Evidence-based drugs policy works: provide safe injectable-heroin rooms throughout the UK
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FIFTY YEARS OF DRUGS POLICY HAS BEEN A DISASTROUS FAILURE, BASED ON PREJUDICE AND NOT ON EVIDENCE
On 14 July 2017, the Home Secretary, Amber Rudd, announced a new drugs policy which she claimed was evidence-based, but which in fact ignored the evidence of the Random Injectable Opiate Treatment Trial, as well as other research and experience (https://www.facebook.com/transformdrugs
The science demonstrates that addiction to drugs and alcohol is a medical condition affecting a minority of people exposed to these widely-available substances. The young people affected are unlucky - they have a genetic predisposition to become addicted, probably due to high sensitivity of the mesolimbic or reward system in the brain, but do not know this when they experiment with drugs. Heroin addiction results in compulsion to obtain the drug by any means available and often forces close family to abandon a much-loved son or daughter, brother or sister. Family members who stay in touch and feel compassion, are subjected to begging, pleading, lying, stealing and deception from their loved to feed a monstrous habit.
In the 1960s there were reckoned to be only 6000 heroin addicts in the UK. They were prescribed heroin and were able to hold down jobs. That is still known as 'The English System' and many other countries have recently introduced something similar (e.g. Portugal, Switzerland). By ending that policy the UK opened itself up to black-market heroin supply via criminal gangs, crucible of knife and gun crime, using 'pushers' to increase the buyers for street heroin. It is now estimated that there are over 300,000 UK heroin addicts. Cuts to substance misuse services mean that detox and rehab is currently much less available to the vast majority; and even when it is, relapse rates within 3 years were extremely high, so the effectiveness of that approach is questionable. Heroin addiction is frequently lifelong, and involves the sufferer in a dangerous criminal lifestyle, with a high risk of premature death. The social effects of addicts' compulsion are unacceptable but current policy is failing to deal with them. Prescribing injectable heroin would rapidly pay for itself in terms of reduced shoplifting and burglary, and would simply replace the fairly ineffective methadone that is currently prescribed.
Heroin addicts face many other threats e.g. deep vein thrombosis, pleural infections, being ripped off by dealers, mates stealing from them, being malnourished, fear, panic and depression. In some cases people are self-medicating to prevent psychosis. Addicts' lives are chaotic and miserable, and deliberate overdose is not rare. This is not a lifestyle choice, it is a tragic misfortune which leaves people powerless, ruinous not only for the individuals but also for their families. Over 300,000 UK families need a new approach to drugs policy now. http://anyoneschild.org/about/
Overdosing can be countered by naloxone, and heroin itself is far less likely to kill the user than the ingredients used to 'cut' it.- currently dangerous fentanyl is being used for this and has already caused fatalities. http://www.talkingdrugs.org/the-uk-government-can-prevent-a-fentanyl-crisis-but-it-must-act-now
The RIOTT trials in London, Brighton and Darlington demonstrated the value of providing injectable heroin for addicts who cannot be helped by other methods.
The results were reported in The Lancet in 2010
Supervised administration of injectable ‘medical’ grade heroin (diamorphine) leads to larger reductions in street heroin use in chronic heroin addicts who are failing in conventional treatment, than does either supervised injectable methadone or optimised oral methadone. The findings of the Randomised Injectable Opiate Treatment Trial (RIOTT) trial are reported in an article in the Lancet, written by Professor John Strang and colleagues from the National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s. https://www.kcl.ac.uk/ioppn/depts/addictions/research/drugs/riott.aspx
At least 5–10 per cent of heroin addicts fail to benefit from established conventional treatments but whether they are untreatable or just difficult to treat is unknown. A scientific evidence base is emerging to support the effectiveness of maintenance treatment with directly supervised medicinal heroin (diamorphine or diacetylmorphine) as a second-line treatment for chronic heroin addiction.
This randomised controlled trial looked at chronic heroin addicts who were receiving conventional oral treatment but continued to inject street heroin regularly. Patients were assigned to receive supervised injectable methadone, supervised injectable heroin, or optimised oral methadone. Treatment was provided for 26 weeks in three National Health Service (NHS) supervised injecting clinics in England (London, Brighton and Darlington).
Lower use of street heroin
The researchers found that at 26 weeks, 80 per cent of patients remained in assigned treatment - 88 per cent on supervised injectable heroin, 81 per cent on supervised injectable methadone and 69 per cent on optimised oral methadone. Proportions of patients achieving 50 per cent or more negative samples for street heroin were highest in the injectable heroin group (66 per cent) followed by injectable methadone (30 per cent) and oral methadone (19 per cent). The measure of measurable improvement, the pre-selected primary outcome, was that, through months 4-6, at least 50 per cent of randomly collected urines tested negative for street heroin (from weekly random urine analysis). The authors report on 'abstinence from street heroin' also, and a similar greater benefit of the supervised heroin treatment was seen, compared with the other two treatments.
The authors say: 'We have shown that treatment with supervised injectable heroin leads to significantly lower use of street heroin than does supervised injectable methadone or optimised oral methadone. Furthermore, this difference was evident within the first six weeks of treatment.'
They conclude: 'Rolling out the prescription of injectable heroin and methadone to clients who do not respond to other forms of treatment, is detailed in the UK Government’s 2008 Drug Strategy, subject to the results from this trial. In the past 15 years, six randomised trials have all reported benefits from treatment with injectable heroin compared with oral methadone. Supervised injectable heroin should now be provided, with close monitoring, for carefully selected chronic heroin addicts in the UK.'
Professor Strang said: 'Our scientific understanding about how to treat people with severe heroin addiction has taken an important step forward. The RIOTT study shows that previously unresponsive patients can achieve major reductions in their use of street heroin and, impressively, these outcomes were seen within six weeks. Our work offers government robust evidence to support the expansion of this treatment, so that more patients can benefit.'
Unfortunately the trials were discontinued when the government changed in 2010. However, injectable heroin is now to be introduced in Glasgow and Durham.
Durham press release
Heroin addicts are to be given the Class A drug in supervised "shooting galleries" as police bid to tackle drug-related crime.
Durham Police is to become the first force in the country to introduce a scheme in which users are treated with diamorphine - medical grade heroin.
Ron Hogg, County Durham's Police, Crime and Victims' Commissioner, says such treatment lowers offending levels.
Opponents claim trials have not shown significant benefits.
Mr Hogg told BBC Newcastle existing national policies had not been effective and pointed to six-year trials in Darlington, London and Brighton which he said had helped wean users off the drug.
Addicts were given the opiate in consumption rooms, often referred to as "shooting galleries", supervised by medical professionals.
"It got them back into a normal life and it cut crime," he said.
"We saw health benefits for the individuals, we saw needles being taken off the street, so there's an awful lot of evidence both in the UK and across the world that such schemes do actually work.
"All police and crime commissioners spend a lot of money on what we call diversionary work - community projects and youth offending schemes - because we know this will stop people committing crime.
"This is just an extension of that rationale. The controversiality is because it's drugs."
Mr Hogg said the UK had the highest rate of heroin, cocaine and ecstasy use across the European Union with drug-induced deaths totalling 45 people per million compared with 17 per million in the EU.
Aiming to introduce the scheme "by the end of this year", he added the force's public health partners were working out the cost of administering the drug to users twice-daily.
He previously mooted such a move in 2013.
Ron Hogg, County Durham's Police, Crime and Victims' Commissioner, believes current policies have not proved successful
"If we go back to the 1960s, doctors used to prescribe heroin as a means of treating someone back to recovery. It's not that unusual," he said.
"We've got to consider the Misuse of Drugs Act has been in since 1971 and we haven't arrested the way out of the problem, have we?"
A Home Office spokesman said there was evidence "supervised use of [diamorphine] in a medical environment as part of a treatment plan can help keep patients in treatment and out of criminal behaviour".
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