra is a doctor who for five years has worked on the drug problem in Italy. Three years ago he founded Villa Maraini, in Rome, a commune for adddicts who have just stopped, or are stopping, taking heroin.
IDN: Recently, various politicians have suggested that heroin be distributed to addicts legally, thereby taking the addict out of an illegal environment. Do you think this could work?
BARRA: No. The question is: Do we want to maintain the addict on his normal dosage indefinitely, or are we trying to wean him? From the physical standpoint, stopping heroin is not difficult. There are various techniques, including “cold turkey”, and the real problem is not physical and cannot be dealt with by legal distribution of the drug. If the object is maintenance, then methadone is better than heroin, because tolerance to it increases only slightly with time. Another problem is that the effects of heroin only last about six hours. So every six hours the poor addict would have to go to hospital to get his dose. Methadone lasts 24 hour, so the subject would have a better change of doing things other than to do with his drug habit. Also, the state would tend to supply a black market of heroin. With the free distribution prices would probably go down, but a black market would still exist.
IDN: How, exactly, does heroin work on the human mind and body?
BARRA: Heroin depresses the central nervous system. Consequently it works as an analgesic, physical and mental, it calms, relaxes, and produces a feeling of well-being and euphoria. It is the best antidepressant on the market.
IDN: And why does and addict feel bad when he or she stops taking heroin?
BARRA: For the moment this is only a theory, but I think that the body produces a substance which we call endomorphine. This should normally produce a feeling of well-being in a person. As morphine, or heroin, is taken into the body from outside, so the natural production of endomorphine is reduced, since the body always tries to maintain certain equilibriums. When the outside dosage then stops, the body needs a certain amount of time to produce enough endomorphine again. The greater the quantity and the time span in which heroin was taken, the greater the difficulty for the endomorphine production to get back into its stride. At Villa Maraini, for instance, we have found that acupuncture is effective in stimulating endomorphine production, especially in the milder cases of addiction.
IDN: How do you see “the cure” for heroin addiction?
BARRA: It takes a long time, first of all. The addict’s relationship with heroin follows a certain course. In the first period, which I call “honeymoon”, he is in love with heroin and nothing and no one can make him stop. In this stage the only thing we can do is help him to avoid death from an overdose, or illnesses that will kill or seriously harm him. This period then passes, and there is a long period of “love-hate”. In this period we try to creat existential alternatives to heroin, interests for the addict other than heroin. This may last years, by the way. Finally, we hope to reach point where the addict hates heroin, as he might hate a beautiful woman that has taken away everything from him.
IDN: And what exactly do you do at Villa Maraini?
BARRA: Villa Maraini is a daytime commune, from nine to nine, run by the “guests” themselves. In other words, if no one cooks there is nothing to eat, and if they do not clean then the houses gets dirty. The idea is to provide a temporary alternative to the vita “di piazza”, stimulating other interests and activities.
IDN: What are the causes of the heroin epidemic?
BARRA: They can be divided into three parts: family, environment, and social. In each individual the percentages that contribute to heroin use are different. Today we find heroin used almost exclusively by the 17-25 age group. Undoubtedly it is a symptom of a larger social illness. And what many people forget, when they center attention on the so-called “cures”, is that if the illness did not show itself through the symptom of heroin use, it would manifest itself through other, perhaps equally damaging channels. This is why it is absurd to talk so much about “disintoxication”. This is no problem. The problem is that once the addict is no longer addicted, he finds himself in exactly the same situations that caused him to start using heroin in the first place.