EXPERT MAKES U-TURN TO BACK HEROIN PRESCRIPTION

Scotland's Leading drugs expert has admitted he has changed his mind
and now supports the prescribing of heroin to addicts.

Professor Neil McKeganey, director of the centre for drug misuse
research at Glasgow University, has called for a pilot study to
evaluate the outcome of giving heroin to addicts.

He said: "I don't think we have had enormous successes in tackling our
drugs problem and we should be prepared to develop innovative
initiatives of various different kinds and have them rigorously
evaluated, and pilot provision of heroin is one of them.

"I don't think that it's sensible to rule that out in principle. One
should be prepared to evaluate its possible use. But I think one would
have to recognise it's an extremely risky proposal; that it may be of
benefit for some addicts but one would have to have it very tightly
controlled."

And he added: "There is perhaps a degree to which I have changed in so
far as I am now saying that it could be evaluated because it certainly
is being actively discussed."

McKeganey's latest comments are at odds with his previous assertions.
In an interview in 2002 he had rebuffed the idea, saying: "The problem
with prescribing heroin is that you're almost giving out the message
use heroin and don't be an addict and pay for it, or use heroin,
become an addict and we'll give you it for free'."

His apparent U-turn comes days before a major drugs debate, to be held
on Tuesday at the Scottish Drugs Forum's (SDF) annual general meeting.

McKeganey added: "If you identify who it heroin prescription is
effective for, then the natural next stage would be to make sure those
individuals get it and I think we have spectacularly failed in doing
that with methadone.

"If research shows that an intervention, even one as controversial as
heroin prescription, is effective in getting some addicts off heroin,
then I think we should have the confidence to provide it to those for
whom it shown to be effective for."

SDF's debate will see MSPs from all major political parties discussing
the future of Scotland's drugs policy in the run-up to next May's
Holyrood elections.

Ministers' attempts at curbing heroin addiction by rolling out the
methadone programme came under increasing fire after the death of
two-year-old Derek Doran, who allegedly drank methadone at his
parents' home in East Lothian, just before Christmas last year. His
death led to first minister Jack McConnell launching a review of the
programme, which will be published in the next few weeks.

Solidarity MSP Rosemary Byrne, who will be speaking at this week's
debate, supports the proposal for a pilot scheme as a means of
reducing the current number of heroin addicts, which is estimated to
be more than 51,000.

"I put down a bill in parliament called Drug Rehabilitation Scotland,
the consultation was completed and ready to go to stage one and it's
been bumped off the health committee agenda. It's very disappointing
because communities had hopes raised by this bill.

"We want a pilot scheme on heroin to be closely monitored over a
period of time because there are some people who won't go on to
methadone and will continue to use street heroin and maybe one of the
ways to get them into treatment may well be to offer that prescribed
heroin as a substitute.

"We're not saying wide-ranging use; it's a very calm look at what a
pilot scheme could do, setting an agenda which could be looked at in
the future."

A pilot study on heroin prescription is currently being carried out in
England and another ran in the Netherlands between 1998 and 2001,
which had positive results. Dutch researchers said patients who were
prescribed heroin and methadone experienced 23% to 25% more
"clinically relevant improvements" including physical and mental
health than those on methadone alone.

The debate on heroin prescribing was further fuelled by a statement by
Howard Roberts, deputy chief constable of Nottinghamshire Police, who
told an Association of Chief Police Officers conference at the end of
last month that the controversial measure could be "highly effective
in actually helping reduce crime", as drug users would not have to
steal to fund their habit.

Green MSP Patrick Harvie said the current approach to tackling drugs
was "failing" and that "radical, unpopular measures might be necessary".

He said: "I think what we will do is talk about those creative ways in
which the Scottish Executive could do something to address the
problem. There are some obvious routes that we've not tried, like
prescribing heroin in a controlled environment.

"We either need to put all of our ideas on the table and sit down and
say the current approach is failing and some radical unpopular
measures might be necessary if we want to solve the problem, or we
could say this problem will carry on festering and that's a choice
that our government can make."

Also attending Tuesday's debate is Liberal Democrat MSP Jeremy Purvis,
who said he was "reluctant" to endorse heroin on prescription and is
instead calling for health authorities to make better use of
residential rehabilitation.

"There are currently vacancies in residential places in Scotland. It
has been the policy decision within local health boards that they
would prefer community methadone stabilisation and reduction programmes.

"Yes, the residential places are more expensive in the short term, but
they are cheaper in the long term because it will end with
abstinence."

And he added: "What the health boards have been making decisions about
is maintaining a budget strand and level at a relatively constant rate
so they can argue for that budget."

McKeganey said he agrees there should be more residential
rehabilitation provision. He said: "Research published this month
showed approaching a third of addicts treated with residential rehab
were able to become abstinent, and less than 5% treated with methadone
are able to become abstinent.

"That means that our most effective treatments at the moment are
rehabilitation services and yet we are under-using the existing
services and far too few of them are available. There probably is a
degree to which some authorities are simply not using existing
provision because they perceive the methadone programme as cheaper."

David Liddle, director of the SDF, added that there needs to be
"increased spending on appropriate clinical treatment to reduce the
spread of HIV and hepatitis C, including through heroin prescription
and wider provision of needle exchanges".

Although heroin pilot studies are currently being conducted in England
and have received support from police south of the Border, their
Scottish counterparts aren't so enthusiastic.

Detective Superintendent Jill Wood, national drugs co-ordinator for
the Scottish Drugs Enforcement Agency, said she wants to "distance the
police from medical decisions".

"The view from Acpos the Association of Chief Police Officers in
Scotland would be that the decision of treatment is for clinicians and
colleagues in the health service and we couldn't see that it would be
a realistic medical disposal except for a small number of people."

A Scottish Executive spokesperson said: "There are no current plans in
Scotland to promote the medical prescribing of heroin for long-term
addicts.

"Prescribing of heroin, particularly injectable heroin, is not
something which can be undertaken lightly. There are complex issues
about security of supplies and safety of patients, dispensing
arrangements etc.

"It is naive to think that criminals involved in drug dealing would
stop their criminal activities because of this."

However, McKeganey warned the drugs problem may "overwhelm" the
country in the next 15 years.

He said: "We have a situation where the drug problems are having such
an adverse impact on Scotland. Our policies are having a limited
impact on that problem and it is right that we foster a debate on how
we address it.

"If in the next 15 years we see anywhere near the growth of Scotland's
drug problem like in the last 15 years, it will be a problem that will
simply overwhelm Scotland."