Legal Heroin Turns Lives Around

[Citizen Kane]

'I get my heroin on the NHS'
By Tom Geoghegan

BBC News Online


Why did I have to wait until I'd finished selling my young body to men?

Get caught with heroin and you face seven years in prison. But not Erin O'Mara, one of 440 addicts in the UK to get a regular fix from an NHS prescription - an arrangement she says has turned her life around.

Erin O'Mara is a bright, bubbly magazine editor - hardly the stereotype of someone who injects heroin four times a day. But her habit, now in its 20th year, does not line the pockets of a drug dealer. The 34-year-old gets her fix from her local chemist in west London. This "perfect prescription", as she calls it, began two years ago and rescued her from a life of prostitution, drug dealing and serious illness.

The downward spiral began with Erin's first taste of heroin aged 15 while in her native Australia, and has included unsuccessful methadone programmes along the way. To finance her habit, she began working as a masseuse, which led to
escort work and then street prostitution. That stopped when she discovered she was HIV positive.

But the prescription has transformed her life. As founder of Black Poppy, a magazine by and for drug users, she addresses drug conferences and is being consulted about pilot projects.

Sitting in her office, she says: "My prescription has meant I have money now, and choices I can make in my life - simple things like what I want for dinner. I can do things I haven't done for years and can think five years ahead. Before I was just thinking about my next 'hit'."

ERIN'S DAILY PRESCRIPTION
° 4 x 100mg diamorphine (solid)
° 4 x sterilised water
° 4 x sterilised needles
° 4 x swabs
° pharmaceutically prepared
° advice leaflet enclosed

Each shot supplied by her chemist is just enough to enable Erin to function properly and prevent the onset of withdrawal. She only feels the buzz if she relaxes.

The NHS allows only licensed doctors to prescribe diamorphine, the medical name for heroin, to addicts if they have failed to respond to methadone treatment. At present just 0.5% of those in treatment are prescribed heroin, but new pilot projects are expected to increase that number.

Supporters of this policy, such as the independent research group DrugScope, say controlled distribution by the state can drastically reduce crime. They also argue that clean heroin like diamorphine is not in itself dangerous, just incredibly addictive.
And a pharmaceutical prescription excludes all the risks associated with unsafe injecting and enables the user to gradually be weaned off the drug.

Topped up doses
Erin believes this approach can save lives. But prescribing heroin is not always the answer, as she herself knows from the first programme she took part in in 1998.

HEROIN & THE NHS
° Prescriptions peaked in 1960s
° The UK is one of the few countries to allow it
° Any doctor can prescribe it for medical conditions, but need Home Office licence to treat addiction
° Home Office says every £1 spent on drug treatment saves £3 in less crime

Source: Drugscope


Prescribed heroin 'safe'

"The whole set-up was really oppressive and heavy-handed, but the doses were too low so people were using other drugs and too scared to admit it. No-one was happy and no-one was doing well on it. The carrot and stick approach doesn't work because you can't punish users enough to make them stop".

One patient, a 45-year-old woman, threw herself off a tower block two days after being penalised by having her prescription withdrawn, Erin says. And with strict attendance requirements and supervised injections, it prevented users from getting full-time employment.

Erin claims she was forced off the course after 18 months when she tried to start a support group. She then founded Black Poppy to give a voice to drug users, and address issues missed by treatment programmes.

After leaving the prescription programme, Erin was put on methadone injections, which she topped up with crack. This period was one of her lowest and her veins began to collapse.

When she heard about a vacancy on a pioneering prescription course at the Maudsley Hospital in south London, she cornered the doctor in charge at a drugs conference. "I remember my sense of complete and total desperation. I felt I could
not go on any longer, that if they didn't help me, I didn't know where I would be. I felt that this was my last hope, that I'd tried everything. And I begged."

Her powers of persuasion paid off and she joined what turned out to be a more flexible programme. She was able, for instance, to spend a few months at her mother's in Colchester and pick up her prescription from
a local chemist, so long as she visited the doctor every fortnight.

Her immune system strengthened, and two years on she is on a reduced dosage and aims to come off heroin completely.

HEROIN IN THE UK
° 200,000 heroin users
° 88,000 in treatment , of which 40,000 on methadone
° Heroin is an opiate which depresses the nervous system
° It can combat physical and emotional pain
° Users can feel warm, relaxed and detached
° Purity of street heroin varies, with a risk of fatal overdosing
° Unsafe injecting means risk of HIV, hepatitis, abscesses and ulcers

Source: DrugScope, NTA

As she looks to the future, there is a trace of anger about the years spent on and off treatment programmes.

"Why did I have to wait until I'd finished selling my young body to men, until I'd got sick and deeply depressed, until I'd used every vein in my body from my neck to my feet, until I'd contracted both HIV and Hep C?"

But she is optimistic that the government has begun to move in the right direction and listen to what drug users want.

[Source]

[serotonin]

i definatly think they have got the right idea.


i have never heard of heroin prescriptions before, but in severe cases like her's its a really good idea. i'm happy for all those people who are really trying, and now they can get the help they really need. i hope she is able to eventually quit completely one day. great article.

[Citizen Kane]

Originally Posted by serotonin

i definatly think they have got the right
idea.

For sure. However, I just found out that the
British authorities forced Dr. Marks to close the Clinic. Here is
the bad news:


"At about the same time, another
GP, John Marks, who pioneered the prescribing of heroin to drug
abusers in Liverpool, was forced to abandon his practice because
of Home Office pressure. He said he had helped patients lead stable
lives and cut crime rates in the area. He is now living in New Zealand."</font>


[Source]





I'm beginning to lose my patience with these idiotic Drug Warriors.




Here is the background story:


<div>Liverpool</span> Clinic Mocks Drug Warriors</font>



From Mike Gray of the Drug Reform Coordination Network



The British Health Service plans to terminate the contract with the Liverpool drug clinic </span>that has recently become the focus of the international drug policy
debate. The clinic is one of the last in England operating under the
rules of the so-called "British System" where addicts are given free
prescriptions for their drug of choice. Until the 1960s, this practice
was the norm in Great Britain, and was credited by many experts with
keeping the English addict population limited to a few hundred in
total. But over the last twenty-five years, outside forces -- largely
from the United States -- have pressured the British to bring their
policies in line with U.S. drug prohibition. The concept of heroin</span>
and cocaine maintenance for addicts has been slowly replaced with a
stringent methadone reduction policy intended to lead to total
abstinence.



The Chapel Street Clinic in Widnes (a suburb of Liverpool</span>) run by Dr. John Marks is the most famous holdout for the old system of free drug maintenance.
The incredible success of this small institution has been a stark
contrast with the documented failure of the other alternatives.
Unfortunately, the U.S. government has maintained constant pressure to
shut down this glaring example of an approach that flies in the face of
American drug war orthodoxy.



The situation became critical following a CBS "60 Minutes" broadcast on
the clinic. The facts in this story completely debased fundamental U.S.
policy assumptions. The
most startling statistic was the crime rate. Beginning in 1988, the
local police began tracking the criminal records of 112 addicts who
entered the drug maintenance program at Chapel Street. According to the
Cheshire Drug Squad, there was a 93 percent drop in theft, burglary,
and property crimes among this group over the next two years -- thus
illuminating the age-old argument about whether it is the drugs
themselves or the pursuit of drugs that drives addicts to criminal
behavior.



In addition, the HIV infection rate among these injecting drug users
was zero. Zero. And the incidence of death among addicts -- normally 15
percent per year -- was also zero.



Even more significant was the fact that the incidence of new drug users
in the Widnes-Holton area dropped dramatically -- contrary to popular
assumptions. Drug dealers simply stay away because they know the local
addicts don't need them anymore. And the addicts themselves have no
reason to sell drugs since they can get whatever they need for nothing.</font>



The "60 Minutes" broadcast and subsequent world-wide media attention --
MTV broadcast a segment from the clinic last fall -- has been a
terrible embarrassment to the British government, and its American
allies.



The British government could not attack Dr. Marks directly because the
British medical establishment -- unlike their American counterpart --
will not permit the state to get between a doctor and his patient. So
they attacked the clinic on the basis of economics, saying that heroin</span> maintenance is too expensive and that Methadone is much cheaper. A one- year supply of heroin</span>
costs the clinic 10,000 pounds, where Methadone costs 500 pounds. And
why does a synthetic drug cost less than the natural product? Because a
single British pharmaceutical company has been granted a heroin</span> monopoly and they are allowed to charge whatever they want.



The local health authority informed Dr. Marks that his services were
too expensive and that the future health needs of the addicts in the
district would be managed by the Warrington Health Clinic. There they
will be switched to a regime of Methadone maintenance and withdrawal.
Oddly, the Warrington Health Clinic has no trained personnel, their
management was recently investigated for fraud, the chairman had just
resigned -- and in fact, the clinic had not even bid for the contract.
Their solitary asset seems to be their Christian fundamentalist
philosophy.



So on April 1st of this year, Dr. Marks' Chapel Street Clinic will lose
its funding and 450 addicts now receiving maintenance doses will be out
on the street.



For many years, researchers in England and elsewhere have been asking
for a study of the British drug clinics to determine which approach is
most successful. This study has finally been commissioned. It will
start on April 1 -- the day Dr. Marks loses his funding. Then the
Methadone treatment centers in England will be able to avoid any
embarrassing comparisons with a system that actually works.



In March of last year I visited the Chapel Street
Clinic and met with several of the patients. I sat in on a group
session where eight heroin</span> users discussed their lives and problems with a counselor before picking up their weekly prescriptions for pharmaceutical heroin</span>.
Unlike the junkies we are used to seeing, this group was virtually
indistinguishable from any other bunch of young adults on the streets
of Liverpool</span>. They were well dressed, talkative, energetic -- they had jobs -- and they used heroin</span> daily.



One of the most attractive was a young woman named Juliette who had
been an addict for 13 years. She came from a middle-class background,
married a rich kid who got her into heroin</span>,
then left her with two kids and no money. She tried desperately to kick
but couldn't make it. Somehow for ten years she managed to stay afloat
through petty theft and prostitution, with the authorities breathing
down her neck. Finally, terrified that they were about to take her kids
away, she happened to find the right doctor and he sent her to John
Marks. Marks gave her a check-up, satisfied himself that she was indeed
a heroin</span> addict, and wrote her a prescription for a week's supply.



"For the first time in ten years," she said, "I had spare time. I
didn't have to worry that my dealer wouldn't show -- I didn't have to
worry about the price or where to steal the money. So for the first
time in ten years, I had a minute to look in the mirror. I looked and I
said, `Oh, my God.' Then I looked at the kids, and I said, `What have I
done?' All these middle-class values came flooding back in on me."



Today Juliette has a job, a house, and a mortgage. The kids are in
school and doing well. Everybody's in excellent health. And once a week
she comes to Chapel Street for her prescription. I asked John Marks
what will happen to Juliette on April 1. He said, "Well, she'll go down
the tubes."</font></div>

i have never heard of heroin prescriptions before, but in
severe cases like her's its a really good idea. i'm happy for all those
people who are really trying, and now they can get the help they really
need. i hope she is able to eventually quit completely one day. great
article.

They also exist in Switzerland. The experiences have
been extremely positive as well.






From the Heroin</span> OD Conference in Seattle</font>





Christoph Bürki</span>, MD, MPH



KODA-1

Belpstrasse 47

Postfach 450

3000 Bern 14, Switzerland





Swiss Approaches to Heroin</span> Overdose: From Safe Injection Rooms to Heroin</span> Prescription </font>





In Switzerland, heroin</span> overdoses
and measures against it are closely linked to the general discussion
about harm reduction, which was triggered in the 80's with the
emergence of HIV/AIDS. The early high prevalence of HIV, as well as
growing public gatherings of drug addicts in major cites (e.g. the
famous Platzspitz-needle park in Zurich), led to an early sensibility
of service providers and the broader public to issues of reduction of
drug related harm. This discussion led to the introduction of syringe
and needle exchange schemes, better access to methadone maintenance
treatment and the opening of "safe injection rooms", where IVDUs could
inject their drugs in a medically supervised environment. Safe
injection rooms proofed to be an effective way to change HIV/Hepatitis
related risk behavior on the one side and to reduce immediate dangers
of drug injection on the other side. In the Bernese room Ndgeligasse,
thousands of patient have been successfully resuscitated in the past 15
years, and not a single person has ever died, despite the fact that
Narcane has practically never been used.





Another project in the late 80's was the Kocherpark project, where
nonprofessionals (workers in a street syringe and needle exchange
program) were trained in basic life support measures, especially
resuscitation.





The continuing public pressure to do something against the open drug scenes in the early 90's finally led to the introduction of heroin</span> assisted treatment. Research has shown that heroin</span>
assisted treatment is effective in improving participants mental and
physical health, in improving their psychosocial situation, in reducing
drug related criminal activity and in drastically reducing mortality.</span>
Whereas cases of death from overdose in Switzerland have skyrocketed
from 120 in 1985 to 419 in 1992, they have since fallen constantly to
210 in 1998. Safe injection rooms and </span>heroin</span> assisted treatment have certainly contributed to this decline.</span>






Here is a chat with Dr. Bürki.

[VincentVan]

I know of the sad fate of one french experimental program with an heroin distributing clinic.
It seems that just a couple of months after the pilot program started working by letting selected addicts come into the clinic and have supervised safe injections of heroin, one of the patients that few minutes before got out of the joint, jumped in his car and shortly after drove down and killed a young mother with her baby.
To the police that intervened on the scene of the tragic accident and that could see that the driver appeared to be in an alterated and semi-confusional state, the driver admitted of having come out just minutes before from the clinic where he had been administered (if I remember right) 100mg of diacetylmorphine (heroin).
The father and houseband of the victims contacted his lawyer to sue the ministry of health for conspiracy to commit murder or aiding and abetting murder or both.
In order to avoid a politically devastating case, however, the Health Ministry agreed to settle out of court by paying to the plaintiff an undisclosed, and reportedly record breaking high, sum of money and granting him other undisclosed benefits.
The clinic in question and the pilot program were terminated within days of the accident.


Now, before telling you this story I have tried to find some reports of it in the french press . I was badly hindered by the fact that I can´t remember the year when it happened nor the town (even if I´m nearly sure it was either Paris or a suburb of Paris).
I think I had read about it either on "L´Express" or "Le Canard Enchainé"
Maybe some french member remebers this story?

VV.

Reputation Comments on this post:

Interesting story. Thanks for sharing it.