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"Heroin: The solution?" by Jeremy Laurance, Health Editor, The Independent (UK)

2nd June 2006

Drugs charities called yesterday for Britain to abandon its tough approach to heroin use after research showed one European city had cut the number of new addicts by transforming the image of heroin into a "loser drug".

The UK should follow the example of Zurich, which adopted a liberal drug policy a decade ago, and has seen an 82 per cent decline in new users of heroin, experts say.

The change has been achieved by offering drug addicts in Switzerland "substitution" treatment with injectable heroin on prescription, as well as oral methadone, needle exchange and "shooting galleries" where they can give themselves their fix.

The new approach has medicalised drug use and removed its glamour, researchers say. Crime and deaths linked with drugs have fallen, and the image of heroin use has been transformed from one of rebellionto an illness.

"Finally, heroin seems to have become a loser drug, with its attractiveness fading for young people," said Carlos Nordt of the Psychiatric University Hospital in Zurich. The Lancet, which publishes the research today, accuses the Government of resisting reforms such as the introduction of drug consumption rooms - safe injecting houses for addicts - which are contributing to Britain's death rate from illegal drug use, which is the highest in Europe.

Their introduction was first recommended by the Home Affairs Select Committee in 2002. Last week a report from the Joseph Rowntree Foundation, backed by police chiefs, urged the Government to act.

"After four years and thousands of needless drug-related deaths, a thorough trial of drug consumption rooms is a requirement the Government cannot afford to refuse a second time," The Lancet says in an editorial.

Responding to the report, Vernon Coaker, a Home Office minister, reiterated the Government's key objection, that drug consumption rooms risked increasing localised dealing and antisocial behaviour.

The Tories said they would consider the proposal. Edward Garner, shadow home affairs minister, said: "If this is to be used as a stepping stone to actually getting people off drugs we will look at it carefully."

There are an estimated 280,000 problem drug users in the UK, most taking heroin and crack cocaine, and around 2,500 deaths a year. Professor John Strang, director of the National Addiction Centre at the Maudsley hospital in south London, said: "If there is something magical about what the Swiss have done it is not handing out the heroin - it is the heroin mixed with routine and drudgery. All the drugs are consumed on the premises and the patients have to come in three times a day for their dose. It is extremely medicalised. The rebellious nature of drug use has been institutionalised - in the same way that punk was institutionalised when it was adopted by the fashion industry."

Writing in The Lancet, Dr Nordt and his colleague Rudolf Stohler say drug use in Zurich rose rapidly from 80 new registered users in 1975 to 850 new users in 1990. It culminated in open drug scenes at the Platzspitz ("needle park") and subsequently at the former railway station Letten.

Since 1991, when substitution treatment became available to all heroin users in Zurich, the number of new addicts has dropped sharply to 150 in 2002. The overall number of heroin addicts in the city has declined by 4 per cent a year, even though the average length of time each user spends on the drug has increased.

The researchers say the finding confounds critics of the liberal approach who predicted that it would increase drug use. Despite giving addicts readier access to the drugs they want, drug use has fallen. Deaths from overdoses and drug seizures have also declined, they say.

Supporters of the approach hailed the study yesterday as evidence that the policy works. Drug use in the UK continues to rise, figures show.

Victor Adebowale, the chief executive of Turning Point, the drugs charity, said: "Heroin prescribing should be part of the mix of getting people to succeed in treatment. Experience abroad has shown that prescribing heroin helps to stabilise some users who have tried and failed with a methadone prescription, and have been in and out of detox and rehab." A spokeswoman for Drugscope said: "We would very much like to see heroin prescribing extended here. There is a lot of international evidence that it can help entrenched drug users to stabilise their habit and move to a drug-free lifestyle."

Many robberies and much antisocial behaviour is drug-related, and a large number of addicts are homeless. Extremely pure heroin appearing on the streets can lead to a surge in deaths. A BBC survey found that three out of four people believed that illegal drugs were a problem in their local area and more than half thought that the police should be doing more to tackle it.

The spokeswoman for Drugscope added: "The problem with many drug users is that they keep going back to street drugs and drop out of treatment. Effective measures that keep them in treatment are what we need."

Five steps to a more liberal policy

* Prescribing injectable heroin: Evidence shows it can draw users into treatment, is safer, and can help long-term users stabilise their lives.

* Drug consumption rooms: Provide a safe house for drug users to inject, where they do not cause a nuisance and can be monitored.

* Methadone substitution: Offered as an alternative to street drugs it is taken orally, is safer, and gives a gentler high.

* Needle exchange: Providing clean needles reduces the risk of the transmission of diseases including HIV and hepatitis.

* Relaxing the law on cannabis: Downgraded two years ago from a class B to class C drug to free police to concentrate on suppliers.

The doctor: 'Lives have been turned around'

"Our clinic in south London is modelled on the Swiss one. It is deliberately sterile - we don't allow Led Zeppelin or joss sticks. It isn't about creating a social ambience. We are treating 20 to 30 patients - pretty entrenched cases.

"We have no published results yet but we have been very surprised at how well some people have turned round their lives. These are people who had been in treatment and doing badly, usually for years."

"Experience [from elsewhere] shows a large number move on within a year, usually to oral methadone. It is the routine and drudgery that does it. The heroin hooks the junkie into a routine that makes them think, 'I want to move on from here.' That is what the Swiss have achieved.

"But it would be a mistake in the UK to think that this endorses a liberal prescribing policy in the sense of a free-for-all. What it endorses is heroin prescribing in an incredibly rigid environment.

"Drug-users don't want to keep coming to see their drug worker three times a day. If they switch to methadone it might be once a day or once every three days."

"Heroin has been prescribed in Britain to a small group of about 500 users for years. But the scheme lost credibility because the drug can be taken away and is given in very small doses out of fear it would be sold on the black market.

"The new clinic allows high doses like the Swiss because it all goes up their arm - it has to be taken on the premises - and we don't have to be institutionally paranoid about where it is ending up."

Professor John Strang is director of the National Addiction Centre at the Maudsley hospital in London. The hospital has opened the first pilot scheme offering drug users heroin on prescription. Three more are planned

The former addict: 'Give them heroin'

"I agree with giving addicts heroin in very controlled conditions. I am not saying the method should be used on a 15-year-old but if someone has tried rehab, counselling and everything else but they keep relapsing and committing crimes, then I believe it should be used as a last resort.

"I was addicted to heroin for 23 years, from the age of 15 to 38. I lived on the street, squatted and went in and out of prisons.

"It wasn't a life choice at 15. I was self-medicating at home because I was brought up around alcohol and Valium, which my father used. He was aggressive. I tried to run away three times - first at 12, then 13, and then finally at 15. I ended up on the streets in London, where I met a lot of other distressed young people who were self-medicating.

"I spent quite a lot of time in prison - I think I went in a total of nine or 10 times - because you will do anything to feed your habit. It controls you and you are its servant. You will either resort to crime or to drug dealing because those are the only ways to fund your habit.

My addiction cost £200 a day and it wasn't numbing me any more, my tolerance was so high. I believed I was going to die that way.

"Every time we left prison with our medication, we'd be selling it by the time we got to the prison gates.

"I tried to give up in rehab when I was 34 but I got thrown out after 28 days for being disruptive. I remember being in tears as I walked out of the gates and I was already back on heroin by the time my train pulled into King's Cross.

"When I finally gave up at 38, it took me 12 months to stabilise myself on methadone. I have seen what methadone addiction can do."

Rob English, 42, is a former heroin addict from south London. He uses the services of Turning Point, a social care organisation

(c) Independent
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