The best treatment for addiction: Free heroin! It is the best way to slash crime

The Independent UK

6 March 2004.

The best treatment for addiction: Free heroin!
It is the best way to slash crime

By Johan Hari

When Erin O’Hara was using street heroin, she explains, “I was supporting myself either by drug dealing or sex work. I was constantly thinking about my next fix. Then, when I went into treatment I entered the nightmare merry-go-round of trying to get something to treat my addiction from the NHS, I went through 10 methadone programmes trying to find one that worked for me. Because of inflexible regimes and restrictions on what doctors are allowed to prescribe, I lived in a limbo land of trying to get what I needed.” She developed vicious abscesses. Her veins were corroded because of the impurities in street heroin.

Yet today, Erin, 34, is a dazzling success story. She edits an acclaimed magazine, Black Poppy, discussing harm reduction. She neither deals nor sells her body. Her veins are healing and there are no abscesses on her flesh. Except she isn’t a poster girl for abstinence, a “Just Say No” calendar girl. She is still using heroin – but this time, it’s legal. She is one of 450 people who is being given on the NHS the heroin her body is chemically dependent on.

The debate about heroin in Britain rampages without ever mentioning the people at the frontline of the war on drugs: heroin addicts themselves. But now the junkies are fighting back. Since 1971, the British government has waged war not just on heroin but on heroin addicts; and they have been treated not as victims of an illness but as morally fallen criminals.

Over the past two days, heroin addicts have been gathering in London for a National Treatment Conference where they are liaising as equals with health professionals and drug workers. Organised by the Alliance, an advocacy group for opiate-dependent people, they are no longer prepared to be passively pushed around a punitive system. Now that they have (to the Government’s credit) been given statutory rights to be consulted, there is a large and growing heroin users’ movement which is demanding that the wider public acknowledges some basic – if uncomfortable – truths.

Lesson one: detox very rarely works. Even the most successful detox programmes in the world have a success rate of just 25 per cent when it comes to heroin. The average is closer to 10 per cent. This means that for three quarters of the people who go through gold standard, lavishly-funded detox, it fails completely, and they return to heroin on their release. How can it be sensible for this failing approach to be the only treatment we offer to addicts on a national scale through the NHS?

Lesson two: prescribing opiates works. Mike Trace, the former deputy drugs tsar and an international expert on harm reduction, explains: ”There’s a huge amount of research – so conclusive that it is not even disputed – that methadone prescription can have a spectacular impact on both the health and social functioning of an opiate-user and on the wider crime rate. The recent Swiss experiment – where they have begun at a national level to prescribe heroin to anyone who needs it – seems to indicate that heroin prescription can be even more effective.”

Lesson three: pure, pharmaceutical heroin can be taken indefinitely without any negative effects. This is so counter-intuitive that it needs to be explained. If an alcoholic like George Best continues to drink indefinitely, the alcohol itself will destroy his liver and kill him. Isn’t giving heroin to a junkie every morning like handing a crate of whisky to an alcoholic at dawn? Every single doctor agrees that heroin is not like that. If an addict is using pure heroin, it does not damage their bodies at all.

It is true heroin rapidly makes you completely dependent on getting more heroin. That’s why anybody would be very foolish to start using it. And street heroin screws you up badly, because it is cut with all sorts of – to use the term doctors repeatedly use – “crap”.

In light of these truths – which are considered totally uncontroversial by all policy experts – we all, as citizens, need to ask what to do now for the 280,000 heroin addicts in Britain. The Alliance, and most heroin addicts I have met, argues that the Government needs to offer much more widespread maintenance prescription of heroin on the NHS. This won’t be the solution for everyone. The Alliance supports people who think detox is the best solution for them, because some extraordinary people do manage to wean themselves off completely. But for most people whose bodies have a desperate chemical need for heroin, the best way to live a normal life is to be prescribed heroin.

It is natural for some people to object to this on the grounds of cost. “Why should my taxes pay for a load of junkies to get stoned?” they might well howl. Simple: because it saves vast sums of money overall. Half of all burglaries are, according to the Home Office, committed by people driven by opiate dependency. If diabetics could not get their insulin without paying, they would do the same.

Prescribing heroin saves money further down the system in policing, inflated insurance premiums, hospitalisation, and prisons. When we prescribed heroin in Britain, until 1971, our crime rates were far lower. The Swiss experiment has seen a staggering fall in crime – over 20 per cent in some areas. As one heroin addict who asked not to be named explained to me, “Of course, I stopped stealing when I got a prescription. I wasn’t doing it for fun.”

The story of New Labour’s policy in this area has barely been told. As in so many areas, ministers are split between their “tough on crime” neurosis and their sensible, centre-left natures. We all know the “tough” bit: drug-testing in schools and other impractical nonsense. Yet who has heard the pragmatic side? Who knows that the dramatic fall in crime the Government boasts about is not due to its “toughness”, but to its centre-left spirit?

Look at the facts. In 1997, there were 40,000 methadone prescriptions in Britain – enough to cover around 15 per cent of our opiate dependents. Today, there are 70,000 prescriptions – enough to cover around 25 per cent of addicts – and the number doctors are giving out is rapidly rising. Is it pure coincidence that the crimes most often committed by junkies (burglary, muggings, shoplifting) have plummeted as prescriptions have risen?

Government policy is working – but the Government is so afraid of public prejudice it won’t boast or take its success to the logical conclusion by offering full heroin prescription to all addicts. David Blunkett will reply, no doubt, he is trying. He recently made an eloquent case for increasing not just methadone prescription but licences to prescribe heroin. The Government has projected a further 2,000-3,000 heroin prescription, but nobody at the Home Office press office believed there had been any progress on this. The addicts I know haven’t seen any increased rate.

Until this legal heroin starts getting to people, they will continue to get it the only way most know: through crime. So every time you are burgled, curse the Government’s refusal to prescribe heroin. Every time your car radio is stolen, curse the Government’s refusal to prescribe heroin. Every time your child is mugged, curse the Government’s refusal to prescribe heroin. Blair and Blunkett’s own policies have demonstrated that prescribing opiates directly slashes crime. Never imagine this is an issue only for them, Erin and the other addicts in the Alliance arguing for humane treatment. It is an issue for you too.