Get caught with heroin and you face seven years in prison. But not Erin O'Mara, one of 440 addicts in the UK to get a regular fix from an NHS prescription - an arrangement she says has turned her life around.
By Tom Geoghegan
BBC News Online
Erin O'Mara is a bright, bubbly magazine editor - hardly the stereotype of someone who injects heroin four times a day.
But her habit, now in its 20th year, does not line the pockets of a drug dealer. The 34-year-old gets her fix from her local chemist in west London. This "perfect prescription", as she calls it, began two years ago and rescued her from a life of prostitution, drug dealing and serious illness.
The downward spiral began with Erin's first taste of heroin aged 15 while in her native Australia, and has included 10 unsuccessful methadone programmes along the way.
To finance her habit, she began working as a masseuse, which led to escort work and then street prostitution. That stopped when she discovered she was HIV positive.
But the prescription has transformed her life. As founder of Black Poppy, a magazine by and for drug users, she addresses drug conferences and is being consulted about pilot projects.
Sitting in her office, she says: "My prescription has meant I have money now, and choices I can make in my life - simple things like what I want for dinner. I can do things I haven't done for years and can think five years ahead. Before I was just thinking about my next 'hit'."
Each shot supplied by her chemist is just enough to enable Erin to function properly and prevent the onset of withdrawal. She only feels the buzz if she relaxes.
ERIN'S DAILY PRESCRIPTION
4 x 100mg diamorphine (solid)
4 x sterilised water
4 x sterilised needles
4 x swabs
advice leaflet enclosed
The NHS allows only licensed doctors to prescribe diamorphine, the medical name for heroin, to addicts if they have failed to respond to methadone treatment. At present just 0.5% of those in treatment are prescribed heroin, but new pilot projects are expected to increase that number.
Supporters of this policy, such as the independent research group DrugScope, say controlled distribution by the state can drastically reduce crime.
They also argue that clean heroin like diamorphine is not in itself dangerous, just incredibly addictive. And a pharmaceutical prescription excludes all the risks associated with unsafe injecting and enables the user to gradually be weaned off the drug.
Topped up doses
Erin believes this approach can save lives. But prescribing heroin is not always the answer, as she herself knows from the first programme she took part in in 1998.
"The whole set-up was really oppressive and heavy-handed, but the doses were too low so people were using other drugs and too scared to admit it. No-one was happy and no-one was doing well on it. The carrot and stick approach doesn't work because you can't punish users enough to make them stop".
HEROIN & THE NHS
Prescriptions peaked in 1960s
The UK is one of the few countries to allow it
Any doctor can prescribe it for medical conditions, but need Home Office licence to treat addiction
Home Office says every £1 spent on drug treatment saves £3 in less crime
One patient, a 45-year-old woman, threw herself off a tower block two days after being penalised by having her prescription withdrawn, Erin says.
And with strict attendance requirements and supervised injections, it prevented users from getting full-time employment.
Erin claims she was forced off the course after 18 months when she tried to start a support group. She then founded Black Poppy to give a voice to drug users, and address issues missed by treatment programmes.
After leaving the prescription programme, Erin was put on methadone injections, which she topped up with crack. This period was one of her lowest and her veins began to collapse.
When she heard about a vacancy on a pioneering prescription course at the Maudsley Hospital in south London, she cornered the doctor in charge at a drugs conference.
"I remember my sense of complete and total desperation. I felt I could not go on any longer, that if they didn't help me, I didn't know where I would be. I felt that this was my last hope, that I'd tried everything. And I begged."
Her powers of persuasion paid off and she joined what turned out to be a more flexible programme. She was able, for instance, to spend a few months at her mother's in Colchester and pick up her prescription from a local chemist, so long as she visited the doctor every fortnight.
Her immune system strengthened, and two years on she is on a reduced dosage and aims to come off heroin completely.
As she looks to the future, there is a trace of anger about the years spent on and off treatment programmes.
HEROIN IN THE UK
200,000 heroin users
88,000 in treatment , of which 40,000 on methadone
Heroin is an opiate which depresses the nervous system
It can combat physical and emotional pain
Users can feel warm, relaxed and detached
Purity of street heroin varies, with a risk of fatal overdosing
Unsafe injecting means risk of HIV, hepatitis, abscesses and ulcers
Source: DrugScope, NTA
"Why did I have to wait until I'd finished selling my young body to men, until I'd got sick and deeply depressed, until I'd used every vein in my body from my neck to my feet, until I'd contracted both HIV and Hep C?"
But she is optimistic that the government has begun to move in the right direction and listen to what drug users want.
What do you think of this story? Do you have experience of treatment for heroin?
Send your comments on the form below:
My sister died of a heroin overdose at 25 because there were no programmes like this. She tried to get off and was left with what the street had to offer because drugs are not regulated. Now a clever beautiful woman is dead, and society, quite apart from my family, is all the poorer. It could have been avoided if we were rational about dealing with drug addiction.
Craig Arnott, UK
My sister has chronic asthma, which she's had since a child. She has to pay for her treatment - why can't the NHS fund her condition, instead of a self-inflicted drug habit?
I whole-heartedly support any effort that is being made to help people turn their lives around from the desperation of addiction. Too often people are treated as scum, for mistakes that they made when young and impressionable.
It is long overdue to help break the criminal cycle attached to drug addiction. This country - and addicts - would be better off if we faced up to helping people rather than vilifying them. I fail to see how Erin's story would encourage people to take up the drug; addicts have a role to play educating the young and the ignorant.
To those who despise drugs and users: why do you want to pay to keep them tortured in prison when they can be working and paying taxes? Reform of heroin laws would be the single most profound move the government could make in reduction of property crime, prostitution, HIV and human suffering.
Richard, Sheffield, UK
I was denied this treatment by the NHS, and even basic methadone maintenance, because every area has a different approach. There are few doctors in the private sector willing to prescribe heroin, and to go private the costs are in excess of £60 for a weekly prescription. Where are the other doctors offering this service? There won't be many, as too few want to work with those seen as undesirable patients.
I'm still to be convinced about these programmes, but remain open-minded. However, I take offence about her attitude that she had to sell her body, and that she's angry about the years spent on various courses. She must take some responsibility for her position. I wonder how much the programme costs the NHS (and me)?
Stephen Kerin, UK
Stephen asks how much this program will cost him. Well, it's nothing like £60 a week. Heroin is a cheap drug, about as expensive as aspirin, and only costs more if you buy it illegally. Chances are it'll cost the taxpayer much less than Erin will pay in tax - tax she wouldn't pay without this programme. And it probably costs less than the standard prescription charge she pays.
Simon Richardson, UK
Having been a long term heroin user for over 15 years, my life was made manageable by being prescribed morphine. It took all the stress out of an already painful problem. And eventually gave me enough time to address the total problem on my terms, rather than my dealer's. I have now been free of drugs for over five years, and could not have done it without a program like this.
James W, US
I have watched a friend's lovely, intelligent, 17-year-old descend into the hell of heroin addiction. Her days are spent shop lifting, finding money to pay the dealer. Her family in abject despair, fear for her life & have nothing left for her to steal. A scheme like this one would surely be much more likely to help addicts recover and live without the daily fight for drug money, not to mention reduce the crime that heroin causes.
What utter tosh! Will we be paying for her beer and fags next!
Gary Clarke, Hong Kong
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