IN THE NEWS

HEROIN PRESCRIPTION FOR ADDICTS IN THE -WHAT IS GOING ON?

The has had, for more than fifty years, some sort of programme of heroin prescription for addicts. (The British System). That was much limited at the end of the 1960s after there was found to be significant leakage of heroin, legally supplied for addicts, into the parallel illegal heroin market. Heroin leaked into the illegal market in two ways, either from addicts selling some of their prescribed supply or through corrupt or incompetent doctors over-supplying. It was concluded that heroin, if prescribed at all, needed to be taken under direct medical supervision. That is, in the presence of the physician or nurse.

Diamorphine (Heroin), is a legal medicine in the for treatment of pain in (say) terminal cancer. That is not true of some other countries.

Of the Doctors who have special licences to supply heroin to addicts, very few show any great enthusiasm for it or seem to believe in it for other than the short term. Only very few clinicians have ever shown any enthusiasm for long term maintenance heroin for addicts. General Practioners (local Doctors) show no enthusiasm to become engaged in supplying/treating addicts with heroin.      

On the basis of a research carried out for the Joseph Rowntree Foundation it is understood there are only around 70 doctors licensed to prescribe heroin to addicts, of which number around 40 are regularly doing so to less than 500 addicts in total. The costs of heroin prescribing are thought to be around three times that of methadone given the need for much tighter supervision of prescription and supervision. The Royal College of General Practitioners has not shown any appetite for extending heroin prescribing with the pressure for this largely being driven from the Home Office (Criminal Justice & Law and Order), not the Dept of Health.

There is substantial prescription of the heroin substitute oral methadone. The bill for methadone is rising and the system of continuing prescription of that has been challenged by the leading academic drugs expert in . He has said that methadone as a treatment, is not working. Very few addicts who are prescribed methadone are becoming free of addiction, the costs are continually rising.

There is no substantial evidence that prescription of methadone has much effect on crime rates and addicts who are prescribed methadone will frequently supplement that supply with street heroin AND take part in crime, which may include drug dealing.

Initial prescription of heroin can, in the view of some people, be reluctantly justified in terms of stabilising the most chaotic addicts and as an aid to lead them into a course of treatment designed to lead to abstinence. That is what the majority of addicts want.

Now why is there all this talk in the about prescription of heroin?

Analysis based on good sources is this. Prime Minister Tony Blair has always been highly concerned by crime figures, some of those figures undoubtedly related to drug consumption & addiction. (Although there is research to show that involvement in crime generally precedes heroin addiction). It is alleged that Prime Minister Blair was "sold" cannabis downgrading, against his better judgement, because he was told at the same time more Police resources would go into heroin interdiction and more addicts would be prescribed heroin and thus kept away from crime.

The Chairman of a parliamentary select committee Chris Mullen Member of Parliament, now with the SENLIS group, also argued for maintenance heroin for all addicts. There has been little support for that idea. It is regarded by drug prevention experts as being on the “flat earth” side of drug policy and more than slightly mad.

Heroin prescription is being pushed by the drug legalisation and so called harm reduction lobby, for their own reasons, it is being presented as a crime cure-all. That ignores some realities. The idea is getting media attention and was also much publicised because of the speech by a Deputy Chief Constable two weeks ago at a Police Conference. The Deputy Chief Constable emphasised it was a personal view. His main objective was a reduction in crime. His suggestion ignores some political and financial realities; it also is by no means certain that it would substantially reduce crime.

The realities are that heroin maintenance on any substantial scale is just not possible; the costs have been massively under stated, not least by the Deputy Chief Constable. A proposed heroin prescribing experiment in Brighton will deal with 30 carefully selected addicts out of a total population of around 2,500 addicts.  To suggest that this could happen, wide, is misleading in the extreme. It would mean massive diversion of resources from the publicly financed UK Health Service; it is politically and financially unsustainable. That is, even if clinicians could be found to do the work, which is very doubtful. The cost is not just the cost of the heroin.

Heroin because of its short acting nature, ties an addict to his clinic in a why that longer lasting oral methadone, does not. Heroin through injection, preserves undesirable and risky, injecting behaviour.  Each small town would need its own clinic with at least two clinicians depending on addict population plus premises, security, nursing staff (minimum two on duty at any time for security). Larger towns and cities would need more than one such clinic, London for example, would need several. Each clinic would need opening hours of early morning to late evening. On this basis the costs mount up alarmingly-all this at a time when some new treatments and new drugs for real illness such as cancer are in short supply and there is selective prescription largely based on cost, with differences (again unsustainable politically) between Scotland and England.

All this and the added point that on anything other than a huge scale it would not have much affect on crime. Many addicts would STILL commit crime, many are poly-drug users-particularly Crack Cocaine. The whole idea is being misconstrued and misinterpreted sometimes no doubt, deliberately so, by those who favour legalisation. Done on any substantial scale it would also encourage “drug tourism”.

Heroin prescription should only be considered within carefully controlled conditions and for specially selected long term addicts. Heroin needs to be prescribed (if prescribed at all) in the context of a real effort (with other committed support), to get addicts free of addiction. The on-going small scale prescription will be represented as something else; because the media loves an argument about our UK Health Service and our opponents think it is a route to legalised drugs for all. It is not, of that I am absolutely confident.

We need to keep speaking out about it and explaining the flaws, I call it "reality seepage".

David Raynes  Member, International Task Force on Strategic Drug Policy

http://www.itfsdp.org/

&  

Executive Councillor. Advisor on Drug Policy, Drug Politics & Trafficking, National Drug Prevention Alliance

 www.drugprevent.org.uk

December 2006