Guest Post by Stuart Rodger
Heroin addiction has hit the headlines once again and – as ever with drug policy – much of what is being said is misguided at best and plain wrong at worst. Russell Brand’s documentary From Addiction to Recovery aggressively criticized the methadone maintenance programme and endorsed abstinence-based recovery. The BBC reported the following day that drug deaths were at their highest on record. And the Daily Record led a hysterical front-page report on Monday calling the Scottish Government ‘the biggest drug dealer in Scotland’. This outburst of half-informed commentary cannot go unanswered.
I say half-informed, because both Brand and the Record are right about one thing – to highlight the flaws of the methadone programme. Methadone Hydrochloride is a chemical used in the Scottish NHS’s heroin substitution programme – a bright, sweet, green gloop consumed orally, and handed out daily by pharmacists around Scotland. Patients however, detest the substance, and it’s not hard to see why – the epidemiologist Dr Ben Goldacre has done a detailed study of methadone, saying it leads to ‘nausea and vomiting, weight gain, profuse sweating, dysphoria, and tooth decay.’ It therefore does not successfully take addicts away from the illicit drugs trade. And crucially, it has a higher mortality rate than even street heroin: 4 times higher, according to the best estimates.
But they are spectacularly wrong about a second key point – in dismissing the idea of harm-reduction and heroin maintenance therapy, and endorsing the idea of abstinence as the answer. Let me be clear that I think residential rehabilitation is great for people who can benefit from it, and I think it’s essential that the rehab services we have at the moment are enhanced and improved (the money we waste locking junkies up would be a good source of funds). But it has a limited success rate: just over 40%, according to Dr David Best, chair of the Scottish Drug Recovery Consortium, a statistic confirmed by at least two other studies, one referenced by the Scottish Government (see section 4.41) and one conducted by the National Addiction Centre . What to do about the remaining addicts?
At this point, there are two routes you can go down. The first is to let the addicts fend for themselves, and abandon them to the anarchy of the illicit drug trade. Do this, and you stand back and watch the rates of prostitution, burglary, homelessness, HIV infection, and heroin addiction itself go through the roof. 63% of women involved in prostitution say they are doing so to fund a drug habit, black-market drug users are associated with 80% of burglaries, 50% of London’s rough sleeps became homeless because of drug addiction, and HIV infection among injecting users is over 35% in countries like Russia – without harm reduction techniques like needle exchange – compared with 2% in Switzerland, which does.
Or you can go down the second route, which is to gave them a safe, clean, supply of medical heroin (known as diamorphine) administered by a medical professional in a designated Drug Consumption Room. Clean, unadulterated heroin – though indeed very addictive – is relatively safe. It may seem shocking at first, but the distinguished investigative journalist Nick Davies has conducted a detailed study into this, highlighting large scientific studies of unadulterated heroin users. He states:
The Oxford Handbook of Clinical Medicine records that a large proportion of the illness experienced by blackmarket heroin addicts is caused by wound infection, septicaemia, and infective endocarditis, all due to unhygienic injection technique.
When the Joseph Rowntree Foundation conducted a comprehensive study of Drug Consumption Rooms around Europe, they found that one only person had ever died in one since they were introduced in 1986 – and that was of an allergic reaction. Rates of HIV infection had fallen from 50% to 2%. And when heroin prescription was experimented with in Liverpool in the 1980s, the number of new users fell by 92%, and when it was experimented with in Zurich, the number of new users fell by 82% Why? Because the need to deal to fund a habit had vanished – ending the most vicious of vicious cycles. This is partly why the number of heroin addicts in the UK has jumped from around 48 in 1955, to over 280,000 today
The opponents of this approach need to be challenged – why are they rejecting a policy with such a spectacular success rate, and letting hundreds and thousands of addicts die unnecessarily? For just now, though, the government seem content to carry on with the status quo. But with the number of new addicts and the number of drug deaths persistently on the rise we need urgently to reconsider our approach.