Pubdate: Mon, 05 Sep 2005
Source: Herald, The (UK)
Copyright: 2005 The Herald
Contact:  http://www.theherald.co.uk/
Details: http://www.mapinc.org/media/189
Author: Neil McKeganey
Note: Neil McKeganey is professor of drug misuse research at Glasgow
University.

WE ARE TRYING TO CUT HARM TO ADDICTS. WHY ARE WE FAILING?

A drug-addict death virtually every day of the year. That is the picture
revealed in recent statistics from the Scottish Executive. Multiply every
one of those deaths by a mother, a father, a brother, a sister, a husband
and a wife, aunts and uncles and sundry cousins and friends and you have
somewhere near the size of the tragedy we are facing in Scotland.

What is even worse is the fact that around half of the drug addicts in
Scotland may be Hepatitis C and yet the deaths related to Hepatitis C have
not yet even begun to show up in the official statistics. Those deaths we
will start to see in the years to come. When you look at our addict
population what you see is death hovering on the shoulder of tens of
thousands of our young people. In the eighties, in San Francisco and other
US cities, you could tell the gay men with Aids because the disease gave
everybody the same ravaged, skeletal look. Now in Scotland we have the same
uniformity in our drug addicts. All skin and bones and imminent death.

The Scottish Executive's stated goal in relation to drug deaths in Scotland
is to bring about a 25% reduction in the number of addicts dying. There is
simply no way we are going to achieve a 25% reduction in drug deaths. When
Hugh Henry the deputy justice minister with responsibility for drugs was
asked last week about the latest drug-death figures he said that he wanted
to set aside the debate over the statistics and focus instead on the tragedy
behind every individual death. A laudable sentiment, but unfortunately
numbers count and the numbers are going up.

What does this mean for drug policy in Scotland? Over the past 10 years harm
reduction has become the watchword of drug policy in Scotland. The aim of
this policy is not so much to get addicts off drugs as to work with them to
reduce the risks associated with their continued drug use.

There is nothing wrong with the theory of harm reduction other than the
awkward fact that the reality of addict lives seems to be undermining it.
When you see more than 300 addict deaths a year, getting on for 50% of
addicts being Hepatitis C-positive, many thousands who are malnourished and
similar numbers homeless and unemployed and many with mental health
problems, you have to wonder what conceivable harm that policy is actually
reducing.

A cornerstone of the harm reduction policy in Scotland has been to sign
addicts up on to long-term methadone programmes. It is repeatedly stated by
the Scottish Executive that no one approach to treatment works for all
addicts. But we were told earlier this month that almost a third of
Scotland's addicts are now on methadone programmes. Since only a fraction of
Scotland's addicts are actually in treatment at any one time, this must mean
that the vast majority of those in treatment are receiving methadone.

The level of methadone prescribing for heroin addicts in Scotland looks less
like individually tailored health care and more like social problems
prescribing on a massive scale. The budget for methadone in Scotland is now
running at more than ?11m a year with no evident sign of it decreasing. The
picture in England is depressingly similar with almost half of the ?500m
drug treatment budget now being spent on methadone alone. There is a lot of
money being made out of the drug problem in the UK and much of it is going
to the companies making methadone.

Methadone is heavily promoted in Scotland, and in England, by doctors
stressing that it is a route to creating stability in the addict's life. As
it happens, it is also the drug that is associated with almost a third of
all addict deaths in Scotland. Recently there was a massive award made
against the drug company Merck because one of its painkilling drugs was
found to have increased the risk of death of those arthritis sufferers
taking the drug. In Scotland we find that a third of addict deaths are in
some way connected with a drug that is being prescribed to them and we
accept that finding with staggering equanimity. Why is that?

The supporters of methadone will tell you that the drug is helping addicts
to commit less crime and lead more stable lives. They will quote the
research studies showing that addicts on methadone do better than addicts on
other drugs or those experiencing cold turkey. But is methadone helping
these addicts get off drugs or is it simply maintaining them on another
drug. Important as that question is, it is not one to which we have an
answer at present because we have never even bothered to find out how many
addicts are able to overcome their drug addiction through the route of
methadone prescribing.

What we have done instead is to provide a highly addictive drug to a group
of people with a known capacity to become drug dependent and we have not
even asked whether it is helping them to get off drugs or simply adding to
their addiction. And we have done that confident in the belief that addicts
on methadone commit fewer crimes than those who are not on methadone.

But if that belief was correct we should now be seeing a massive reduction
in crime in Scotland, given that almost a third of our addicts are taking
the drug and most of the crime is committed by addicts. The reason we are
not seeing a massive reduction in crime in Scotland is because the capacity
of methadone to reduce addict crime is nowhere near what it is claimed to
be.

The other arm of the harm reduction policy in Scotland has been to develop
needle and syringe exchange services across the country. Within these
clinics, addicts can get sterile needles and syringes. These services have
worked well in reducing addicts' chances of getting HIV infection but have
had miserable success in protecting them from Hepatitis C. The policy of
harm reduction has not helped these addicts to anywhere near the degree we
had hoped and it is right now to ask whether the policy of discouraging
addicts from sharing needles and syringes is good enough. As unpalatable as
it may sound, it may well be that the only way of reducing the number of
addict deaths is reducing the number of addicts in the first place.

Stopping sharing is not good enough, we need success in stopping injecting.
In much of our thinking about the drug problem in Scotland we have set the
bar of aspiration too low. We have aimed to create stability in the addict's
life when what we need to be working towards is getting them off the drugs
entirely.

It is time to look critically at the policy of harm reduction not because
the idea of reducing harm is somehow misplaced, but because we are so
plainly failing to reduce the harms our drug users are facing. Do we have
the right drug policies in place in Scotland? Are our treatment and
prevention services the best they can be? Are we helping addicts get out of
the addict lifestyle or are we maintaining them in it through the process of
methadone maintenance. These are increasingly urgent questions.

Last year, Cathy Jamieson, the justice minister, announced her intention of
setting up an agency which will provide oversight of our drug treatment
services in Scotland. We need that agency now more than at any time in the
past for the simple reason that we need the very best drug treatment
services in Scotland. It is anybody's guess how close or far we are from
that goal. 
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MAP posted-by: Josh