UK heroin trial publishes results

The recent trial of heroin prescribing at the Institute of Psychiatry published its results last week in an article in the prestigious medical journal The Lancet. They provide significant new evidence as to the effectiveness of providing diamorphine ( pure medicinal heroin) to those who have derived little benefit from orthodox, methadone-based treatment. The primary measure used was abstinence from street heroin, and, unlike many similar trials, this was calculated by urine testing rather than by reliance on the client’s word. The trial tested the effectiveness of injectable heroin, given in daily doses under clinical supervision, against both injectable and oral methadone, all strands receiving counselling and social support services. While all clients showed improvement, it was found that injectable heroin was significantly more effective in terms of reducing use of street heroin. The researchers conclude that, “In the past 15 years, six randomised trials have all reported benefits from treatment with injectable heroin compared with oral methadone. Supervised injectable heroin should now be provided, with close monitoring, for carefully selected chronic heroin addicts in the UK.”
While recognising the controversial nature of addiction therapies, Release hopes that the new government will act upon the substantial and growing evidence base in support of heroin assisted treatment and make this option more widely available for those in clinical need.

More information available here.

Death penalty for drug offences- New IHRA Report

The International Harm Reduction Association (IHRA) has this week published a report providing a global overview of the use of the death penalty in drugs offences. The publication makes alarming reading, finding that the total figure exceeds 1,000 judicial deaths per year. “Hundreds of people are executed for drug offences each year around the world, a figure that very likely exceeds 1,000 when taking into account those countries that keep their death penalty statistics secret,” state the authors, Patrick Gallahue and Rick Lines.

Some 32 states permit the use of the death penalty in drugs cases, mostly in relation to production and trafficking. Of these countries, 13 retain a mandatory death sentence for certain types of drug offences. The leading executors are China, Iran, Saudi Arabia, Vietnam, Singapore and Malaysia; these are the only states that have, in recent years, deployed capital punishment to an extent that the report judges to indicate ‘high commitment’ to the practice. Iran, for example, executed 172 people last year. Some cause for optimism lies in the fact that a number of these countries have, however, greatly reduced their reliance on capital punishment over the last years.

IHRA’s legal experts argue that recourse to the death penalty in drugs cases is contrary to international law, and that the measure should, pending full abolition, be limited to a discretionary option in cases of willful murder.

The report is available here.

News US drug strategy

The new US drug strategy, the first to be published under the Obama administration, was released yesterday. The strategy’s appearance was heralded by the Whitehouse with claims of a new direction for US drug policy, and a new emphasis on combating the problems around illicit drug use by focusing on the demand side of the equation. This tactic is based around a broad set of community based prevention interventions, and an expansion of drug treatment into mainstream healthcare. And while the language itself continues to be rejected, the strategy involves measures which embody the principles of harm reduction.

The strategy can thus be said to build on the administration’s movement away from drug war rhetoric, its repeal of the ban on federal funding for needle exchange, and its acceptance of (or non-interference in) state-level medical cannabis provision. There are also encouraging signs that congress will, over the next year, end the mandatory minimum sentencing disparities between powder cocaine and crack, laws which are racist in effect if not intention.

At the same time, beneath the rhetoric of change there are large areas of continuity with the drug war, readily apparent in the fact that two thirds of the budget remains devoted to law enforcement. A more profound and significant break with the failures of the past would be demonstrated by a strategy aimed not so much at stopping or reducing drug use as such, but at minimising the harms associated with both drugs and drug policies. These harms are tightly interwoven with the mass incarceration of US citizens for non-violent drug offences. Nonetheless, such changes as there are should be welcomed, and it will be interesting to compare the performance of Britain’s new government when its new drug strategy appears.

Mexico: War without end?

Last weekend in Mexico, in a new escalation of the drug war, 24 people were killed in a 24 hour period. While falling short of the grisly record established in January this year, when 69 individuals died violent deaths in one day, it should give pause for thought to anybody who still believes that repressive methods can suppress the illicit drug market. In total, since President Felipe Calderon took office in 2006, over 23,000 people have died in the bloody war the US government continues to support.

Plan Merida, the government’s assault on the country’s massive drug trade, is funded by the US to the tune of $1.4 billion. It relies heavily on military intervention, with the bulk of the money going to equip the Mexican army. However, the project’s ‘successes’—centred on the arrest of cartel bosses—have only exacerbated the violence, creating a power vacuum quickly filled by violent conflict. And, despite the army’s new US weaponry, organized crime appears able to match it, using a combination of corruption and guns flooding in from across the US border. Human rights groups in Mexico have claimed that this southbound traffic is more severe in its consequences than the northward flow of drugs, despite the publicity generated by the latter.

To add to the human rights deficit associated with the drug war, Arizona has recently passed an anti-immigration law that gives the police the right to search and detain anyone they think looks like an illegal immigrant. Naturally, this is going to impact on US citizens of Hispanic appearance, adding a new layer to an old pattern of racism linked to the war on drugs. It has led the Mexican government to issue a travel alert urging extreme caution to its citizens travelling in Arizona. The measures have also been highly divisive inside the US, with mass protests across American cities and opposition from prominent figures including President Obama. In a final irony, traffickers have started avoiding border controls by moving the growing operation into the US, setting up plantations in National Parks, a displacement tactic familiar across decades of prohibition.

‘Crack Babies’- the Final Solution?

The US-based charity ‘Project Prevention’ has this week arrived in the UK. The organisation is offering £200 to addicted women in order to undergo sterilization. In the US, some 1200 women and 50 men have entered into such a contract over the group’s history. Its founder, Barbara Gamble, defends her approach on the grounds that the rights of the child should supersede those of the mother. She has argued her case in the following terms: “We don’t allow dogs to breed like this, we spay and neuter them.”

What Project Prevention is practising is eugenics—the management of racial stock. Its arrival in the UK has been controversial, and rightly so. While there may be real problems associated with bringing up children while dependent on illegal drugs, there are other, less drastic and potentially damaging ways of alleviating them. Contraceptive advice can be offered as a part of drug treatment, and psycho-social support services may offer stability to drug dependent women. No information is provided on the group’s website about the medical practicalities of the sterilization process, and Release is concerned about the medical ethics involved. The issue of informed consent also looms large; one wonder how ‘informed’ this consent really is.

In addition, the assumptions in play here need questioning: there are many drug using families who bring up their children successfully, and many non-drug using families who don’t. Such problems as do arise should be addressed by policies to end the criminalisation of drugs and the stigmatisation of users, to provide high quality treatment and support where it is needed—including heroin prescribing—and offering people meaningful employment and a real chance of building a better life.

Heroin prescribing on the NHS

The topic of prescribing heroin to addicts on the NHS was proposed for debate yesterday at the National Congress of the Royal College of Nursing. The subsequent discussion highlighted the promising preliminary results of the recent UK trial in which diamorphine, the clinical name for heroin, was prescribed at various locations in England to those for whom more conventional treatments, such as methadone, had been unsuccessful. The study found that crime was greatly reduced and that health and social functioning showed significant improvement. Some individuals said that the treatment had given them back their lives.

The debate recognised that this issue is an emotive one, a fact quickly confirmed by an inspection of the comments left by members of the public when the story appeared online in the popular tabloids. Amongst the most vicious, but by no means unrepresentative, is the following contribution: “How about letting them rot in the gutter where all drug user (sic) belong and start saving lives of the good by prescribing life-saving cancer drugs.” The prevalence of such opinions only reinforces the urgent need to remove drug use from the criminal sphere and treat it as a public health issue, since the law as currently framed serves to legitimise prejudice against drug users.

The scientific evidence base for its effectiveness is growing stronger each year, and the prescribing of heroin must certainly be included in the range of treatment options available to those in need.

Manifesto Macho

The major parties have this week published their manifestos for the general election, including proposals for drug policy. All three are light on detail, and political courage and imagination are not strongly in evidence; however, some are certainly worse than others.
The Labour Party’s offering is entitled ‘A Fairer Future for All’, and discussion of drug policy is confined to one short paragraph appearing in a section named ‘Crime and Immigration’, a disturbing pairing of two policy areas not closely related except in the politics of prejudice. The content of the paragraph would not, indeed, appear out of place in such a context, being encapsulated in the following slogan: “Our message is clear: we will not tolerate illegal drugs.” The general tone of Labour’s short reference to drug policy appears calculated to bring it closer to the Conservatives.

The Conservative own proposals, contained in a section named ‘Fight back against crime’, once again link the motifs of drugs, crime and immigration. “Extremists, serious criminals and others find our borders far too easy to penetrate.” The manifesto commits the Party to ‘crack down’ on drugs and build more prisons, and makes inroads into clinical territory normally regarded as the preserve of doctors and others with specialised training. In an obvious reference to the use of methadone and opiate substitution therapy (OST), we are told that “the treatment too many addicts receive just maintains their habits.” The fact that OST is underpinned by an extensive scientific evidence base does not appear to matter. They go on to say that, “We will give courts the power to use abstinence-based Drug Rehabilitation Orders to help offenders to kick drugs once and for all.” This represents a dangerous development, with politicians determining clinical health measures on ideological grounds.

The Liberal Democrats are the only Party to make an explicit promise to base drug policy on scientific evidence, and to ensure that the Advisory Council on the Misuse of Drugs is genuinely independent of government. They are also committed to ensuring that police and court time and funds “are not wasted” on prosecuting and imprisoning drug users.

We leave it to our readers to decide which of these positions is least likely to result in a public health and social disaster.