An Injection of Common Sense?

When the National Treatment Agency for Substance Misuse began its heroin “shooting gallery” pilot project four years ago, critics argued that it would result in a proliferation of drug dealing and crime.

In fact, it has had the opposite effect. In the areas of south London, Brighton and Darlington where heroin prescribing clinics have been set up, levels of both drug dealing and crime have declined.

The controversial trial has witnessed heroin worth millions of pounds administered to users at special NHS clinics in a bid to stop them funding their habits through crime. Indeed, the primary purpose of the clinics is to minimise the social harm that heroin addicts inflict on the wider community.

Britain has an estimated 280,000 Class-A drug addicts. Official figures show that hard core drug users are responsible for three quarters of acquisitive crime in the UK. Advocates argue that the clinics, which offer free injectable heroin, reduce the need for addicts to steal to buy their fix from street dealers.

Paul Hayes, Chief Executive of the National Treatment Agency (NTA), has stressed that the clinics should not be confused with “shooting galleries”, which are simply legalised consumption rooms for the use of illicit street heroin. Rather, prescription clinics are well supervised and provide pharmaceutical diamorphine administered by a doctor.

Heroin clinics have had a positive effect on local communities in Switzerland, the Netherlands, Germany and Canada, reducing crime and boosting rehabilitation success rates. Last year, Swiss voters approved a nationwide rollout of prescription heroin in a referendum.

So are heroin prescribing clinics a practical, cost effective and humane way forward?

Critics say giving addicts drugs they were previously scoring off the street is not treatment, and argue that the cost at £15,000 a year per head cannot be justified when many NHS patients are being denied the latest cancer drugs.

However, addiction experts insist the scheme is about “harm reduction”, not cure. Moreover, they stress that the £15,000 sum is a third of the £44,000 annual cost of sending convicted junkies to prison.

Drug treatment in England has expanded since the NTA was created in 2001. The standard front-line treatment for heroin addiction, as recommended by the National Institute for Health and Clinical Excellence (NICE), is substitute prescribing, such as methadone, combined with psychological interventions, such as counselling. However, the effects of methadone (which is taken orally once a day) are much duller, and most patients continue to buy heroin in addition.

An expert group was recently asked by the Department of Health to look at the emerging evidence about injectable heroin and methadone in order to advise the Government on the next step forward. The study concluded that there is enough beneficial evidence to merit further trial clinics.

The findings revealed that the average number of crimes committed by addicts who attended the clinics fell from 1,731 in three months to 547 in six months. One third stopped buying street heroin altogether, while those who continued visited their dealer less often – around once a week instead of every day. These figures greatly supersede the success rates of methadone.

Professor John Strang, head of the National Addiction Centre at the Maudsley, who led the study, has described the UK scheme’s results as “genuinely exciting”, boasting that it has “medicalised” heroin addicts’ drug use, simultaneously breaking the link to street dealers and crime.

However, the scheme has come under fierce attack from Mary Brett, UK representative of Europe Against Drugs, who ridiculed it as “ludicrous”.

She said: “Most drug addicts want to give up, and addiction can be cured. We should be trying to help them get back to a normal life.”

“But this isn’t even trying to cure them; it’s just giving them heroin for free. It is defeatism.”

“What are we going to do to help alcoholics? Give them alcohol on prescription?”

She added: “I fear it will be the thin end of the wedge. It will start with the most hardcore cases, but treatment services will find it easier to just give them a prescription, and more and more will be included in this scheme.”

In an age where GPs are more than happy to shovel antibiotics and ‘don’t be sad pills’ down our gullets to aid our every ache and whimper, does Brett pose a valid case? Or should we advocate harm reduction over mindless prohibition?