Great article - v sobering. Thanks.

Perhaps our politicians new found backbone will allow some sensible solutions to come to the fore, whithout the tabloid scaremongering warping the debate.

i wont be holding my breath though.

In Glasgow I have observed former heroin users abuse a cocktail of methadone, booze and valium. The conclusion is that the while the substance may change - the patterns of getting intoxicated does not. Not sure what the answer is - methadone has its uses in helping to stabilise people in desperate circumstances, but long term it cannot be the only solution.

Following on from the comment above - On several occasions I have wondered why the government has a Drugs Advisory committee when they never act on their advice, and more often than not, they do the complete reverse.

Medicalise all drugs. Solve the problem and save a fortune.

"There is growing evidence to support treating these long-term relapsing addicts with pure heroin. A blueprint for the requisite regulatory changes has been created, but until the laws are changed they must remain thieves and prostitutes"

This is a bit misleading. It is perfectly legal to prescribe heroin to addicts, it happens every day. The evidence base for the effectiveness of heroin prescribing is indeed growing, with successful trials in the UK as well long established programmes in the Netherlands, Switzerland etc. No new laws required, simply political will and doctors prepared to support it.

In my experience the use of mind altering substances to the point of abuse or self harm is the result of some unhealed untreated and often unknown psychic injury. Unknown in this instance means that the person is consciously unaware of or dissociating from the injurious event. They do not meaningfully relate the emotional triggers they feel, which they are trying to escape from via being high or drunk, to the event if they recall it.
The trouble getting off the stuff is mainly making a safe environment for that person. The feeling of inner security and knowing that security will last into the future is the start of long term sobriety. The esteem building that 12 step work (if you want estemm do esteemable things) gives helps build this security as well as the necessity for a safe and rationally nonjudgmental social environment. I modify nonjudgmental with rational because some things need judging. you don't want to be nonjudgmental with someone who is abusing others or stealing or bringing drugs into the safe place etc...
Its all very complicated stuff and subject to interpretation. The main thing is that society in general needs to acknowledge it is not a character issue and that poverty and a bad environment from which one cannot see a way out (lack of fairness in society) and psychic injury are the main causes.

There was a clinic in Widnes,in the '90s, that prescribed heroin to addicts, resulting in a large drop in crime, and zero death / HIV infection amongst addicts. Read about it here.

methadone is crap and should be replaced with straight forward heroin, to be taken in the clinic orally only and nothing to take home. it will do wonders to the addicted person who won't have to race around for a complement to make the methadone bearable or more rosy.

40 years ago anyone could get a prescription for heroin and a complement of cocaine (to take the edge off the heroin). the mistake was that it was easy to use in a syringe and thus was. move it into the clinics and make a digested drug and a lot of problems will be taken care of.

Methadone is a highly addictive synthetic opiate, more addictive than heroin and harder to withdraw from

Since it is used to get people off heroin, I naively assumed the reverse was true. One wonders what is going on here.

When the reality of life is so hellish that opiates, synthetic or natural, are needed to endure it's pain and misery serious questions are needed to be asked about the lives of these poor unfortunate people. They require medical and compassionate help, not criminalisation, prison and punishment. You give a drowning man a lifebelt not a lead weight.

Good article.
I wish the people involved all the strength they need to get on with life.
As for those of us who believe all Drugs should be made freely available and legal, albeit controlled and monitored.....your all wrong.
Particularly as some vulnerable people have addictive personalities, to say nothing of children experimenting.
Besides, the Criminals behind the industry just go on to something else equally as profitable and with even more victims, gambling, prostitution and tobacco smuggling to name but a few.

I am not familiar with the concept of psychic injury, there may be aspects to the individual's psyche that may some people prone to addiction and dependency. Some arguments see familial patterns to usage and dependency, similarly GP attitudes to prescription, and referrals will influence methadone take up in certain areas. Availability, access and social norms are also determinants to individual heroin usage.

I know very little about this stuff. I thought people got addicted to heroin either because they were stupid, or because they tried it and loved it so much they just didn't care about the implications. I'd be interested to hear alternative reasons or theories about why people get into it. I used to live in a town where loads of people were on it, I just thought they were mugs, but maybe not, maybe there's something else going on in our society.

Victims of childhood sexual abuse are overepresented in both people with severe and enduring mental health conditions and chronic drug addictions.
It doesn't account for it all, but whilst this cancerous scourge continues to destroy the self esteem and confidence of children, there will continue to be large numbers of people who need to blot out reality or break down, or both. And a small minority will go on to inflict their personal miseries on yet more innocents. I don't know the answer, though I suspect it would need permanent exclusion from wider society for offenders and much more support and follow up for victims.

That is a great article.. thanks nadreck.

We had a similar program here in Finland in the late 1990's organized by Dr. Pentti Karvonen, who used Subatex as a better alternative to heroin than methadone. He was framed by the authorities for smuggling subatex into Finland, stripped of his license to practice as a doctor, and imprisoned.

He is now helping addicts all across Europe but is no longer allowed to serve the desperate population in his home country, due to the official view (political and medical) that all addicts in Finland are criminals.

Why have we not made any progress with this health issue for fifteen to twenty years.... The war on drugs?

What are the Police doing to curb the drug problem, Nothing there must be greater control of the Dealers and Pushers severe prison sentences total loss of assets derived from Drug Dealing.

Strong measures will reduce the addiction of the young and new users.

Without strong Police control there is no point.

Look at where heroin addiction is largest and it is mostly in isolated areas of high unemployment, low educational acheivement and poor housing.

Methadone maintenance is a sound idea in theory. Heroin use is by its nature chaotic; methadone enables an individual to take a drug once a day so that they can work on the issues that led to them using drugs on the first place. It engages people with services that they wouldn't otherwise access and is safer than the heroin sold on the streets if used correctly (no risks of smoking/injecting, no contaminates or toxins like anthrax). While there are benefits to it, methadone is not a solution to heroin use in itself, although all too often it is seen as such.

For more insight into the problem of heroin addiction in Finland (yes Finland) check out the movie "Reindeerspotting"

By odd coincidence while collecting a new inhaler today, the previous customer, who had just taken her methadone dose, was telling the pharmacy staff that her daily visit and chat with them was the highlight of her day because they were the only people who ever listened and were nice to her. So there's an upside the current treatment policy.

the irony is that heroin was created (at st marys hos london) to cure opium addiction, hence why its called heroin.

Why the methadone doesn't work

Whether or not depends on what you are trying to achieve. If you are just trying to placate them then I'm guessing it does work.

You CANNOT talk purely about Methadone. Google SUBUTEX

We spend 500 million on drug addiction a year, around 440 people a year get drug free including booze using Govt funded services. Shocking figure.

Im a heroin addict, I have in the past been prescribed a drug called Subutex in the past. Good drug for some, I was lucky it did the job.

But I took myself off the subutex too fast.... I thought I was going to be fine..... I relapsed within 2 weeks.

Do you know the depressing thing, I did REALLY well. If I had been clean for a few months that would have been even better.

Prescribed Diamorphine sounds great, but it can lead to a dramatic rise in crack use. So its not nearly as simple as it seems at first. And crack is arguable worse, as you can NEVER have enough crack.

Methadone is dated drug, get ride of it. But DONT see prescribing diamorphine as a golden bullet.

Yes, that's worked well so far, hasn't it?

Dignified treatment to help support substance abusers is, of course, very important, as well as somehow improving the social environments many addicts find themselves in. Going clean is one thing, but if it's becoming drug-free and then returning to the same life of little or no opportunity, and a lifestyle populated by users and the same daily rituals... i don't know. it just seems very hard indeed. To go "straight" many people also have to loose their friends.

Having huge unemployment, and little or no industry, mainly office and retail work., can't be helping either.

Even if this was a solution the police do not have the resources and there aren't enough prison spaces to jail every person who sells drugs (which is in effect every person who takes drugs).

I had a conversation with a Met Police Borough Commander a few years back. She said that if drugs were decriminalized she could put double the amount of of police officers on the street.

Rabbits dont take drugs or smoke but feel sorry for those that have to kill themselves with substance abuse...

http://www.youtube.com/watch?v=50GQJ6TdrRw&feature=share

as my colleague already mentioned: drugz are baaad!

Rabbits dont take drugs or smoke but feel sorry for those that have to kill themselves with substance abuse...

You've not heard from the rabbits of Porton Down for a while, I take it.

Rabbit shivers ... Well not as a recreational persuit

What about prescribing prolactin inhibitors instead?

Taking methadone in order to get over heroin addiction is, I suppose, a bit like using nicotine chewing gum to help quite smoking. It cuts out a great many of the harmful aspects, but doesn't do anything in the end to get rid of the chemical dependency - meaning that the user will still go into withdrawal if they try to stop using the substitute and their body never gets used to being without the addictive drug. But methadone is clearly a much, much better alternative than driving addicts back to street use. The lives of many drug addicts are truly chaotic and desperate, and methadone treatment gives people the opportunity to get their lives back on some kind of even keel.

Many (though not all) people may have underlying psychological issues that led them to drug use originally, and these will vary from person to person. Any good addictions treatment will give people the opportunity to explore and deal with these issues, but will also give them the tools for understanding the nature of addiction and tackling the addictive pull itself. This puts them in control, and enables the person to make rational choices whenever the urge to use/smoke/drink again arises in the future - which it inevitably wil ldo from time to time even after years of abstinence.

This is why, as I have mentioned on other threads, I think it is unfortunate that the only approach on offer for addicts is often the faith-based 12-step programme of AA/NA. This preaches that the addict is completely powerless over their addiction, and the only solution is to depend on God, who will be found through carrying out the religious practices of the 12 steps. Rehab centres make a fortune from selling this programme, with very little to show for it in terms of people getting clean or sober.

As for it being rational, as someone up-thread suggested, I would urge people read the chapter We Agnostics in the bible of AA, the 'big book' (just Google) which is an exhortation to all to abandon rationalism and science and embrace God. This chapter does not mention alcohol or addiction at all, and therefore has absolutely no place in any treatment programme. But it pretty well sums up the agenda, as does the author's declaration that:
:

At the moment we are trying to put our lives in order. But this is not an end in itself. Our real purpose is to fit ourselves to be of maximum service to God...
The Big Book, William G. Wilson

Time for addictions treatment in the 21st century to grow up really, and stop relying on divine intervention and the religious opinions of a 1930s salesman for solutions.

One of my biggest fears for my own children is coming accross heroine in their teens! When I was that age I saw the reality of it, people in a terrible state covered in vomit and generally not a good place mixing with the predatory types and subsequently some are dead ,still addicts or still trying to avoid the stuff in and out of prison,kids form good families loving parents etc etc.Heroine isn't choosy. The reality of the drug and what REALLY happens in a short time should be shown in schools. I myself was offered it many times luckily had enough self respect and confidence to say no not everyone can do that-people are easily lead. Methadone obviously isn't helping. Educate young people to the REAL HORRORS and CONSEQUENCES of what it does.

Good, insightful article. Methadone is indeed outdated and the negative effects of its long-term use can be as bad as those of heroin, it not worse. I think legalisation combined with education is the way to go, but it is unlikely to happen in the UK for the foreseeable future.

that's one confusing article, with one misleading headline. nobody would think that methadone would work to get people off the drug alltogether, what it does is that it keeps the addict from criminal activities to finance his abuse. call it nationalised drug dealing, or whatever if you want: it's infinitely better than leaving the addicts to care for themselves by robbery, drug dealing and prostitution.

Ibogaine + support programs could be the golden bullet...

It's a pity that the main stream media didn't report that in the last few years of the Labour government, the number of addicts treated successfully was increasing, whilst the money spent was decreasing.

Saying methadone is more addictive than heroin is slightly misleading to someone not in the know, so to speak. Physical withdrawal symptoms are both more severe and last considerably longer but have not got the intense mental cravings of heroin. Its the mental side of addiction that mostly sends users back to drugs.

I had a conversation with a GP several years ago about prescribed heroin and the ineffectiveness of methadone to curb some users habits. Her opinion was that it would be wrong for addicts to get any pleasure from a prescription drug, while also conceding that it may be a more effective harm reducer.

In the end, that's what I think it boils down to, some type of victorian prudishness about the effects of drugs and the morality of addicts deriving pleasure from treatment. Methadone does'nt get you high, so it won't be replaced, certainly not by heroin.

Can you imagine the Daily mail's response!

Great article - an honest and insightful account of the pharmacy stage of methadone treatment for heroin addiction in Britain. Two points. First, supervised consumption is largely employed to prevent re-sale of dispensed methadone by heroin addicts.But it is counter-productive because it removes the capacity of the intervention to allow addicts to develop control of their own methadone intake, i.e. to take personal responsibility for their drug using behaviours. As I understand it, the second-stage water-drinking procedure required under supervised consumption regimes is mainly to prevent "chuckbacking" (keeping the methadone syrup 'half-swallowed' at the top of the throat, and regurgitating and bottling it outside the pharmacy, in order to sell it on). But research suggests that this is a rare activity exhibited by a few drug-desperadoes. In short, we should treat heroin addicts like any other pharmacy client, allowing them to take their presciption home and to self administer it as convenient. Second, there is now a great deal of evidence supporting heroin prescribing as a cost-effective useful additional treatment for some types of opiate addiction - including the recent trial in England. Why are we waiting?

Some good points made there.

I have met people for whom methadone has been a great help, allowing them to get control back over their lives and, in some cases, eventually get off drugs completely. But I've also met plenty who are simply trapped on it, and I am aware of more deaths by methadone intoxication (usually in a cocktail with alcohol, Valium or both) than by diamorphine.

Prescribed diamorphine certainly wouldn't be a perfect solution. The problems that push people to taking these narcotics in the first place wouldn't go away, and some users if given ready access to clean heroin will doubtless simply displace their addictions onto other substances. But even so the vast majority of criminal justice professionals (police, judges, social workers) I've spoken to regard it as the least worst option. And certainly a much better solution than parking folk on something as toxic and unpleasant as methadone for decades.

Sorry, I know this is a very serious issue, but did anyone else think this was a picture of someone taking Lemsip Max (Syrup formula)! Also green gunk - is this a coincidence? I think we should be told.

Methadone is more addictive and harmful than heroin. Addicts can overdose and die, taking methadone and other substances.

'One chance' total abstinence, counselling or rehab. Spend a little to save a lot.

Heroin addiction seems such a sad waste of life. I've only know a friend of a friend who died from taking heroin. Everyone who knew him kind of pulled faces when talking about him afterwards, because he'd constantly beg and steal for money, to the point that they were ashamed to mention him, even in death. But on a brighter note, I gave up smoking in 1998. Yay! To give up smoking, I set about changing my whole lifestyle. I started cycling seriously etc etc. I think the hardest aspect of breaking an addiction is in making that firm decision. I don't take pride in having achieved it, because it just happened, and I'm glad, appreciative etc. Modern society seems to do it's best to make life difficult for people who are already in difficult circumstances, and that's a shame. I'm trying to keep fit by running, but there's so much traffic about - pollution, danger etc etc. Oh well, there's my rant coming to a natural end..... :-)

My point being, maybe, is that methodone isn't much of a help, is it?! Just prolonging a problem and maybe preventing some stealing etc. Not that I've got any better suggestions.

If all registered addicts were given medicinal grade heroin under clinical conditions whenever they liked, you would wipe out addiction in a generation and more than halve crime in the UK. No more dealers, no more overdosing, no more kids getting hooked (not so exciting going to a clinic and having someone inject you), no more deaths from dirty drugs and needles. The people stopping this from happening are the right-wing press and the USA. The current situation is madness when there is such a simple solution.

But seriously, they should medicalise heroin, and also provide remote treatment facilities in beautiful places where people can escape from their lives for several months and get help to break the addiction. Once they have beat the addiction, they should be helped with reintegration; especially helped with ongoing counselling and therapy and safe housing away from areas where they will be targeted by drug dealers.

Methadone is more addictive and harmful than heroin.

That's clearly not true.

'One chance' total abstinence, counselling or rehab. Spend a little to save a lot.

I don't really get that statement either. Are you advocating a "One chance total abstinence" program? What would you propose to do with the 99% that are certain to fail?

You're welcome. Whenever this issue come up, I go to find a link to quote, but oddly enough, information about this is not that easy to locate....

Why have we not made any progress with this health issue for fifteen to twenty years.... The war on drugs?

Because of gutless politicians who keep on insisting on mindless approaches such as the 'war on drugs'. God forbid that they should ever act as the evidence suggests, rather than vote-seeking prejudice.

Just legalise all drugs seriously, great article too

Getting Clean aint the hard part.

Staying Clean is the hard part.

So do we just leave people on a script?

Or expect people from now on to be able to find it much easier to stay clean, which is the current Govt view. Which is dangerous for all sorts of reasons.

I think legalisation combined with education is the way to go, but it is unlikely to happen in the UK for the foreseeable future.

Surely the legislation required is to decriminalise drugs but to prepare for it by education. It won't all be wonderful but the criminal gain from drug dealing will reduce substantially. The policeman above, who said "your all wrong" (sic) should be ignored. If drug crime can be eliminated or severely reduced then it should be, regardless of the future activities of the drug criminals. What a lazy attitude!