Newsgroups: alt.drugs
From: [p--t--r] at [petermc.demon.co.uk] (Peter McDermott)
Subject: Re: Helping addicts in England
Date: Sat, 19 Feb 1994 03:24:14 GMT


In article <[V P kyHc 4 w 165 w] at [mindvox.phantom.com]> [c--el--s] at [mindvox.phantom.com]
(...) writes:
>[h--ps--r] at [crl.com] (Alan Silverman) writes:
>
>> >Funny, they didn't mention a similar trial in Liverpool, England which
>> >apparently met with much success.  What they did was allow doctors 
>> >to prescribe drugs to someone who registered as an addicts.  The
>> >addict could them buy as much dope as he wanted, at cost, and stay
>> >home to get high.  The crime rates in the are dropped precipitously.
>> >
>> 
>> That program was just recently started up again, due to it's success.
>> The program lasts for about two years, after which they expect the
>> user to be off drugs completely.  There was a TV special about it last
>> year. Maybe 20-20 or 60 Minutes.
>
>   What you're both referring to is not some experimental program but 
>rather the standard policy for dealing with addiction in the UK- long 
>known here as the "British System". The UK never criminalized addiction 
>the way the US did, rather addicts (particularly opiate addicts) were and 
>are prescribed a stable dose of heroin or whatever and allowed to live 
>their lives. For some years an effort was made to switch the opiate 
>addicts to methadone instead of heroin (although injectable methadone is 
>often provided), but there is once again more leeway. Formerly private 
>doctors could prescribe, but now they must be associated with special 
>drug clinics. The posters were correct in that Liverpool has been in the 
>forefront of the re-liberalization movement. This policy has many other 
>benefits besides its humanity and the reduction of crime, for example, 
>Liverpool now has an HIV infection rate among IV users of just over one 
>percent, whereas the rate in NYC is around 60%. The US would do well to 
>learn something from the UK.
>
>    Peter, please weigh in here...
>
>

Gladly. A little background first. Since the 1920's, British family doctors
were able to treat addicts by prescribing them the drug of their addiction in
order to enable them to lead useful, productive lives. Concerned by the growth
in the numbers of new, young 'recreational' addicts (as opposed to earlier
generations who were normally doctors or therapeutic addicts) the Home Office
took the job away from family doctors and put it into the hands of the new Drug
Dependency Clinics. Unfortunately, these were staffed by psychiatrists. God
knows why, addiction is *not* a psychiatric illness. Anyway, after the DDC's
had been open for a few years, the clique of psychiatrists working in the DDC's
at the London teaching hospitals got tired of giving free heroin and cocaine to
addicts. These doctors saw their role as 'curing' rather than simply
'maintaining' patients. As few of their patients 'got better', there was
growing pressure for a change.

This pressure was also helped by the US government, who didn't approve of
heroin at all, and wanted the UK to move over to methadone. (Not officially, of
course, but professional contacts, grants, other strategies for influence)

At the end of the 1970's, the government commissioned a piece of research
(Hartnoll and Mitcheson is the ref.) that compared heroin maintenance with
methadone detox. The study suggested that a greater proportion of those people
on heroin maintenance were healthier, led more stable lives and committed less
crime. On the other hand, a greater proportion of those who got methadone detox
were still drug free after a year. However, much larger numbers dropped out of
treatment, got sick, od'ed, etc.

Consequently, the trend throughout the 70's was to drop heroin maintenance and
move over to methadone detox. This happened all over the country. (Cocaine had
been almost completely phased out by the end of the sixties.) If you had been
on a heroin script from the start, you might well still be on it, but by 1976,
anybody approaching a drug treatment service got an oral methadone detox.

Liverpool, however, was a sleepy backwater where there were still a handful of
old-timers getting heroin, and many more getting methadone ampoules. When we
discovered that HIV was transmitted via unsterile needles, my ex-colleague
Allan Parry set up the first UK needle exchange (a model that was copied across
the world) and Dr. John Marks expanded the use of the heroin prescription. As a
result, we caught HIV in the bud, and despite having the highest numbers of iv
drug users per head of pop., we have the lowest rate of HIV in the western
world (less than 0.1% - and all our registered addicts are tested annually).

After the success of this programme, the Advisory Council on the Misuse of
Drugs (the body that recommends policy to the Govt.) embraced the Liverpool
model and called for an enormous expansion in needle exchange and increased use
of 'flexible prescribing', i.e., more maintenance, more injectables, more
heroin. Consequently, there has been an increase in the use of all of these
modalities across the UK, though it is rarely publicised. 

However, in Liverpool, this programme was subjected to a great deal of
political in-fighting and concern about the cost of the drugs. Consequently,
the use of both heroin and injectables has been reined in slightly, in favour
of oral methadone maintenance. However, there are still people on incredible
scripts. Some of the goodies that I know currently being prescribed are:

Diamorphine Ampoules - 10mg, 30mg, 50mg 100mg (man-size amps!)

Methadone Ampoules - 10mg, 30mg, 50mg

Heroin reefers - 60mg (heroin in a smokable, cigarette form)

Cocaine hydrochloride atomizer (nasal spray)

Cocaine hydrochloride reefers (sorry, don't know the dose. However, by all
accounts these don't work.)

Cocaine freebase - Only one person, but he gets a gram of pharmaceutical base a
day!!!

Methylamphetamine (Methadrine) ampoules - 30mg.

.....and a host of other, less sexy preparations.

The biggest supporters of this programme in the UK are the police. Liverpool,
despite having the most addicts and the highest unemployment in the UK, is the
only place where acquisitive crime has continued to fall over the last four or
five years. 

British police have started to recognize that running around harrassing users
is a waste of everybodies time - and small dealers are just users. One gets
arrested, another takes his place. So they want to see programmes that manage
to successfully undercut the black market.

There is also an immense amount of public support. Most of the opposition comes
through people in the medical profession, who hate to see individuals being
allowed to usurp their authority by deciding what drugs they will put into
their body. 

The other issue is that of cost. Some people feel that why should addicts get
free drugs when old people wait years for a hip replacement? The answer, of
course, is if you don't, addicts will burgle your house, and fuck your
daughter. I hope you won't be to upset when she turns out to be HIV positive.
So the Liverpool model is really a pragmatic response to a problem that had
gotten completely out of control. Eventually, I expect to see it accepted and
expanded everywhere, simply because of the cost of the War on Drugs is
spiralling out of control. Eventually, the general public will want measures
that work. This one does....

Is that enough? Questions?

	-peter