(From: The Independent - May 5, 1992)
Anne Montague visits a clinic prescribing hard drugs to prevent needle-sharing, the use of adulterated substances, and crime
By ANNE MONTAGUE
'DRUG use is here to stay,' says Steve Dalton, director of drugs and HIV services with Wirral health authority. 'The sooner we accept that, the sooner we can get on with dealing with it.' Mr Dalton runs a clinic for drug addicts that prescribes heroin and other addictive drugs, not only in oral but also in injectable form. On the Wirral, he says, drug use is fast becoming the norm. 'It's nonsense to say that if we stopped giving people drugs they would stop taking them sooner. They would just damage themselves sooner.' His views may sound controversial, but they are in line with current government thinking. The latest guidelines on drug misuse, issued to doctors late last year, signal an important shift in attitude, away from the 'Heroin screws you up' campaign and the 'Just say no' messages of previous years. Thanks to the threat of Aids, the priority is now one of damage limitation - even if that means prescribing for addicts. This approach is one that health authorities such as the Wirral have long been
advocating. Its service for 'well drug users' was launched just over a year ago. Its focus is a full prescribing service and its chief aim is to halt the spread of HIV and other infection. The authority's needle exchange for addicts, set up in 1988, has already proved remarkably successful: despite having one of the largest injecting populations in Britain, Wirral now boasts one of Britain's lowest HIV infection rates - less than 10 per million population. The new service, based in St Catherine's Hospital, prescribes a range of drugs, including heroin for injecting and smoking, and methadone, an opium substitute, available in both oral and injectable form. Clients are individually assessed and their drug type and dosage agreed by negotiation. There is no pressure to stop drug use, although users must agree to try and move away from injecting and eventually to discuss the idea of coming off. After 10 months the service is already over-subscribed, with more than 1,000 referrals for 750 places. Supporters of t
he service argue that if addicts can get their drugs legally they will not need to risk their health - and that of others - by using adulterated drugs. Neither will they need to sell drugs or commit crime to pay for their habit. It is estimated that drug-related crime forms 65 per cent of the local probation service's workload. Significantly, the local police and drugs squad are giving the service their backing. Although the Wirral is not the only prescribing service, it is already one of the largest. It is unusual in having a GP, rather than a consultant, as clinical director. The staff includes specialist outreach workers - who search out 'hidden users' such as the partners of addicts - a probation officer, doctors, social workers, a midwife, family planning nurse and youth workers. Dr John Marks, a consultant psychiatrist, runs a drug clinic in neighbouring Halton health authority, which has been prescribing for a small number of addicts since 1985. Dr Marks insists there is no evidence that prescribing
drugs prolongs addiction. Addicts, he says, have a spontaneous remission rate of 5 per cent a year, whatever their treatment. 'The average addiction period is 10 years,' he says. 'Surely the best kind of intervention is to keep people healthy, legal and alive until that has elapsed.' The centre has been particularly keen to reach the 'hidden users' - women. Women staff at the centre run sessions for women only, and family planning, midwifery and well-woman services are provided in the same building. Their efforts have paid off. In the service's first six months, 46 per cent of clients were women. A more common female client proportion would be 20 per cent. 'Female drug users face far greater problems than men,' says Mr Dalton. 'They miss out on treatment and care because they are reluctant to say they inject. Even within their own community, women injectors are treated as the lowest of the low, especially if they are pregnant. Partners often don't want them to come forward and the women themselves are worr
ied in case their children are taken into care.' There has been little public opposition to the service, and a poll of 186 GPs asking their opinion drew enthusiastic support from 150. None the less, some of those within the health authority find the pounds 350,000 capital invested in the centre, and the pounds 250,000 annual drugs bill, hard to swallow, especially when the NHS is so severely strapped for cash. But Mr Dalton argues that in the long term, this is money well spent. Compare, for example, the pounds 500 annual drugs bill for the average client, with the annual pounds 30,000 it would cost the NHS to care for an Aids patient. And the cost of maintaining a client on drugs is minimal compared with the price the community pays to finance that habit illegally through crime. So far, the problem of addicts selling prescription drugs has not arisen. It is too early to assess the impact of the service on crime rates, but anecdotal evidence suggests that the centre has affected the local drugs market. 'The
price of methadone on the street has dropped dramatically and the price of heroin has been fluctuating, so we know we're having some impact,' says Mr Dalton. There have also been important spin-offs. Attendance figures for the syringe exchange have more than doubled. Addicts have formed a drug users' group that organises social events for users and their children, provides a forum for debate, and presents their views to staff at the centre. Positive as all this is, Mr Dalton is realistic. While staff may be able to work with heroin and methadone users, they can do little for the growing number of people injecting the sleeping pill temazepam, beyond offering valium and a detoxification regime. 'Temazepam is a very, very dangerous drug that can cause disorientaion and aggression,' he says. 'If injected into an artery, it has been known to block off the blood supply and lead to amputation of limbs.' He also knows that the service cannot reach everyone or solve all their problems. 'There are some people who enj
oy the lifestyle that goes with illegal drug use: being an addict is better then being a nobody. We must be wary about believing all we need to do is replace illegal drugs with free ones. 'We can respond to the most obvious need - but it doesn't change people's lot in life.'
