'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.