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Addiction, Opiates, heroin & methadone
Written by Gary Sutton   
Friday, 22 December 1995 00:00


Doing it for Ourselves

by Gary Sutton

In February 1994 the Leeds addiction unit hosted a symposium on methadone prescribing at the local Hilton hotel. The conference was attended by around 220 delegates, including some of the most prominent names in the field both on and off the platform. One of the presentations was entitled 'Methods of Monitoring Compliance'.

For some time previously a group of drug users centred mainly around the pioneering clinics of Dr John Marks (often called the Merseyside experiment) had been looking for an effective method of organising themselves and redefining the largely meaningless concept of 'empowering the addict'.

Negative images of drug use are so much so the norm and most habitual drug use so defined by the bail or jail response of the criminal justice system, the zoo mentality of most media reportage and methadone reduction/ maintenance 'methods of monitoring compliance' at the state drug units.

There are previous examples of registered addicts trying to set up a pressure group for the promotion of addicts and user rights, after the model of the Australian groups or the Dutch 'junkiebond', but all attempts to date have failed weighed down by the contradictions inherent in organising the chronically disorganised. I would argue that this situation need not be terminal, yet in the first months of the union's existence some of the issues we tried to confront proved as likely to cause division and resentment as provide a unifying platform.

So why is there a need for a users union? Dr John Marks has said that drug users are Europe's last repressed minority grouping. Dr Adrian Garfoot has calculated that his male patients (87 in total) average 50.4 months imprisonment each in using careers stretching over 19.4 years. The vast majority of habitual drug users and an even larger percentage of recreational users rely for their supplies on the black market. This puts drug takers automatically at odds with the law. It also allows complex psycho-emotional and social issues to be reduced to simple sound-bite moralising. Furthermore it tends to suggest stronger links exist between the various drug types in sub-culture than closer analysis would confirm, resulting in for example, the vilification of cannabis as a conduit to a life of substance- dependent slavery.

The decriminalisation/legalisation debate is another instance of expediency overriding informed debate (see the woeful annex D in the Government's Tackling Drugs Together where there is no differentiation between drug use and dependence). From a philosophical angle it seems an idiocy for the Government to say ~we in no way condone drug taking and yet we are committed to the needle exchange programme".

It makes far more sense to say drug use is a complex and diverse dilemma. People used mood altering drugs for a variety of personal reasons from pleasure seeking to pain relief, both occasionally and habitually. Chronic dependent drug us is a medical disorder of varying origins. The only correct approach is a series of medical interventions aimed at enabling the user to immediately access a full range treatment options from therapy-orientated rehabilitation to maintenance prescriptions based on drug/route of choice.

Another criticism I would offer of the White Paper is in the Department of Health provision of an Effectiveness Review conducted around the statutory services. At any estimate around 80 to 90 per cent of opiate users do not use the clinics; this estimate would rise to around 95 per cent or more of stimulanVcocaine users and 99 per cent of cannabis users.

The questionnaire directly asks 'clients' how often they take various non-prescribed substances (when many units actually have a policy of punishing patients for doing so) and if they acquire the funds for their 'street' drugs by crime or prostitution. I wonder how many 'clients' will admit they sell the methadone the clinic gives them to buy heroin? On a recent trip to Liverpool I noticed a crowd of lads under 25 outside a pharmacy in town first thing in the morning. When I mentioned to my guide that hanging around chemists to score was a none too distant memory for me, my friend pointed out that these were the sellers not the buyers.

It has always been a source of some confusion to me why the Home Office considers that the prescribing of heroin would lead to an increase in street availability.

Presumably the idea is that the addict will sell the pharmaceutically pure drug in order to raise money to purchase an adulterated, more expensive version of the same thing with the increased attraction of being arrested or ripped-off in the process. Veale's theory that the closer the prescription to the addicts drug of choice the less chance there will be of diversion to the black market seems to sum up the reality of the situation nicely.

The major difficulty most entrenched addicts have with treatment protocols is the insistence, repeated in the White Paper, of abstinence as the ultimate goal. This perhaps need not be a problem if, as under the system codified by the Rolleston Committee Report (1926) and operated by prescribers and the Home Office prior to the formation of the clinic system in 1968, it remains a theoretical ideal only. Some of the treatment outlines listed in the Effectiveness Review will be seen by those with sufficient experience with long-term relapsing addicts as mutually exclusive. That is too say that for many users their drug of choice provides the necessary ballast they lack in total abstinence, this may not seem an ideal for living to many but the alternatives imposed on the individual drug dependent have proved a disaster.

I recently renewed a friendship I made in the concept rehabilitation programme at Phoenix House, offered to me as an alternative to a custodial sentence in 1984. My friend finished the programme in order to retain access to her son then aged four. Her programme lasted nearly two years as did that of her immediate peers (a huge cost to their local health authorities). Of the ten names inquired after all completed the programme and would doubtless appear as statistical success stories - the ten year follow-up revealed three dead (two overdoses, one suicide) one living with his mother alcohol/benzodiazepine dependent, one back on a national health methadone 'script, one disappeared having stolen his flatmate's housing grant, another well under a well known private prescriber on methadone and dexdrine and one working at a rehab in London. At least three of these people had been diagnosed HIV+ and most will have/or have had hepatitis C - a problem that mainstream health care seems to have greatly underestimated (a recent Australian research study found over 90 per cent of males and 80 per cent of females with chronic injecting histories hepatitis C positive).

What I am saying is that no-one understands or cares about our problems except ourselves. We certainly need to organise to inform (Australian users have input on state and national advisory bodies on addiction) and to improve the quality of services offered to drug users. That there are hundreds of people in jail in this country for possession offences is a human rights outrage. That we are hounded into abstinence and clinical depression in psychiatric wards is unacceptable. That methadone is the only treatment offered to the vast majority of opiate addicts is something to get mad about. That other groups of drug users do not even get this concession must be changed.

When I contacted the organisers of the Leeds metha-done conference and asked them if I could distribute a leaflet about forming a drug users union on the day I was discouraged. I offered a copy of the leaflet in advance and suggested that if they found my criticisms unreason-able I would consider amendments. The next day the organisers were in a meeting, out to lunch and unavail-able (in a variety of permutations). I left my number. I was promised a reply. They did not even have the de-cency to call back. Who is going to care if we don't?

Gary Sutton works at Dr Adrian Gaffoot's London clinic.



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