Yoof of today!

We definitely seem to have entered the silly season in the run up to Christmas. In the past week I have received several inquiries from the press who all seem to think that I must have some kind of crystal ball or arcane knowledge about "young people". I have been asked about young people and AA/NA - “is it trendy for young people to go to 12 step meetings now that Lindsay Lohan has admitted that she is going to meetings?”

Who cares if it is “trendy” or not, they are missing the point – its about saving lives, not fashion! Is coronary care trendy? Are A & E departments trendy? I have to ask myself what kind of rarefied atmosphere do these guys live in? Have they put something in the water in Wapping?

Lindsay Lohan is living in California, I live in South Yorkshire. Young people in California do lots of things that haven't caught on over here – surfing for one – and there are huge cultural differences in the way addiction and recovery are viewed over here and there.

The end result is that young people do go to AA/NA meetings in the US – especially California, while over here in the main they don't.

Most “addicts” seem to turn up in NA at around the age of 30 and it's around 40 for AA. There are of course exceptions to this rule.

I believe that one of the causes of this is the marked reluctance on the part of treatment providers in the UK to properly diagnose alcohol and other drug use in young people.

In the main the attitude seems to be that alcohol and other drug use is symptomatic of developmental problems rather than a condition that requires proper diagnosis and treatment in it's own right. In fact there are very few services in the UK providing proper addiction treatment for “young people”. Our very politically correct practitioners prefer to treat the age rather than the disease.

Then I would say that wouldn't I? I am a grumpy old addict after all!

The next magic bullet.....

There were several interesting news stories this week:

On Thursday The Guardian run a story reporting that the total social and economic cost of class A drug use is around £15.4 billion a year. The research was commissioned by the Home Office and also reported that 90% of this cost was accounted for by drug related crime.

The Guardian followed this up on Friday with another story which reported that the UK has 327,426 "problem drug users" and that the country spent £5.9 billion a year on illegal drugs.

These figures again came from the Home Office.

What is going on here - there are supposedly 181,000 people in "structured drug treatment" in England and Wales (NTA figures).

This represents around 55% of the Home Offices "total number of problematic drug users" (if the numbers in treatment in Scotland and Northern Ireland were taken into account the figure would be even higher!)

Sorry - but I don't believe a word of it! All the research that I have ever seen suggests that the percentage ""in treatment" at any one time is not likely to be more than 25 to 33 % of the total. If the governments research is right then they aren't commisssioning very effective treatment are they ? I mean if a minimum of 55% of all problematic drug users in the UK are in treatment and its still costing £15.4 billion?

Last year we were being told that each £ spent on drug treatment produced savings of £9.50. On this basis we need to be spending say an extra £1.5 billion a year - on top of the roughly half billion already spent. That would represent a 400% increase!

Spend £2 billion a year and the total cost in theory comes down to zero. Yeah well, thats not going to happen anyway - and it wouldn't work if they did spend the money because there will always be "treatment resistant" individuals.

Interesting to compare the Governments expenditure on drug treatment to the cost nevertheless. Interesting to see that we spend 10 times as much on illegal drugs as we do on treatment!

My final news story of the week was widely reported - the suggestion that we ought to consider prescribing heroin instead of methadone. A senior policeman suggested that this would reduce drug related crime - and guess what, he is right! He is after all a policeman, and it his job to reduce crime.

I suspect that this would be even more successful than he thinks - for one thing the bottom would fall out of the drugs market as the dealers could not compete on price and quality against the NHS!

My job however has always been about treating individuals rather than finding solutions to social problems such as crime and from the treatment point of view I would predict the following:

1. The numbers seeking treatment would greatly increase - many users do not seek treatment because they don't want methadone, it doesn't do what they want it to do. Many users who receive methadone on prescription use on top - for the euphoria that heroin provides and methadone does not!
2. Not many people would ever complete treatment "drug free" - although perhaps a few more would than now as the withdrawals are reconned to be less severe!

Either way don't for a moment believe that the Governments aim is to provide quality treatment for the individual - it isn't and hasn't been for a long while now.

It is to save money, to increase its popularity by reducing crime and to reduce the spread of blood borne viruses associated with drug use into the general community.

They really don't care if individual addicts sit in a corner and dribble while life passes them by if that is what it takes to achieve those goals (which are legitimate goals by the way - but not the only ones!)

To this end I suspect that prescribing heroin will be the next "magic bullet" which is going to achieve these goals!

We have now gone full circle and are rapidly coming back to the point where we were in 1966 - in 40 years there are now around 200 times as many heroin addicts as there were last time that prescribing heroin was official policy.

Whitehall's "Spinball" Drug of Choice!

There were two very interesting, yet contradictory, stories in the press this weekend regarding Methadone:

The Scottish press, in the form of Scotland on Sunday and The Scotsman, ran a story on Professor Neil McKeganey's research (from Glasgow University) which shows that only 3.4 percent of drug users who were prescribed Methadone were “drug-free” after 3 years as opposed to 29 percent of those who went into residential treatment.

Other differences were just as startling:

Of those who received Methadone:

• 29 percent were in employment or education.
• 47 percent said that they “felt better”.
• 91 percent admitted to committing crimes.

Of those who took the abstinence route:

• 59 percent were in employment or education.
• 79 percent said that they “felt better”.
• 13 percent admitted to committing crimes.

Professor McKeganey's research seemingly shows that Methadone “treatment” is only marginally better than no treatment at all.

There are apparently around 20,000 addicts receiving Methadone in Scotland.

Meanwhile in England the Sunday Mirror reported that 84,583 people were in treatment for Heroin addiction (in England). Caroline Flint MP (now the Health Minister, previously the Drugs Minister) reported that the figure had almost doubled over the past 2 years and that this was a sign that the government's drug strategy was a success.

It also reported “experts” as claiming that the true number of Heroin addicts could be 120,000 because many users “weren't receiving medical help” . We reckon that the real figure is likely to be at least double this – say 250,000?

Um........ We also note that the report talks about “medical help” - effectively prescribed Methadone. The article then went on to report that drug related crime had fallen by 16 percent from April 2004 to March 2006. It then trots out the old statement that “for every £1 spent on treatment £9.50 is saved in crime and health costs”.

Am I the only one to sense a contradiction here?

Either Scottish Addicts are very different from English ones (They are not – I have worked with both) or Scottish professionals are less competent than their English counterparts ( again we know that they are not) or something is wrong with the figures! Especially so when Caroline Flint's figures don't even seem to relly match up with those from the National Treatment Agency which last month reported 181,000 people in treatment for drug use! ( If 84,000 are Heroin addicts what are the other 97,000 doing?)

Could it actually be that someone, somewhere – perhaps not a million miles away from Central London – is massaging the figures?

If I have to chose between the 2 stories I would have to say that in my experience Professor McKeganey is the one that we should be believing! But Scotland and Glasgow are a very, very long way from Whitehall (unlike Baghdad and Kabul) so we very much doubt that anyone will take any notice whatsoever of this research.

"Evidence based Research" only counts when it says what they want to hear!

National Treatment Agency for policy abuse

I have recently been sent an e mail about a forthcoming one day conference in Leicester about future arrangements for Residential (tier 4) treatment here in the UK. All official statements are now pointing to the fact that it is now policy to improve access to residential treatment.

The government’s initial "bright idea" was to give large sums of money to the NHS to open new units, this might sound like a good idea until you realize that all the existing units have empty beds. The Problem is not so much one of capacity as of commissioning arrangements. Whether one gets residential treatment here in the UK seems to depend on several factors, most of which are financial rather than based on any real assessment of clinical need.

The process takes so long and is so convoluted that there are no doubt deaths each year because of either the time it takes or because individuals are so put off that they don't even bother to try to access residential treatment.

I could go on about this - but what struck me about the flyer was that the NTA were asking me to donate a day of my time and pay £165 for the privilege of helping them to save money! As a consultant in the field who actually has many ideas as to how the system could be improved I find this attitude patronizing. Just what sort of business do they think we all run? Do they really expect hard pressed, highly skilled professionals to pay to have their brains picked?

The biggest block to progress here in the UK is the fact that all policy is ultimately driven by political considerations. The NTA and the UK government are only going down this road now because all their previous attempts at "quick fix" treatment approaches have failed dismally and they are now desperate to achieve some real outcomes rather than ending up with 10% of the UK population on methadone for the next 30 years!

The price of drugs......

News reports in today's press state that the price of heroin per gram is now £40 as opposed to £60 a few years back. The general drift of the articles is that Britains streets will now be "flooded with cheap heroin".

Its interesting to note that when I got clean in 1986 the average price was around £60 to £80 per gram. I guess that if you take inflation into acount then in real terms the price is even cheaper now comparatively speaking.

While I have no doubt that there is a direct relationship between availability and usuage I don't think that the picture is quite as simple as the economic model suggests.

I cast my mind back to when I started using heroin in the early 1960's:

• After a couple of initial hits which were obtained by buying from "friends" who had legal supplies I pretty quickly decided to get "registered" as they called it in those days and to get supplies from a doctor. I would not only be able to have heroin legally but I would have more - always a good idea if you are an addict!

• You might think that it was hard to find a doctor - it wasn't, there were about half a dozen in London who would more or less prescribe to anyone who walked through the door with the requisite cash (about £5) for a private prescription and who said that they had a heroin habit. It was so easy that I not only walked out the door with a prescription for heroin - I had one for cocaine as well! (The doctor asked if I used cocaine as well as heroin - I am an addict so what was I going to say? In reality I had never even used cocaine up until this point.
  

The whole scene in these days revolved around Boots the Chemist in Picadilly circus in Central London. (It was open all night and you could cash a prescription at a minute past midnight!). Pretty soon I was swoping doctors trying to get a bigger prescription and there was even a period when I was getting Methedrine on prescription as well! Yep, you read that right - heroin, cocaine and methedrine on prescription!

I can't say that my life was very manageable around this time or that I was functioning well - I wasn't - and all this was shortly to come to an end.

The end came when the Government acted on the recommendations of the 2nd Brain report which came out in 1965. You see there had been a panic - the number ok known heroin addicts in the UK had gone up to the dizzy heights of around 2,000! (A very large proportion of those actually came from Canada and the USA because of this setup!) This was enough to trigger a panic. (I bet that the "powers that be" would be more than happy with 20,000 today.)

So the law changed and all the prescribing stoped. It was decided that "psychiatrists in special drug dependency clinics" was the way to go.

Why am I telling you all this history? Because up until that point I had never seen street drugs on sale in the UK.

I can tell you however that within a couple of weeks I was buying heroin from the Chinese community in Gerrard Street.

The price? £1 a bag initially. After a police crackdown the price went up to the dizzy heights of £70 for a quater ounce. What I believe happened was that the government legislation actually created an economic climate which made it profitable to import drugs. There was plenty wrong with the so called "British System" but at least the market was dominated by dodgy doctors rather than Gangsters and in fact the gangsters couldn't compete with the "dodgy doctors" plus Boots the Chemist.

The moral? There are now between 150,000 and 300,000 heroin addicts in the UK and the "experts" who presided over this disaster are still in charge! In what other field could the scale of the problem increase 150 times over and we would still listen to these people?

Alcohol and other drugs......

I had a telephone call from a well known National newspaper today asking if I could give any details of anyone that I knew of who had died of a heroin overdose recently - the idea was to establish some kind of a link to the price of heroin coming down.

What is it in this country? More people die of overdoses involving Methadone- prescribed or otherwise - and admitedly usually used in conjunction with other drugs than heroin. However all the total drug deaths pall into insignificance when compared to alcohol and tobacco related deaths.

If one teenager takes an ecstasy tablet and dies then its all over the media for a few days, but I have yet to see the same sensational headlines about the 100 or so alcohol related deaths each day. That might well change however as thanks to the "National Alcohol Harm Reduction Strategy" and longer opening hours the numbers are rising rapidly.

It is very interesting to contrast the differences between the Alcohol and Drug Strategies however...

For Drugs: We must reduce the supply and we will lock up the suppliers for life for preying on the inocent victims.

For Alcohol: It is the consumers fault for not drinking sensibly and we will involve the suppliers in writing the strategy and do all that we can to make it easier to obtain supplies in the name of consumer choice!

Of course the Government taxes alcohol and tobacco but not drugs. Could there be a connection we wonder?

Why do the media fail to see all the inconsistencies and lack of logic in all this? Uhmm? Answers on a postcard please!