Brand and the Record are Wrong on Heroin Addiction

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.

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11 comments
Paul Larkin
Paul Larkin

I don't want to sound like a Hovis ad (the cobble streets ones in a kind of sepia - remember?) but  growing up as a Salford/Irish kid was a rough upbringing in many ways. This coupled with living in Dublin for years has given me a street based view of addiction (first alcohol and then heroin). For the record, I've never taken any form of street sale drug (including tobacco) in my life and only started drinking alcohol when I was 28. 


The thing that everybody misses/refuses to deal with/wishes away, in the drugs debate is that it is NOT addiction but POVERTY that is the key issue. Heroin and more particularly coke/E abuse is fairly widespread in middle class areas but they also have a network of resources and safety nets, which are non existent in poor areas. It is for that reason that burglaries, muggings and street crime are not rife in middle class areas. You drop drugs into a poverty stricken area, even legalised drugs, and its like a mini atom bomb  going off under the founds of everything - all bonds of solidarity and loyalty (the one thing working class people used to have) are dissolved. Why? Because there is no spare flesh there between getting your score and putting bread on the table, clothing the kids and paying the rent. It's not a question of addiction - its a question of how quickly you can get out of  your poverty head by either taking it or selling it, or sometimes both before you get shot or razored for keeping the money.


Of course addicts need to be looked after, they are sick people  - often generationally so, but there is one thing and one thing only that will ease the epidemic - PUT AN END TO NEEDLESS POVERTY.

Paul Larkin
Paul Larkin

I don't want to sound like a Hovis ad (the cobble streets ones in a kind of sepia - remember?) but  growing up as a Salford/Irish kid was a rough upbringing in many ways. This coupled with living in Dublin for years has given me a street based view of addiction (first alcohol and then heroin). For the record, I've never taken any form of street sale drug (including tobacco) in my life and only started drinking alcohol when I was 28.  The thing that everybody misses/refuses to deal with/wishes away, in the drugs debate is that it is NOT addiction but POVERTY that is the key issue. Heroin and more particularly coke/E abuse is fairly widespread in middle class areas but they also have a network of resources and safety nets, which are non existent in poor areas. It is for that reason that burglaries, muggings and street crime are not rife in middle class areas. You drop drugs into a poverty stricken area, even legalised drugs, and its like a mini atom bomb  going off under the founds of everything - all bonds of solidarity and loyalty (the one thing working class people used to have) are dissolved. Why? Because there is no spare flesh there between getting your score and putting bread on the table, clothing the kids and paying the rent. It's not a question of addiction - its a question of how quickly you can get out of  your poverty head by either taking it or selling it, or sometimes both before you get shot or razored for keeping the money. Of course addicts need to be looked after, they are sick people  - often generationally so, but there is one thing and one thing only that will ease the epidemic - PUT AN END TO NEEDLESS POVERTY.

Rupert Wolfe Murray
Rupert Wolfe Murray

Excellent article, brilliant analysis. First I must declare an interest: I work for Castle Craig Hospital in Scotland, a residential rehab clinic that aims for abstinence; so I am biased in favour of abstinence based solutions which, in our case, works for over 60% pf patients who come through our clinic.

I appreciate that you don't dismiss abstinence based appoaches and recognise it works for some.  The problem is that the NHS have totally rejected the residential/rehab approach and have put all their eggs in the methadone basket; and they don't offer any of the psychological therapy that these people urgently need.

The argument for Consumption Rooms and supplying clean drugs are compelling but what about those who do want to give up? The NHS (in England as well as Scotland BTW) routinely ignore all requests to try residential rehab. It's methadone scripts or nothing; alcoholics get offered some detox time in a local hospital -- but detox is only the first stage of treatment.

Our rehab clinic was built up since 1988 into the biggest in UK, with 122 beds, on the back of referrals by GPs. But when they introduced DAAT teams and the methadone programme GPs were not allowed to refer into rehab people any more. We have managed to survive thanks to Holland, where the Dutch govt pays for addicts to come over, but scores of rehab clinics have closed.


Don't you think that residential rehab should be available to at least 5% of those who want it?




Rupert Wolfe Murray
Rupert Wolfe Murray

Excellent article, brilliant analysis. First I must declare an interest: I work for Castle Craig Hospital in Scotland, a residential rehab clinic that aims for abstinence; so I am biased in favour of abstinence based solutions which, in our case, works for over 60% pf patients who come through our clinic. I appreciate that you don't dismiss abstinence based appoaches and recognise it works for some.  The problem is that the NHS have totally rejected the residential/rehab approach and have put all their eggs in the methadone basket; and they don't offer any of the psychological therapy that these people urgently need. The argument for Consumption Rooms and supplying clean drugs are compelling but what about those who do want to give up? The NHS (in England as well as Scotland BTW) routinely ignore all requests to try residential rehab. It's methadone scripts or nothing; alcoholics get offered some detox time in a local hospital -- but detox is only the first stage of treatment. Our rehab clinic was built up since 1988 into the biggest in UK, with 122 beds, on the back of referrals by GPs. But when they introduced DAAT teams and the methadone programme GPs were not allowed to refer into rehab people any more. We have managed to survive thanks to Holland, where the Dutch govt pays for addicts to come over, but scores of rehab clinics have closed. Don't you think that residential rehab should be available to at least 5% of those who want it?

wook5ter
wook5ter

@Graham McIlroy  Brand is not a comedian. Went to his show in Bournemouth once - full of fawning students who enjoyed his plaguiarised act. It was honestly awful. Plays the anti-hero sooooo well. Who gives a shit? Tell me a film that he's done that's been funny?  He ballsed up Arthur.  So I agree with you Graham,  he's not an authority in life.

Kempy Kerr
Kempy Kerr

Of course it shout be on bloody prescription, only a culture that wants to bury its head in the sand and refuse to have an adult conversation about drugs and addiction would say otherwise. My problem with the 'Drug Consumption Rooms', is where will they be and how many? Because if they are located in the town and the addict lives in Drumchapel, thats a long way to go and much easier to score closer to home (Infact it would probably be easier to commit a crime and then score, closer to home!!) I would advocate, herion on prescription, that the addict gets at the chemist instead of the deadly methadone. No it would not stop crime overnight and the addicts would most certainly mix the drugs, trade it amongst each other and some would die. But in the wrong run I believe it would work, and also it would take the power and control over these peoples lives out of the control of the underworld. If an addict can get their fix at home, deal with that monkey on their back, they then have a chance of the rest of that day and what can be done with it, what treatment they need, their jobs, looking after their children etc... that is the only way it can be done, anything else and the addict will be forced to find a way around it.

Kempy Kerr
Kempy Kerr

Of course it shout be on bloody prescription, only a culture that wants to bury its head in the sand and refuse to have an adult conversation about drugs and addiction would say otherwise. My problem with the 'Drug Consumption Rooms', is where will they be and how many? Because if they are located in the town and the addict lives in Drumchapel, thats a long way to go and much easier to score closer to home (Infact it would probably be easier to commit a crime and then score, closer to home!!) I would advocate, herion on prescription, that the addict gets at the chemist instead of the deadly methadone. No it would not stop crime overnight and the addicts would most certainly mix the drugs, trade it amongst each other and some would die. But in the wrong run I believe it would work, and also it would take the power and control over these peoples lives out of the control of the underworld. If an addict can get their fix at home, deal with that monkey on their back, they then have a chance of the rest of that day and what can be done with it, what treatment they need, their jobs, looking after their children etc... that is the only way it can be done, anything else and the addict will be forced to find a way around it.

Graham McIlroy
Graham McIlroy

Why are people listening to Brand? If they would only read his autobiography they would see he's a comedian and TV presenter who glamourises heroin and crack addiction and highlights his extreme need for attention seeking behaviour - he's not an 'expert' on addiction, he's only interested in his bloody self. Anyone who thinks he has ecer lived in the real world should read just one chapter of 'My Booky Wook'. In it he jokes about swinging from stage light fittings on the comedy circuit and dressing up as Osama Bin Laden the day after 9/11, in his job as a TV presenter. If you want to be educated by someone like that, then you deserve everything you get.

Mhairi McAlpine
Mhairi McAlpine

It's also a circular thing. Poverty leads to addiction because its a cheap way of feeling good when other ways are too expensive and then once addicted the cost of it keeps you in poverty constantly struggling to get out but now with the monkey on your back to feed as well. Free heroin would at least take away one of the causes of poverty for those who are already addicted

wook5ter
wook5ter

@Graham McIlroy 

Brand is not a comedian. Went to his show in Bournemouth once - full of fawning students who enjoyed his plaguiarised act. It was honestly awful. Plays the anti-hero sooooo well. Who gives a shit? Tell me a film that he's done that's been funny?  He ballsed up Arthur.  So I agree with you Graham,  he's not an authority in life. 

Pindy
Pindy

@wook5ter 


I think you'll find that Russell Brand is a comedian. Now if you mean that you don't find his act funny then why not just say that. He was in a film called Get Him To The Greek which was quite funny. I agree that Arthur was not so great.

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