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Last Updated: Monday, 19 November 2007, 11:03 GMT
A fix on the state
Heroin preparation

By Gaetan Portal
BBC News

A small core of hardened heroin addicts are being supplied with the drug as part of a government backed experiment to help them get clean. The BBC has been given unique access to the scheme to hear the stories of those hoping to turn their lives around.

It flies in the face of all official wisdom: heroin, a highly-addictive "class A" drug that commonly destroys lives, saves them. But that's the claim of Gary and Jamie - two long-term users of the drug and volunteers on a radical new treatment programme.

What's more, the heroin they believe saved them from an early grave was supplied and paid for by the state.

If I was on methadone and occasional street drugs... I would have died from liver cancer
Gary

Gary, 45, is one of a small group of hardened heroin users who have been attending clinics for two years as part of a controversial experiment jointly funded by the Home Office and the Department of Health.

In London, Darlington and Brighton, users visit clinics daily to inject themselves with diamorphine - the clean, unadulterated form of heroin.

The addicts take the drugs under the supervision of a dedicated team of nurses and clinicians in a special but simply furnished room. There are four chairs that are screened from each other with a small work surface. It's here that the addicts keep their equipment while they prepare to inject.

HEROIN CLINICS
so far cost 2.5m
paid for by Home Office and Department of Health
there are 150 users
a third of addicts use methadone orally, a third inject methadone and a third inject heroin (diamorphine)
There are cupboards for storage and a sink. All the addicts must wash their hands before taking their heroin. Compared with the kinds of places where some addicts take their drugs, this is a different - clinical - world.

And this clinical approach is key to the programme's aims.

Addicts don't respond

Treatment for hard-core addicts tends to have two aims: to stabilise drug use to cut out criminality, or to slowly reduce drug use and ultimately end addiction. The problem is that some addicts do not respond to schemes that try to replace heroin with methadone - and may end up taking both drugs. Others respond to methadone - but remain involved in crime and susceptible to relapse because of a chaotic life.

Inside the London clinic
Hygienic environment: The cubicles where addicts inject
This controversial experiment aims to help some of the most difficult addicts in the country rebuild their lives by giving them the drugs they crave, for free. But to stay on the scheme, addicts must be clean of street drugs and regularly attend counselling sessions.

So does it work?

Initial results of the pilot programme have been a big reduction in drug use, according to medical staff at the London clinic.

Gary, an addict since he was 17-years-old, says the effects were profound.

When he was using street drugs he exposed himself to another type of risk associated with intravenous drug taking: Hepatitis C, which he was diagnosed with in 1983. Now he attends the clinic twice a day, every day, to inject himself - and has just finished a six-month treatment which has cleared him of the disease. He was only given the treatment, he says, because he was part of the supervised heroin injecting trial.

"Just because I am addicted to one of the most addictive substances on the planet am I to be written off as a human being and not get any respect from the Health Service?" he says.

Avoid underworld

"If I was just on methadone and occasional street drugs I wouldn't have been given that and I would have died from liver cancer in the next few years."

Time ragout
In June, the chief constable of Tayside police called for 'legal heroin'
As with all those on the scheme, Gary takes the drugs under the supervision of a dedicated team of nurses and clinicians. While this may in itself be controversial, one of the effects is that the addict who sticks to the rules avoids the underworld of crime and drug dealers that dominated their lives when they were reliant on street drugs for their daily fix.

Jamie too says the state-sponsored heroin saved her life.

For the 39-year-old the memory of what life was like before she took part in the trial keeps her on the straight and narrow.

"It was horrible, I was miserable, I was self harming all the time. I lost all me belongings, I lost my children because of drugs, my family had enough because of what I was doing. I had put them through the mill and they couldn't cope."

She has been to prison 28 times, mainly for theft to feed her habit. But she says she has not committed an offence since she started getting her heroin on the NHS and knows that the trial has turned her life around.

"I was like a bag of bones when I come here. So when they brought the clinical trials out... well it saved my life really. I don't know what I would have done without it."

Such results don't come cheap.

More expensive

The costs for treating each addict works out at between 9,000 and 15,000 a year, three times as much as treating them with heroin substitutes like methadone.

Vancouver
'Shooting gallery' in Vancouver: Other countries have similar methods
Dr Nicola Metrebian, who manages the clinical trials, acknowledges that supplying the addicts with the specially imported heroin is a heavy financial investment.

"It is more expensive than standard treatment," she says, "but what we do know is that standard treatment, although it is cheaper, is not effective for this group of people."

An addict for 20 years, Christine says her daily routine when she was on street drugs was fraught with risk.

"You got to go to places, certain housing estates and certain areas that are not exactly nice places to go. You are at risk of being mugged or being sold rubbish by other addicts."

The final results of the programme won't be known for another year, but in London doctors and nursing staff say they have seen lives stabilised.

Politicians will have to judge if the benefits of supplying free heroin outweigh the costs. They will also have to consider whether the scheme risks undermining the government's hard line drug strategy.

For the time being, the clinic will remain open seven days a week, 365 days a year. It is a labour-intensive scheme - but supporters think it could ultimately help 5% of all heroin addicts.

Jamie is convinced that for addicts like her supervised drug injecting rooms are the way forward.

"It's just going to save the government so much money in the long run. So I say yeah, do open up as many clinics as you can, all over the world. I think it's a brilliant idea."


Below is a selection of your comments.

Finally a open minded solution to tackling this problem
Robin, Manchester

About time our government has done something usefull to combat heroin addiction.......instead of leaving it to Police with no tolerance policies,who should be dealing with real crimes ....treating heroin addiction is always going to cost ,but it is clear that what this saves will easily cover the cost.....the hastle for the victims of burglary/theft and the associated court/police costs ....social workers...insurance... you name it .....I would gladly help pay for such a scheme within NI contributions.
Rob Gurney, Luton

We have had a similar system to this in zurich for years and there is a lot less drug related crime as a result, addicts usally only commit crime to pay the dealers who are themselves criminals, this project is a positive step.
paul, zurich, switzerland

And the Government still cannot find the money to 'Reward' Law Abiding Pensioners who have NEVER been Drug Addicts or Criminals. Where is the sense in that? Maybe we should ALL become Criminals? Over to you Think-Tank !
B.W.Moore., Stockton on Tees.

Fantastic scheme. I wonder about it taking so long to get off the ground. With a small group like this I don't have to imagine why it may be so costly, but if applied on a wider scale taking into consideration the amount of money poured into prevention/smuggling, and so, it has got to be more economical. All money confiscated from crime should go to rehabilitation in general. If a person is content (unless he's a psychopath) he won't want to commit crime- why on earth would he/she?
Alan Dunn, Mikkeli Finland

I have been using for 12 years now and this project is the light at the end of the tunnel. It should be rolled out across the country because it will eliminate drug traficking, massively reduce crime, save the NHS money for treatments for Hep C, HIV and other heroin use associated diseases. It will also be less expensive if it is done on larger scale. So, it will save the police valuable time to tackle 'real' crime, it will save the legal system enormous amount of money, it will save the NHS money, it will save peoples lives and the society will have no more drug crime victims. Whichever way you look at it, reasonably, it makes sence in every way, for the society and for the user. It really is the only way forward. Thank you
Vladimir Mandic, London, England

Absolutely disgusting! Getting free drugs so that they can get high at the expense of the NHS! How can this be justified when cancer sufferers (or any other illnesses) are told that they cannot receive their life saving treatment on the NHS because of lack of funds, when they have been contributing to the system all their lives! Absolutely unfair!
Catherine H, Bristol

How ridiculous that 'specially imported heroin' is thought too expensive when we are supposedly in control of the world's main growing areas in Afghanistan. In fact, we are actually spending money on 'eradication' rather than buying the crops and distributing them legally. Incidentally many developing countries cant afford opiate painkillers for their health services.
CDY, London

Methadone was for harm reduction only, not detox. As a locum pharmacist in edinburgh i would welcome any new ways of rehab. The supervision of methadone by pharmacists was once seen as a responsible act. But patients in edinburgh once stabilised do not get supervised, they routinly take large bottles away from the premices, which i feel is very irrisponsible prescribing by doctors. The question is, when the funding for a 'shooting gallery' runs out. Will the patients be allowed to 'take home' the diamorphine. I hope that this trial has been thourghly thought out. Especially for the sake of the patients who fail on the program.
Chris, Edinburgh

Free, hassle-free drugs paid for by the state are the way forward. Well, addicts would say that, wouldn't they? But is it really helping people rebuild their lives, or just creating a new form of (taxpayer-sponsored) dependency?
Holly G, London

The liberals strike again. Why dont we give them all a massive overdose? It would be cheaper in the long run.
Terence Webb, london England

Haven't they been doing this in Vancouver with good results for years? It makes perfect sense - sure it costs the taxpayers money, but I't means that the addict's can get on with the rest of their day trying to rebuild their lives rather than resorting to crime to pay for their habit.
Tristan, London



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The services offered to drug users at the clinics




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