ROOMS FOR IMPROVEMENT

As Needle Exchanges Celebrate Their Th Anniversary, Two New Reports
Call For Increased Help For Class A Drug Users

Maggie is shivering and sweating. She's withdrawing from heroin and
is craving the crack cocaine she injects with it. Her boyfriend,
Bill, arrives with the precious packages of "brown and white" -
heroin and crack. They will inject both drugs together in a practice
known as speedballing. Both are street homeless and hurry off to find
a quiet doorway to get their fix.

Cocaine does not produce the intense physical withdrawal symptoms of
heroin, but it does cause a powerful psychological longing among
regular users. Maggie and Bill have sterile needles in their pockets
to inject with, picked up from a local needle exchange.

In 1986, the UK was among the first in the world to establish needle
exchanges, where injecting drug users can pick up free sterile
needles and return used ones for safe disposal. The aim was to
prevent the spread of HIV transmitted through sharing dirty needles.

The UK's first needle exchange began operating in Peterborough in
early 1986, and the first pharmacy scheme, operated by Boots, began
in Sheffield in the same year. The policy has been successful.
According to Health Protection Agency statistics published in April,
just 4% (1,241) of the total number of people living with HIV in the
UK (22,099) contracted the virus through injecting drugs.

As needle exchanges celebrate their 20th anniversary, two new reports
call for an extension of harm-reduction policies to tackle the
increasingly complex patterns of drug use among the Class A addicts of today.

The first report, from the Joseph Rowntree Foundation, is a study by
the Independent Working Group on Drug Consumption Rooms. Following an
appraisal of 65 drug consumption rooms in six European countries and
Australia and Canada, it concludes that similar places should be
introduced here on a pilot basis.

The second report, based on research from the Psychiatric University
Hospital in Zurich, has found that giving heroin on prescription to
all heroin addicts who request it has led to a decline in the overall
number of addicts in Zurich by 4% a year - although the average
length of time each user spends on the drug has increased.
Drug-related seizures and overdoses have also declined. Supervised
consumption of heroin is currently being trialled at the National
Addiction Centre at King's College, London, and three more schemes
are due to be rolled out this year.

Injecting rooms are an extension of, rather than a departure from,
existing needle exchange policy. As well as the clean drug
paraphernalia to which they already have access, users will have a
clean room to inject in and medical staff on hand in case anything
goes wrong. The UK has the highest rate of drug-related deaths in
Europe, with 1,388 deaths in 2003. If anyone overdoses or has a
seizure in a drug consumption room, they can get immediate medical attention.

Despite the government's longstanding commitment to the provision of
needle exchanges, a Home Office spokeswoman says: "Drug consumption
rooms do not form any part of our strategy." She adds that such
venues would increase the risk of localised dealing, antisocial
behaviour and acquisitive crime.

The Zurich report says that medicalising heroin strips it of its
illicit, seedy glamour and so makes it less attractive to the
uninitiated. As well as improving the health of drug users, one of
the arguments for prescribing a Class A drug such as heroin is that
the shady types trafficking and dealing it become redundant. But this
argument is flawed. If heroin was the only Class A drug in use, the
Swiss model could work here. But vast numbers of Class A users are
wedded to the heroin-crack combo, sometimes injected together,
sometimes heroin injected and crack smoked separately, and sometimes
both smoked.

Heroin addicts can stabilise their lives with a regular dose at
regular intervals and may decide to reduce or end their use of the
drug. Some doctors are happy to prescribe it because, apart from its
addictive quality and the risk of infections from injecting, it isn't
innately damaging. Cocaine, on the other hand, damages the heart, can
lead to strokes, and can induce paranoia. It has a more-ish effect -
particularly in crack form - costing some users between UKP500 and
UKP1,000 a day. If doctors agree to prescribe heroin but not cocaine,
drug users will still consort with dealers and the link with crime
will not be broken.

Unsustainable system

Danny Kushlik, of Transform, the anti-prohibition organisation,
argues that if doctors won't prescribe cocaine, then retailers should
sell it instead because the current system of prohibition is damaging
and unsustainable.

Gary Sutton, of the drugs organisation Release, isn't convinced by
the argument that making heroin uncool will deter people from using
it. "Heroin isn't a loser drug or a winner drug," he says. "With very
few exceptions, the people I have worked with who are
opiate-dependent are depressives or are suffering from some sort of
post-traumatic stress."

Meanwhile, Maggie returns, her shivers and sweats vanished after her
fix. In theory, the new proposals sound good, she says, but in
practice they might not work for her and other Class A drug users.

"Prescription heroin sounds fantastic, but I'd still go to my dealer
for the crack," she says. "And I suppose some people might sell their
heroin to buy more crack. It would be nice to have access to clean
works all the time, but what the 'experts' don't seem to understand
is how sick we get when we start to withdraw. It's always a struggle
to get money together for my next fix, and as soon as I've bought my
drugs I need to inject them straight away. If using a drug
consumption room means half-an-hour or more of travelling across town
to reach it, feeling as if I've got the worst flu imaginable, then forget it."