‘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.

Public Accounts Committee questions cost effectiveness of drug treatment in the UK

The House of Commons Public Accounts Committee yesterday issued its Report on the government’s strategy for dealing with ‘Problem Drug Use’, a term referring to the estimated 330,000 users of heroin and crack cocaine. The Report quotes figures that problem drug use costs £15.3 billion, of which £13.9 billion is associated with acquisitive crimes to fund dependence. Government spending on the strategy is currently £1.2 billion per annum. The main conclusion picked up by UK media is the Committee’s statement that “we find it unacceptable that the (Home Office) has not carried out sufficient evaluation of the programme of measures in the strategy and does not know if the strategy is directly reducing the overall cost of drug-related crimes.” The MPs did, however, welcome the belated agreement of the Home Office to produce a framework to evaluate and report on the strategy. This step was taken in response to a recommendation from the National Audit Office, and initial reporting will commence in ‘late 2011’, and may represent the beginning of the Impact Assessment of drug polices called for by our colleagues at Transform Drug Policy Foundation.

Release is disappointed, however, at the lack of any honest appraisal of the continued failure of present drug policies or serious discussion of alternative measures. There is no recognition, for example, of the degree to which ‘Problem drug use’ is rendered more problematic, not less, by criminalisation or coercive treatment. The question of supplying heroin addicts with heroin was raised, but the senior Home Office official retorted that this is “absolutely not” government policy; he called it a ‘counsel of despair’ and said such a course meant addicts could never live productively or pay taxes. In fact, people are quite capable of living and working productively while on opiates; while of course individuals vary, much of the despair associated with heroin addiction stems from tying to maintain a steady supply of a drug whose expense is inflated and quality degraded by the illicit market, and the criminal relationships this imposes on users. If the market is legally regulated and distributed, health, time and freedom of attention become available once again to the user. Many productive and fulfilling lives have been lived under these more benign conditions.