Whilst politicians in this country refuse to talk any sense about our utterly failed drug policy and there is still a naive belief that a 'war on drugs' can be won, we have this news from Durham. How can this be legal and how can it be safe when I always thought that only doctors were able to prescribe potentially dangerous medication? What sort of society are we living in where the health service can't do this, but a police force can?
Durham police will give addicts heroin to inject in 'shooting galleries'
Force will be first in England to implement radical approach that has achieved positive results in a number of European countries
Heroin addicts will be given supplies to inject in specially designated “shooting galleries” under radical plans to tackle drug-related crime in Durham. The police force is set to become the first in England to implement an approach pioneered in Switzerland and credited with achieving positive results in a number of European countries but unlikely to attract much domestic political support.
Under the plans, Durham constabulary, which was last week rated the best in England, would buy diamorphine – pharmaceutical heroin – to give to addicts, which they could inject twice a day in supervised facilities. The proposals, currently under scrutiny by public health officials in the area, come as Glasgow is trying to push through its own plans to open the UK’s first “fix room”, where clean, medical–grade heroin would be given to some users.
Ron Hogg, Durham’s police, crime and victims’ commissioner, said the UK was failing on drugs and desperately needed to try alternative approaches. “If we look at the UK’s position, we have got some of the highest levels of heroin abuse in Europe, also of cocaine use and [drug-related] deaths,” said Hogg. “Someone’s got to step up to the mark and do something a little bit different.”
Durham has about 2,000 heroin addicts, but Hogg said the scheme, known as heroin-assisted treatment, would target a small number of “really prolific, at-risk offenders”. It could be administered through the north-east county’s six existing recovery and treatment centres for drug users and alcoholics.
A part government-funded pilot scheme in Darlington, London and Brighton involving 127 chronic addicts found that giving them heroin significantly reduced both their drug usage and crime. In December, the government’s expert drug advisers suggested introducing heroin-assisted treatment after statistics showed deaths from the drug in England and Wales have soared recently. But the Home Office rejected the recommendation from the Advisory Council on the Misuse of Drugs, saying it had “no plans to introduce drug consumption rooms”.
Hogg, who spent 30 years as a police officer, said: “When I first joined [the police] I was part of the ‘best [to] lock them up brigade’, but you observe it doesn’t work. “Even now I am still going out more than 30 years later with police officers on raids we were doing in 1978. My experience has certainly shaped my thinking.
“Sadly, none of the political parties is up for change. Our whole drugs legislation should be fundamentally reviewed. I have been there to see the bodies with needles sticking out, the human despair. It will actually pay in the long-term. The whole idea is to get people into recovery and change their lifestyle.”
Hogg claimed that politicians were out of step with the public, who realise the current policy is not working. The cost of supervised heroin treatment is about £15,000 per patient per year, a third of the typical cost of keeping someone in prison. It is about three times the cost of prescribing methadone, the usual GP-administered treatment for heroin addicts. However, methadone has its own issues in that it also highly addictive.
Danny Kushlick, director of Transform, said: “We congratulate policymakers in Durham. Heroin prescribing is proven to save lives, improve health and reduce crime. In fact, one would have to wonder why anyone would opt for criminal control of the trade, especially when overdose deaths in UK are at their highest level ever.”
The Office for National Statistics have recently published figures for drug-related deaths and although those for heroin show a marked decline, somewhat bizarrely those connected to the so-called treatment have rocketed. The 2011 figures for heroin or morphine overdoses were 596, compared to 791 in 2010. In 2008 there were nearly 900.
According to the ONS, these figures reflect a reduction in the total number of hard drug users in the UK, together with a 'heroin-drought'. This shortage, caused mostly by poor weather conditions in Pakistan and disruption of supplies from Afghanistan, has led to heroin supplies drying up on the street and made finding any of high quality extremely difficult.
Conversely, if the disease is not killing people, the treatment certainly is. Methadone deaths have risen from 355 in 2010 to 486 in 2011. It will be recalled that the Chairman of the Royal College of General Practitioners, Dr Clare Gerada, recently re-assured Russell Brand in his tv documentary that methadone prescribing was 'the gold standard' in drug treatment. In reality it's just a cheap treatment option and many people tell me much harder to withdraw from than heroin.
As an aside, I found it fascinating how the discovery of the substance came about in 1937 as a result of a German military search for an opiate substitute. It will be noted that they decided not to use the substance due to the significant number and character of side-effects, a situation confirmed to me on a regular basis by current users.
PS Since publishing the above, I've been looking around further on the subject and found this response to an article in the British Medical Journal from 2009. In addition to highlighting just how dangerous methadone is, the author mentions something I was loathe to as possibly being in bad taste. They ponder the possible perverse incentive of such a treatment policy "as death is without doubt a drug free state."
So it's official. Justice Secretary Ken Clarke has told the House of Commons Home Affairs Committee that 'the UK is plainly losing the war on drugs'.
"We've engaged in a war against drugs for 30 years. We're plainly losing it. We have not achieved very much progress. The same problems come round and round but I do not despair. We keep trying every method we can to get on top of one of the worst social problems in the country and the single biggest cause of crime."
The best he could offer the committee was that "there was better co-ordination between government departments".
So since when do intelligent people just carry on doing the same thing, when clearly as Ken confirms "nothing seems to be working". If he was a probation client and displayed such obvious cognitive deficits, we'd put him on an Enhanced Thinking Skills course. You'd think that the time had come to consider other options, a different approach perhaps, but not at all. What the government is actually doing is carrying on with the same failed policies and just 'reshuffling the deckchairs' by paying drug treatment providers differently.
As I have discussed previously, the government is convinced that introducing Payment by Results to whole swathes of public service provision will miraculously deliver better value for money by encouraging better outcomes. In April this year this new miracle accountancy device was rolled out in eight areas who bid to be guinea pigs under the grandly titled Payment by Results for Recovery Pilot Programme. From the initial twelve applications, Bracknell, Enfield, Kent, Lincolnshire, Oxfordshire, Stockport, Wakefield and Wigan were selected, not to do anything substantially different, just carry on with failed policies like community methadone prescribing. This initiative follows on from the previous one entitled Drugs System Change Pilot Programme that involved lots of accountancy changes, but kept delivering the same failed treatments.
Confident in the knowledge that the war is being lost, I nevertheless forced myself to read some of the impenetrable crap that the new PbR industry has spawned and in the process provided lots of jobs for bean counters. This is typical from Enfield:-
In 2009 the DAAT was keen to develop a revised commissioning framework to
embrace the wider Personalisation Agenda and Department of Health’s World Class
Commissioning Vision. This included tendering for a new contract that required
applicants to submit proposals for a mixed outcome and activity service level
agreement against a capped annual contractual value of £1.35M. Tender applicants
were also tasked with driving up performance against previous activity levels to
ensure that the DAAT Partnership was able to evidence value for money. The tender
applicants had to submit two separate weekly unit costs: one for people in treatment
in receipt of prescribing services; the other for those in treatment but who were not
receiving prescribing services. The new contract was awarded to a third sector
provider and came into effect on 1st January 2010, running for 5 years. The DAAT,
therefore, has obtained set weekly tariffs with the prime provider for processing
individual community treatment budgets.
Reading this stuff you could be fooled into believing that it might represent a policy that could lead to better services for alcohol and drug dependent people. Instead we all know it will just lead to cynical creative accounting on an industrial scale. What's needed of course is a change in policy, away from methadone or abstinence for everyone, to a real personalised agenda that includes heroin prescribing and residential treatment. Just imagine what a difference it would make if a heroin addict could be assured of regular, quality assured, free doses in a safe environment and without the risk of contaminated needles or the imperative to go out stealing. It would reduce crime at a stroke and make our job a damn sight easier.
I can't help noticing that my mention of drugs the other day as having utterly changed the criminal justice landscape over my working life, generated quite a lot of comment. My most popular post ever was about the war on drugs having been lost, so I thought it might be an idea to add a bit more to the discussion.
When I took up post in my small English town in 1985, heroin had yet to arrive. I found that most of my reports for court concerned offences that in some way were connected to alcohol misuse. Of course this legal, but potentially highly addictive mind and mood-altering substance, is so socially acceptable that its consumption is almost compulsory. This is despite there being loads of evidence to show that it's a dangerous substance, both in health terms and as a major ingredient in the commission of violent acts. If it was invented tomorrow, it would surely be illegal.
But of course despite being potentially dangerous, like many things in life, it's also very enjoyable and that's why I indulge regularly, along with many other people I know. What makes the difference is that despite being an addictive substance, alcohol can be enjoyed without it becoming an addiction. For the fortunate majority, they remain in control, not the other way round. Of course there is scope for any of us to possibly be deluding ourselves, but the key is whether or not a person finds that their life becomes adversely affected by a driving compulsion, the satisfaction of which takes priority over all else. I would normally assess someone as suffering from an addiction when their health is seriously affected and when they are unable to function normally in terms of shelter, nourishment, employment and relationships.
Trying to supervise clients suffering from alcohol addiction and slowly killing themselves can be a harrowing experience. The same goes for heroin of course or any number of other illegal substances. But addictive behaviour can come in many forms and gambling, driving or sexual activity can all be just as potentially harmful or disabling and bring people into contact with the Probation Service through associated criminal activity. I have remained of the opinion that such behaviour should be viewed as a medical phenomenon and indeed back in the 1980's it used to be. In those days I was able to refer clients relatively easily to a Regional Addiction Unit that was based at an NHS hospital. In my experience it's not so much a case of an addictive substance, but rather a propensity towards an addictive behavioural trait.
In suggesting that society takes a radically different approach towards illegal substances, I'm basically wanting to highlight the utter futility of the present approach. Virtually no aspect of the current regime works, in fact much of it compounds the problem and is hugely expensive along the way. Even though politicians dare not talk much about the issue, tentative prescribing regimes within the NHS are beginning to prove what many of us have suspected for some time, namely that legal access to heroin can enable a person to live a normal life, either on a maintenance dose, or withdraw more easily if they so desire.
We've all known for years that the middle-classes can manage to keep a good job and hide their drug use because they have the means to fund the habit without recourse to acquisitive crime. In the absence of a chaotic lifestyle and criminal activity, there's also evidence to support the thesis that many can maintain a recreational level of consumption, similar to that of responsible alcohol users.
So, just to be clear, certainly in relation to heroin and similar substances, I'm not advocating decriminalisation, but rather a return to the situation pre Misuse of Drugs Act when heroin could be prescribed and hence controlled by the medical profession. Alone it would not solve the drug problem entirely, but it would be an intelligent move in the right direction and help both those who have a problem addiction and those who might be termed to have a recreational need.
The following happened several years ago when probation officers still enjoyed a mixed bag of cases to supervise, by which I mean we were not restricted to just high risk cases, but some that might have a significant 'welfare' dimension as well. It was also a time when typically you would have written the PSR, decided what the key issues were, what the recommendation would be, how the supervision plan would look and would have taken the case when sentence was passed. All this was regarded as completely normal and in fact was extremely good practice for the time. The ground work had been done, building a relationship had started and the person wasn't passed around like a parcel. Sadly it is most unusual nowadays if the author of a report subsequently ends up supervising the case. But that's another story.
The client in question was a young woman of about nineteen years of age. She had lost touch with her family, been in care, suffered sexual abuse, had a string of unsuitable boyfriends who introduced her to heroin and had already accumulated an offending history that had led to several periods in custody. This is a scenario that will still be very familiar to probation officers nationwide and usually signals a rapidly descending spiral of decline. If I remember correctly I interviewed her on remand for a whole string of shoplifting offences whilst on licence.
The young woman was homeless and in a sense the report was fairly easy to write because the disposal appeared so obvious to me. She clearly needed help and a Probation Order seemed the most appropriate way to try and give her a fresh start, as long as a hostel place could be arranged. I felt it appropriate to attend court on this occasion so as to be able to convey her to the hostel if an Order was made. It duly was about 3pm, but unfortunately no provision had been made by the prison to supply a methadone script so that her treatment could continue straight away when released. This is not that unusual, even though prisoners attending court are routinely 'discharged' with their belongings. It represents but one of those very irritating lack of joined-up parts of the Criminal Justice System.
We arrived at the hostel at about 4pm and I stayed to chat with the staff and make sure she settled in ok. I remember we were in the middle of a conversation in her room when she suddenly announced 'Look Jim you're a nice bloke, but if I you don't give me a lift into town now so I can graft it'll be too late.' It's one of those absolutely classic defining moments in your career. What the hell do you do? There was no hope of getting any methodone legitimately at that time of day. This woman is going to be 'rattling' shortly and could only think about how to avoid it. She had told me too much information and was effectively inviting me, her probation officer, to assist in the commission of criminal activity by giving her a lift into town. My career could be ending with a headline in the local paper. I could refuse, give her a lecture or worse in my view, money. Of course parents of drug-using children are often faced with a similar dilemma. Throw them out, or give them money for drugs.
This is a difficult job at the best of times and sometimes decisions are just not clearcut. I had to carry on working with this person and help her turn her life around. In order to try and fulfill that longer term aim, my decision was to reluctantly give her that lift on this occasion.
It seems incredible, but there was a time when heroin did not have such a strangle hold on certain parts of society. When I started out in 1985 there was some glue sniffing, abuse of cough mixture (still containing opiates) and some cannabis use, but the main drug problem was alcohol. In those days drug addiction of any serious nature was referred to a Regional NHS unit, complete with admission and treatment beds - oh how things changed over the following years when widespread heroin use and associated offending began to be the predominant feature of the majority of probation work. I remember a senior police officer telling me it arrived in my small town in the boot of a black BMW in 1991. Sadly, as the problem grew exponentially, the resources to deal with it have proved woefully inadequate. Residential treatment beds became as scarce as hens teeth, and if located, funding proved a bureaucratic nightmare. For whatever reason the answer was felt to be methadone treatment in the community - cost must have been a factor, but it soon became clear to me that this 'one size fits all' approach was clearly not working. Client after client would describe to me how much more difficult it was to come off methodone than heroin. They said things like 'it gets into your bones' and many chose the nightmare of 'cold turkey' from heroin rather than go back onto a methodone script. As the years have rolled on, I've become aware of increasing numbers of clients on maintenance doses of methodone, rather than the reduction programmes that have clearly failed - and yet as a society we remain wedded to this failed model.
I once had the chance to speak to Hilary Benn when he was probation minister - he was lamenting the state of many neighbourhoods littered with sharps when I said 'well why don't we prescribe heroin?'. He said 'you know, you're the third person to have said that to me today'. Sadly he was soon promoted to Overseas Development and you have to start again with another minister. The reason we don't of course is because all ministers are scared witless of public opinion and especially by the right-wing press such as the Daily Mail. Nevertheless, there have been quiet prescribing experiments taking place in a couple of cities and the results are confirming what has been found to be the case in Switzerland - it works in weaning off those that are well motivated, is safer for those maintained and offending dramatically reduces. So, the question is, does the new coalition government have the bottle to finally signal a rethink on drug treatment - and sod the Daily Mail?
