Giving addicts their drug of choice: The problem of consent

Bioethics

Volumn 22, Issue 6, 2008, Pages 314-320

  Walker, Tom ^a  

^a KEELE UNIVERSITY   (United Kingdom)

Author keywords

Addiction; Informed consent; Research

Indexed keywords

DIAMORPHINE;

ADDICTION; CLINICAL TRIAL; ETHICS; HUMAN; INFORMED CONSENT; METHODOLOGY; MOTIVATION; PSYCHOLOGICAL ASPECT; RESEARCH; REVIEW;

CLINICAL TRIALS AS TOPIC; HEROIN; HUMANS; INFORMED CONSENT; MOTIVATION; RESEARCH; SUBSTANCE-RELATED DISORDERS;

EID: 44649122158     PISSN: 02699702     EISSN: 14678519     Source Type: Journal    
DOI: 10.1111/j.1467-8519.2008.00647.x     Document Type: Review

References (38)

1. T.V. Perneger et al. Randomised Trial of Heroin Maintenance Programme for Addicts who Fail in Conventional Drug Treatments. BMJ 1998 317 : 13 18 van den Brink et al. Medical Prescription of Heroin to Treatment Resistant Heroin Addicts: Two Randomised Controlled Trials. BMJ 2003 327 : 310 312.
2. L.C. Charland. Cynthia's Dilemma: Consenting to Heroin Prescription. American Journal of Bioethics 2002 2 (2 37 47
3. Charland L.C. Cynthia's Dilemma: Consenting to Heroin Prescription. American Journal of Bioethics 2002; 2(2). Ibid: 47
4. B. Foddy J. Savulescu. Addiction and Autonomy: Can Addicted People Consent to the Prescription of Their Drug of Choice. Bioethics 2006 20 (1 1 15
5. Quoted in Charland, American Journal of Bioethics op. cit. note 2, p. 37.
6. See Charland, American Journal of Bioethics op. cit. note 2, p. 41.
7. See G. Dworkin. 1988. The Theory and Practice of Autonomy. Cambridge: Cambridge University Press;
8. H.G. Frankfurt. Freedom of the Will and the Concept of a Person. Journal of Philosophy 1971 68 (1 5 20.
9. Charland, American Journal of Bioethics op. cit. note 2, pp. 40-41.
10. Foddy & Savulescu, Bioethics op. cit. note 4, p. 6.
11. This type of experiment has recently been carried out in China. However, unlike the one described here the Chinese experiment did not involve the offer of drugs to those who took part. See Z. Xiao et al. Thirsty Heroin Addicts Show Different fMRI Activations when Exposed to Water-Related and Drug-Related Cues. Drug and Alcohol Dependence 2006 83 : 157 162.
12. Note that in this case consent will have been obtained before the study starts. However, if there is a need to remind the participants of the research to ensure that they are continuing to take part voluntarily, then it is important that they are competent to consent at the time this is done. If they were not, there would seem to be little to gain by carrying out such a procedure.
13. Cue conditioned craving is the name given to the phenomenon whereby a craving for drugs can be triggered by the presence of cues in the environment. These cues can come in a variety of forms, including drug paraphernalia, people or places associated with consumption in the past, mental states such as depression, as well as the availability of the drug itself. It is of particular interest for many of those studying addiction as it seems to be part of the explanation for the extent to which addicts relapse after a period of abstinence. See See J. Elster. 1999. Strong Feelings: Emotion, Addiction and Human Behavior. London: The MIT Press: 66-67;
14. G. Loewenstein. 1999. A Visceral Account of Addiction. In Getting Hooked: Rationality and Addiction. J. Elster & O.-J. Skog, eds. Cambridge: Cambridge University Press: 235-264: 243-245;
15. F.H. Gawin. Cocaine Addiction: Psychology and Neurophysiology. Science 1991 251 : 1580 1586.
16. See Elster, Strong Feelings: Emotion, Addiction and Human Behavior op. cit. note 12, p. 69;
17. Loewenstein, Getting Hooked: Rationality and Addiction op. cit. note 12, pp. 238-9 and 245-6;
18. G. Watson. 1999. Disordered Appetites: Addiction, Compulsion, and Dependence. In Addiction: Entries and Exits. J. Elster, ed. New York: Russell Sage Foundation: 3-28: 10-11;
19. and R.J. Wallace. 2006. Addiction as Defect of the Will: Some Philosophical Reflections. In Normativity and the Will: Selected Essays in Moral Psychology and Practical Reason. R.J. Wallace, ed. Oxford: Oxford University Press: 165-189: 183-4.
20. See Foddy & Savulescu, Bioethics op. cit. note 4, p. 10.
21. Loewenstein, Getting Hooked: Rationality and Addiction. op. cit. note 12, pp. 239 and 245-6.
22. Charland, American Journal of Bioethics op. cit. note 2, p. 41.
23. Foddy & Savulescu, op. cit. note 4, p. 14.
24. Charland, American Journal of Bioethics op. cit. note 2, pp. 43-44.
25. Foddy & Savulescu, Bioethics op. cit. note 4.
26. Foddy & Savulescu, Bioethics Ibid: 7.
27. Loewenstein, Getting Hooked: Rationality and Addiction op. cit. note 12, p. 239.
28. Charland, American Journal of Bioethics op. cit. note 2, p. 44.
29. T. Stewart. 1987. The Heroin Users. London: Pandora Press;
30. J. Neale. 2002. Drug Users in Society. New York: Palgrave.
31. Xiao et al., Drug and Alcohol Dependence op. cit. note 10.
32. Neale, Drug Users in Society. op. cit. note 23.
33. van den Brink et al., BMJ op. cit. note 1, p. 311.
34. Perneger et al., BMJ op. cit. note 1, p. 16.
35. Perneger et al. BMJ Ibid: 17.
36. M. Wilkinson A. Moore. Inducement in Research. Bioethics 1997 11 (5 373 389.
37. van den Brink et al., BMJ op. cit. note 1, p. 310.
38. Perneger et al., BMJ op. cit. note 1, p. 15.