JURIST - Hotline: Heroin prescription for addicts is not a viable long-term treatment option

David Raynes [former Assistant Chief Investigation Officer in UK Customs, member of the International Task Force on Strategic Drug Policy]: "Observing from the US, what is happening in relation to drugs policy in Europe must seem truly confusing. Lurid headlines "Swiss legalise Heroin" or similar are half-truths. The reality is different. Prescribing heroin for the most chaotic addicts is nothing new, nor was it invented in Switzerland or the Netherlands, though both those countries do a little of it and the Swiss have just had a referendum on it. The reality is that both systems are only slight adaptations of the "British System."

The UK has had some sort of programme of heroin prescription for some addicts for over fifty years; it was reduced in the 1960s because of significant heroin leakage into the parallel illegal market in two ways, either from addicts selling some of their prescribed supply or through corrupt or incompetent doctors over-supplying. It was concluded that heroin, if prescribed at all, needed to be taken under direct medical supervision. Of the doctors who have special licences to supply heroin to addicts in the UK, very few show any great enthusiasm for it or seem to believe in it for other than the short term. Only very few clinicians have ever shown any enthusiasm for long-term "maintenance heroin" for addicts.

The UK's top academic expert has questioned if prescribing heroin is really "treatment" or if it is "social problem prescribing." Certainly in the UK much of the recent enthusiasm comes from some police officers and even the odd politician, frustrated at the lack of success in dealing with crime associated with drug use. They ignore the reality that criminal careers typically precede drug addiction and, in the UK anyway, much crime now is associated with crack cocaine use. That is certainly not being prescribed. The move in Switzerland is only for a select band of addicts who are a tiny proportion of the whole addicted population. It was driven originally, by a wish to clean up "needle parks," with obvious addict populations dealing and using in specific areas. These initiatives are also subject to heavy criticism.

So lurid headlines have overstated exactly what the Swiss "experiments" have achieved or even what they represent. The realities are that heroin maintenance on a substantial scale is just not possible. The costs have been massively understated. The cost is not just the cost of the drug. Heroin because of its short acting nature, ties an addict to his or her clinic, in a way that longer lasting oral methadone does not. Heroin, through injection, preserves undesirable and risky injecting behaviour. Each small town needs its own clinic with at least two clinicians depending on addict population plus premises, security, nursing staff (minimum two on duty at any time for security, plus other security) and 365 days a year opening. Larger towns and cities would need more than one such clinic, London for example, would need many. Each clinic would need opening hours of early morning to late evening. On this basis the costs and resources mount alarmingly and the illegal market does not disappear.

In addition, if such programs are provided on anything other than a huge scale they will not have much effect on crime. Many addicts would still commit crimes and many are poly-drug users - particularly crack cocaine. The issue is being misinterpreted, sometimes deliberately so, by those who favour legalisation. On any substantial scale it would encourage "drug tourism" across the EU. The arguments against substantial prescription of heroin in the UK are overwhelming. In the UK there is another current debate about to what extent getting users free of addiction is part of the treatment regime. That is what most addicts want.

Heroin prescription should only be considered within carefully controlled conditions and for specially selected long term and chaotic addicts. Heroin needs to be prescribed (if prescribed at all) in the context of a real effort (with other committed support), to get addicts free of addiction. The on-going small scale prescription in a few countries will be misrepresented as something else; because the media loves an argument and legalisation lobbyists think it a route to legalised drugs for all. It is not, of that I am absolutely confident.

We need to keep speaking out about it and explaining the flaws, a process one might call "reality seepage.""