A tale of two drugs this week, one illegal and one legal, but both showing that what ever it is the government are trying to do isn’t working.
Paul Hayes of the NTA in the Guardian
Firstly poor old Paul Hayes of the National Treatment Agency (NTA) went into print in the Guardian to defend the organisation he heads against the charge that it’s failed to get many heroin addicts free of drugs.
Of course, this is true to an extent. The policy of this government for the past 10 years has been to get heroin addicts off street smack and into “treatment”. The trouble with this is “treatment” has come to mean addiction maintenance using methadone, rather than as most people naively believed, to make them “better”, ie to cure their addiction. What has happened to a huge number of people is that they’ve swapped their heroin addiction for a methadone addiction. What’s happened to others is they’ve kept their heroin addiction and also become addicted to methadone with only around 3% actually ending up drug free. People are beginning to ask “is this progress”?
Paul Hayes insists it is. He says “We need to keep maintenance prescribing as an integral part of the drug treatment system because it stabilises people, reduces crime, reduces deaths.” Of course, he’s right, it does.
Methadone maintenance is what passes for harm reduction in the UK drugs policy. Because it’s taken by swallowing it avoids the dangers of injecting, it gets people away form the street dealers and diverts them away form impure street smack. But it gets them hooked on something just as addictive if not more so than heroin, it does nothing, critics say, to allow them to “recover” and to be drug free. This is where things get messy: Enter the new abstentionists. We’ve heard a bit about these guys of late, the new Scottish drugs policy is “abstinence based” and enforcement lead, “harm reduction” is replaced by “harm prevention”, it’s all a code for tighter prohibition.
Now there are many in the drug treatment field who genuinely believe in “recovery” as an achievable goal, working with the addict to encourage them into more stable lives and away form dependence on drugs. This is fine, it encourages people to quit drug use because, above all, they want to.
The new abstentionists come at it in a very different way. The movement in Europe has its home in Sweden, the one country in Europe with a hard line drug policy to rival the USA.
Of course, the key to “harm prevention” is the prohibition of cannabis because, as all good prohibition supporters will tell you, it’s cannabis that causes heroin addiction. It works like this: Kids smoke weed, get a taste for intoxication and pretty soon realise cannabis just doesn’t cut it anymore, so off they go looking for bigger kicks. Before you know it that one puff on a reefer has lead to needles in the eyeballs. It’s not true of course, but this is the logic of the new abstentionists, and they’re on the attack.
The new abstentionists very much have the ear of the Conservative party here. We can expect to hear much more of worthy sounding phrases like “harm prevention” in the coming years sadly. There’s an interesting discussion of the new abstentionists on the Drugscope site here – worth a read.
Of course, non of this applies to that not-really-a-drug substance, booze. This week has seen the launch of a new campaign called “know your limits”. An interesting campaign is this one, because it highlights the dangers of over indulgence in booze, doesn’t give a “don’t use” message but instead encourages people to drink sensibly, hence “know your limits”.
Odd, isn’t it, that a drug like cannabis which while not harmless, has few of the blatantly destructive effects of alcohol – let alone the really serious dangers up to and including fatal overdose – is considered dangerous enough to ban and to impose draconian penalties against, whereas with alcohol we’re advised to go careful.
“Know your limits” is run by the NHS – the health department of government of course – whereas Talk to Frank (which deals with real drugs) is run by the Home Office.
This binge drinking problem of course has come to a head over the past 10 years, oddly enough the time span of the present drug policy – the same drug policy that’s created the methadone problem. Maybe it’s time for a reality check as to what we’re trying to do and why.
Rewind 10 years and nightlife was dominated by raving. It seems hard to believe now but back then many night clubs were full of people dancing around holding plastic bottles of water. Sure there were clubs where the drug of choice was alcohol, but in many the bar area was close to deserted as people preferred pills and weed to plonk. Killing off this MDMA based rave culture was central to the government’s drugs strategy introduced a decade ago. So they closed down the old clubs and the new “nighttime economy” was born. Nightclubs became “drug free” and new drinks appeared marketed in yoof drug speak – VK the vodka Kick (pictured), a brainstorming mix of vodka, caffeine and Taurine is just one example. Taurine, as I’m sure you know, is an inhibitory neurotransmitter. So that’s OK then.
What we’ve seen over the past 10 years is an attempt to substitute drug use from those drugs the government doesn’t control, to those it does. This isn’t something based on the “goodness” of the drug – it’s potential for harm to the body for example – but cynics would argue on the ability of big business to make money.
This of course ties in with the methadone debate, because that substance is an industrial product of the pharm industry. Whatever the rights an wrongs of heroin substitution with methadone, or Ecstasy substitution with booze, be sure a lot of people made a buck on the back of it and in so doing tried to solve a problem by creating a new one.
So there you go, the UK drugs policy ambles along as normal, totally lacking in consistency, driven by twisted morals and having failed badly it’s ripe for a good hefty dose of new abstinence, after all, prohibition as a policy hasn’t got anywhere else to go. Frying pan to fire time.
I cannot agree with your remarks regarding methadone–especially in referring to it as trading addictions, etc.
While the goal of many opioid addicts is indeed to be “drug free”, the sad fact is that many of them are not able to remain so. This is often due to brain chemistry issues. Long term opioid abuse shuts down the brain’s production of natural opiates–endorphins. When the user quits, there is a period during which they suffer from the lack of exogenous and endogenous opiates–severe depression, inability to feel pleasure or happiness, anxiety, irritablilty, extreme cravings, exhaustion, etc. For some–primarily shorter term addicts, but also some long termers–this begins to slowly lift as time apsses and the endorphins begin being made once more by the brain.
However, for others–primarily long term addicts, but also some who may have experienced a deficiency even from a young age, pre-drug abuse–this NEVER occurs, no matter how long they may wait or how badly they may want it. These are the ones you see relapsing over and over again, even with the best of support and counseling–because the problem is not so much emotional or mental as it is biochemical.
For these patients, talk therapy and social supports are simply not enough to control their illness. Methadone rebalances the brain chemistry so they are able to live a normal life–one in which they can feel pleasure and happiness, and are not “high”, and are able to function and be productive. Opioids are not “evil”–we all produce natural opiates and need them in order to function normally. When this production is derailed permanently, supplemental opioids may be required. Methadone is a good choice for this because it does not produce the euphoria, is long acting, and because it does not cover all the opiate receptors in the brain, unlike most opioids, leaving some of them open to encourage the natural manufacture of endorphins, if the brain is still able to produce them.
To consider someone who is still on methadone after 3 years’ time but is taking no illicit drugs and is doing very well on treatment a treatment “failure” (as the “3%” study did)makes no more sense than to consider a diabetic who is still on insulin after 3 years a treatment failure. And the term “replacement” or “substitution” treatment is a misnomer. We are replacing the missing endorphins–not the heroin or other opioid drugs the patient was abusing.
There is a big difference between addiction and dependence. Methadone patients are dependent physically on their medication, yes–but very few are “addicted” to it. Addiction includes a set of behaviors that are not found in functional methadone patients not abusing other drugs–behaviors like increasing their use of the drug secretly, lying and manipulating to get more, being obsessed with getting and using the drug, losing interest in other activities and personal hygiene, and so on. This does not apply to most adequately dosed methadone patients–in fact, just the opposite is true.
Hi Zenith
I agree that some – maybe many – addicted people will never become drug free for the reasons you state. I hope it was clear that the above item was not promoting abstinence as the only way forward or indeed the only acceptable end result!
Of course I agree that getting addicts lives back in order, stabalising their habit, keeping them away form the illegal trade etc is a major aspect of recovery.
My point is that an addiction to one drug has been replaced (at best) by an addiction to another, more often than not in addition to the original addiction. Better, I would argue, to give maintenance with the original drug of addiction – ie heroin, especially if that maintenance is to be long term.
I’m a bit concerned that you seem to think medicines should be unpleasant when you write “Methadone is a good choice for this because it does not produce the euphoria”. This is surely a matter of dose and proper management?
Another excellent article that gets to the nub of the problem.
Cannabis users (in particular) need to re-evaluate their own view of themselves. Social attitudes to this drug of choice often make them feel like lesser citizens and not entitled to the benefits of society in the way alcohol users do. This may include the feeling that law enforcement, medical attention and equal opportunities in life are not for them. This is especially destructive in poorer areas of society where people already feel disadvantaged. They put up with alienation and persecution and people wonder why many of them develop mental health problems.
All the so called solutions are impersonal and seem to have the unspoken assumption that society can decide a form of behavior is unacceptable and that assumption gives the right to persecute people and remove their basic human rights.
Cannabis users need to demand their entitlement to equal rights in society. Legally we need keep pushing the notion of equal treatment under the law when compared to alcohol users – This does not depend on the current legal status of various substances but on the relative harm and consequences of behavior.
To persecute a cannabis user for simple use or possession is disproportionate when an alcohol user is treated so differently under the law.
To turn a blind eye to the use of cannabis by Rastafarians (when they admit to usage and even promote it as a tenet of their religion) and persecute some one with different religious views is definitely discrimination.
Society has always needed a minority to push around and blame for it’s ills.
It is not Negro races,
It is not Imigrants,
It is not Jews,
It is not Muslims
It is not teenagers,
It is not the poor and un-educated …
… and it is not cannabis users.
We need to push for the restoration of the human rights of the millions of people who are affected by society’s current attitudes to drugs. Then we can fix any problems that remain when the dust has settled.
“…Now youv’e seen the light
Stand up for your rights”
Dear All,
I am pleased at the rational respnce to a ‘debate’ precipitated by the ‘New Abstentionist’ lobby & their FUNDEMENTALIST
mentality regarding the ‘gold standard treatment’ of a ‘chronic medical condition’ that is ‘charecterised by relapse’ & may result in ‘Morbidity’ if left untreated or inapropriatley treated.
Sadly, as a supporter of User/Service User/Patient empowerment I see nothing in the ‘New Abstentionist’ fundementalist dogma
that has not been tried before with disasterous results for users & family’s.
If a person is helped to stay alive due to good quality, empathitic, non -judgemental ,
psycho-pharmacological therapy/Agonist Maintenance, then surely, this is a cause for celebation not moral condemnation.
Thousends, in the UK, Millions world wide have died due to HIV/Aids, Hep C, overdose etc, as a direct result of abstentionist fundementalism.
Indeed many of my 70’s & 80’s, let alone 90’s peers are dying and/or suffer debilitating ill health due to the predominance of abstenionist
ideology that pervaded the NHS during this period.
It is a tragic failure on the part of many that
the so called ‘New Abstentionists’ now feel safe to crawl out from under the tombs and graves they have hidden in as the going got tough & their ideological beliefs where at last, subjected to scrutiny , question and evaluation.
These Abstentionist Fundementalists have an agenda, career improvement, increased funding, power & resources, political power, and personal advancement at national and international level.
I doubt if our (the users) interest counts for much at all except when we reinforce their own posistion & beliefs.
As for user empowerment, well I really worry when a senior player in the New Abs ‘cult’ talks about recovery including ‘political awareness’. Clockwork Orange or what?
How dare anyone presume that our drug addiction or dependence precludes intellect, political awareness and so much more.
Given the ‘New Abs’ contribution to Conservative Party Drug Treatment Ideology
I, for one, do not need to be a unwillng recipient of what certain fundementalists
term ‘political awareness’.
Coupled with the ‘New Abstentionists’ belief that they & they alone hold a monopoly of the ‘truth’ of not only regarding ‘addiction’ as they define it but also ‘recovery’ & the pathway to ‘it’ as determined by their own beliefs, values and AGENDA.
This is not to deny the value, for those who are empowered to make informed choice & also to change their ‘choice’ as their condition neccesitates, and seek to cease drug use at a given time and in the right set, settings, & with appropriate (often poor) support plus fallback / relapse planning, including Maintenance if they need it.
As my mentor, the great Bill Nelles said: “You cannot rehabilitate a corpse”, sadly some of the New Abstentionist Fundementalists would chalenge this and by practice demonstrate their belief that we (users) are better off clean and dead than empowered & alive courtesy of well managed Agonist Maintenance Treatment, life long if desired.
It is with deep regret that I have to assert from decades experiance that such Fundementalists “Speak with corpses on their breath”
To add insult to injury the Fundementalists have lttle new to offer to those users who determine to undergo withdrawal, abstinance syndrome, in order to seek cessation of problematic/unmanagable addictive behaviour
& dependence.
Those of us who are users, ex-users,dependent & stable -e.g recovered,& allies,are no longer in the disempowered place we had inhabited during the rule of the Fundemalist Abstentionists and will resist any attempt to turn the clock back , re-introduce enforeced/coerced treatments, & restrict our right, no different from any other NHS Patient, to choice & choose the treatment modality that best meets our needs at any given time.
What next: Supervised dispencing of aspirin for patients with lifestyle related heart disease?
look where this is leading.
Alan J.
Well, what can I say that hasn’t already been said. Methinks its time to up and leave to a country with a more sensible and fact based outlook on its drug policies. How much are homes in the Netherlands?