CAN'T QUIT, WON'T QUIT

What Many Addicts Need Is A Safe Supply Of Drugs

THE WORLD may be on the brink of a recession, but for one business
prospects have never been brighter. World heroin production has
tripled in ten years, and cocaine production doubled. Hard drugs are
no longer the preserve of the affluent. A hundred years ago the
typical opiate addict in the West was a middle-class woman in her
forties. Now it's a young, uneducated male. Even nicotine continues to
enjoy steady global growth, as people in the developing world embrace
the habit.

Despite all the health campaigns and the billions spent on law
enforcement, there are more addicts living today than at any time in
modern history. Governments hooked on "zero tolerance" policies are
condemned to locking up ever more drugs offenders, and footing the
soaring bill for the crimes they commit-or in the case of smokers, the
medical treatments they need.

There has to be a better way, and it's there for the asking-the
alternative philosophy of harm reduction, in which the aim is not
necessarily to wrench addicts away from their drug, but to minimise
the harm drugs do to users and society. Take nicotine. What kills
smokers is not the drug they are addicted to but all the
disease-causing gunk in the smoke they inhale to get their fix. The
good news is that there are now much safer ways of taking nicotine;
the bad is that governments are failing to ensure these products are
taken up.

Across Europe, for instance, cigarettes containing all sorts of
untested additives continue to be sold. Yet a comparatively safe form
of chewing tobacco is banned (see p 28).

Even more bizarrely, governments still lack the power to compel
cigarette manufacturers to make their products safer. A method already
exists, for example, to reduce the levels of cancer-causing
nitrosamines in tobacco smoke, and major manufacturers are said to be
interested. The catch is they want to continue selling all their usual
brands and market the new cigarettes as being "safer". This is like
car manufacturers demanding the right to sell cars with and without
seat belts in the name of consumer choice. The difference is that
governments can insist on seat belts, but not on specific safety
measures for cigarettes. Acquiring such powers should be an urgent
priority.

It's not so very different with heroin addiction. As with nicotine,
the dangers have been massively distorted. Heroin does not rot your
brain or body: if heroin addicts look haggard and thin, it's because
they're spending every waking moment worrying where their next fix is
coming from, and spending their last cent on black market drugs rather
than food. True, many heroin users lead risky lives. But this is
mostly due to the unhygienic and dangerous conditions in which the
drug is bought. Forced to go to criminals, addicts pay excessive
prices for erratic supplies that are likely to be bulked up with
harmful substances. Recently heroin has turned up on the streets
containing the nerve toxin scopolamine, a deadly Clostridium bacterium
and even anthrax spores.

Worse, addicts soon learn how to eke out their erratic supplies by
mixing heroin with other drugs. And it's this-not the heroin
itself-that kills most addicts. To take a typical set of figures, out
of 84 deaths linked to opiate abuse in Dublin in 1999, 73 victims had
two or more drugs in their body. And a majority of the victims had no
remnants of heroin in them at all, only methadone, the substitute drug
that's often prescribed to addicts to wean them off heroin.

The answer seems obvious. If the black market is the source of harm
and methadone is more dangerous than heroin (as the evidence
increasingly suggests), why not let doctors prescribe "clean" heroin?
Switzerland, the Netherlands and Germany are already piloting the
approach, and even Britain is now quietly licensing doctors to
prescribe heroin to addicts who seem unable to give up. But such
schemes are limited in number and are still bitterly opposed by many
politicians and anti-drugs campaigners. At best, they are tolerated
rather than enthusiastically endorsed.

This is a pity, but hardly surprising. Addiction is never a good thing
and nearly everyone has some moral qualms about it. But the fact is
that some people will always seek out drugs and there are no miracle
cures for addiction on the horizon. For now, harm reduction is the
best strategy we have.

For too long we've been forcing addicts to choose between prison,
abstinence or therapy. What many of them really need is the drug of
their choice, supplied to them in the safest possible way.