Abstract
To the Editor.— Although much clinical research is needed before we begin large-scale heroin maintenance programs, Dr. Lewis' five objections to heroin maintenance inThe Journal(223:546, 1973) are specious. His first two objections (rendering addiction less costly... [and] freeing additional supplies of heroin) fit all treatments from therapeutic communities to methadone. His third objection (heroin maintenance make our international of eliminating opium... unrealistic) whips a horse that deserves mercy killing. This goal is already politically and economically unrealistic 1 and may be medically indefensible; have double-blind studies proved synthetic narcotics equivalent to natural ones for all clinical purposes? If opium were unavailable, not illicit sources manufacture and supply synthetic narcotics? Dr. Lewis' fourth objection (other treatments would be unable to compete with heroin maintenance) not apply to controlled, clinical heroin maintenance studies. It also ignores British success in coupling heroin maintenance with other treatments and
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