Pubdate: Sun, 04 Jun 2006 Source: Sunday Herald, The (UK) Copyright: 2006 Sunday Herald Contact: http://www.sundayherald.com/ Details: http://www.mapinc.org/media/873 Author: Neil McKeganey Bookmark: http://www.mapinc.org/heroin.htm (Heroin) Bookmark: http://www.mapinc.org/find?136 (Methadone) Bookmark: http://www.mapinc.org/rehab.htm (Treatment) Note: Neil McKeganey is the director for the Centre for Drug Misuse Research at the University of Glasgow 'WE NEED TO FOCUS ON RECOVERY, NOT MAINTENANCE' Scottish View: By Neil McKeganey Some years ago, when I was interviewing people in a part of Scotland that had been hit hard by years of heroin abuse, many of the locals told me of their own novel solution to the drug problem. Put the addicts on an island, give them all the heroin they need, and let them kill themselves. A suggestion borne of a deep sense of frustration at what appears to be our failure to make an impact on the problem of illegal drugs in Scotland. And now we have a call from our ex-Deputy Justice Minister to develop a programme of prescribing heroin on a maintenance basis to addicts in Scotland. A sense of deja vu or what? Shocking as the suggestion of prescribing heroin to addicts may seem, it is an open question whether it is any worse than signing addicts up for a lifetime on prescribed methadone. Personally, I can see a role for prescribing heroin to a small number of addicts on a decreasing basis as part of a structured programme leading to their becoming drug-free. That, however, is a long way from prescribing heroin on a maintenance basis. Heroin is the drug to which most of our addicts in Scotland are addicted. It is the drug that is killing hundreds of our young people, year in, year out, and it is the drug that they would queue for hours to get if we were giving it out for free. Providing the drug on a long-term basis is not a treatment for addiction but a counsel of despair. It is an approach to consider when all else has failed and when the priority has become not one of treatment but containment. Those who are in favour of heroin prescribing will offer the reassuring words that it would be a tightly controlled programme targeted only on a small number of people failing on the methadone programme. Failure on methadone, though, is not the preserve of the few but the field of the many. Everybody knows that among the 20,000 or so addicts on methadone there are thousands, not hundreds, topping up their prescribed drugs with street-purchased heroin. These are the failures of our methadone programme and they would be first in line for prescribed heroin. Bad ideas, though, don't become good ideas because they are targeted on a small number of people, they just remain bad ideas targeted on a small number of people waiting, in a world of acute frustration, to be delivered to large numbers of people. Trust the doctors who championed our methadone programme to now be recommending prescribing heroin. We need fewer drugs, not more drugs going into our addicts and we need treatment services focused on recovery, not maintenance. Prescribe heroin to our addicts in Scotland? It's 5pm on a Friday in a crowded doctors' surgery, and it's a request easier to accept than turn down - "I need ma heroin, I'm no managing on ma methadone". It's also a road from which there may be no return. - --- MAP posted-by: Beth Wehrman