Originally posted as a facebook note way back when.
Yep. “What about heroin?” is *the* first thing that anyone asks when you talk about decriminalising drugs. Its a hard question, as, according to the Parliamentary Select Committee on science, heroin is the most harmful drug. (For reference, alcohol (legal) is the fifth, tobacco (legal) is the ninth, cannabis (class B) 12th, LSD (class A) 15th, and MDMA (class A) 19th out of the drugs investigated).
So, what to do with the world’s most harmful drug when we decriminalise drugs? It’s a hard question, and it’s important to look at the facts. Heroin use was prohibited in the 70′s when the Misuse of Drugs act came into force. Since then, all drug use in the UK has shot up by 300%, but heroin in particular has shot up by 1000%. Heroin, because it is highly addictive, expensive, and impure due to an unregulated, illegal market, means that the harms associated with its use are many.
I’m a firm believer in a harm reduction approach. I feel that if a policy should be pragmatic, and seek to reduce the number of people harmed by drug use, and minimise the intensity of that harm should it occur. So here are my steps to harm reduction. Im first going to focus on the experiences of heroin users, and then society as a whole.
From talking to a friend of mine who is a drugs worker in Wakefield, there seems to be much anecdotal evidence of overdosing heroin users being left by friends and associates out of fear of legal recriminations, when the ambulance comes. This has reduced somewhat locally in West Yorkshire when the police made the decision to not go out in response to these emergency calls, but people still die unnecessarily out of fear of the police. Whilst i haven’t got any stats for the UK, in America, only 10% of ambulances are called when someone dying of a heroin overdose is still alive, something that could be avoided by decriminalising heroin possession
2. Active Education
Provide adequate education for drug users and their friends on how to recognise a heroin overdose (see the end for information on what an heroin overdose looks like) so an ambulance can be called earlier. At the moment, the drugs education system takes a similar to ‘abstinence only sex education’, and as such is failing the third of us, who choose to do illegal drugs, by not providing us with information on harm reduction and danger signs.
3. Quality Control
If the market for heroin was quality controlled, which is likely to happen in a decriminalised market, many of the health risks associated with heroin use would decrease. Quite a lot of the medical issues heroin users face are caused not by using heroin itself, but by the impurities present in the drug. The impurities are only there because of the government’s policy of prohibition, putting the supply into hands of unaccountable dealers.
4. Sort out needle exchanges.
In this country, our needle exchanges are relatively good. However, not all needle exchanges distribute the essential ‘accessories’ for safe IV drug use, such as filters, sterile water, stericups, and vitamin c. A study also showed that there is a big difference between Scotland and England, with Scotland less likely to give away some accoutrements, and England less likely to give away swabs and wipes, etc. Scotland also has a cap on the amount of needles they can give away to one user in a session, which seems silly as many users may be collecting for others and this could lead to people having to share needles. England are more likely to ‘intervene’ and refuse to give you needles if you are/look under 18, which is horrendous, as this is a likely cause of people under 18 having to share needles – putting our youth disproportionately at risk.
5.. First Aid Training
Train drug users and their friend’s basic first aid such as CPR so the victim of an overdose is likely to get vital help before the ambulance comes. Also, the more IV users know about first aid, especially the importance of sterility and not sharing bodily fluids, the better.
6. Naxolone Provision
Give out naxoline in emergency kits to users and drug workers, and others likely to come into contact with people overdosing on heroin (much like the system with people prone to having anaphylactic shock carrying epi-pens). Naloxone is a drug which has anti-opiod effects, it combats the effects of a heroin overdose when administered to a patient. The dissemination of this drug could save many lives. It also has other interesting properties, which I will come to later.
7. Heroin Maintenance
Methadone maintenance is undoubtedly a good thing, but it is prone to certain problems. The success rate of methadone maintenance programmes are lowered simply because in many cases, people don’t enter them voluntarily, but are coerced (i.e. they are given the choice of either going to prison or going through methadone treatment). So many people in methadone treatment either don’t want to be there, or don’t feel the need to give up heroin. Another problem is that methadone is still a highly addictive drug, which is potentially harmful (especially in its street form), so programme dropouts are put back onto the street with another addiction, often making their problems worse. One solution to these problems would be to actually administer quality controlled heroin to patients. This has all the benefits of methadone treatment (reduction in crime, reduction in the harms associated with an individual’s drug use, increased chance of getting sober, etc.) with a lot less negatives.
8. Expansion of methadone+ treatment
As I mentioned before, methadone treatment is currently one of the best treatment programmes offered at the moment. Studies on heroin maintenance programmes in Switzerland show that quite a lot of people passing through the system end up opting on to methadone or abstinence treatment after a while (showing that after a period of heroin maintenance and emotional therapy, many feel able to start kicking the habit). It is essential that methadone treatment carries on being available. The feasibility of using other maintenance drugs such as Buprenorphine or naloxone (see above) which have the same effect but need administering less often (once every 3 days rather than once a day), which should in theory decrease the cost of these programmes. It is also suggested by some sources that a maintenance programme that requires the patient to be in the clinic less, increases chances of recovery.
9. LSD/ Ibogaine therapy
LSD and Ibogaine are drugs that can, under clinical supervision, break addictions relatively quickly. The main reason why LSD and ibogaine are not used in addiction treatment is because they are currently illegal (because they also happen to make you high, although it isn’t physically possible to be addicted to either drug), and having ‘official acceptance’ of a drugs therapeutical effects calls into question the legitimacy of the illegal status. And so, the drugs remain unused for treating addicts, and remain illegal. Another issue with Ibogaine is that in huge quantities it is neuro-toxic, which is a barrier to its use in treatment. However, a derivative of ibogaine, 18-methoxycoronaridine has no side effects in terms of getting you high, or in terms of toxicity. It is essential that we at least explore further the use of these drugs in treatment of addicts.
10. Questioning 12-step programmes
12 step programmes such as Alcoholics Anonymous and Narcotics Anonymous frankly make me rather uneasy. I know their members feel strongly about the benefits of the programmes, so I’m not going to be too critical here. However, they do seem to be based around a belief in G-d, most of the steps mention G-d or some other sort of moral code. The NA produces literature similar to daily prayer books, and encourage recruitment or in their words “planting the seed of recovery in the minds of others”. 12 step programmes have a relatively low success rate of 10%, which makes them an inferior route to recovery than the above options. However, one of the reasons why they are so popular is the community based around them, something that groups like Rational Recovery, which don’t subscribe to pseudo-religious bs, can provide.
11. Changing Attitudes towards heroin use
One of the most important changes that needs to happen is one of attitude. As a society, we view heroin users as losers, dropouts, scumbags. In reality, all we are seeing is only a section of heroin users, the less privileged ones. Drug use here is fundamentally a class issues. Often people with money and privilege can obtain a steady supply of relatively good quality opiates (especially if one works in the medical profession), whereas what the people who we associate with heroin users are the less prividged, those who cannot always afford a steady, good quality supply, and often have to resort to crime to feed their habit. The fact of the matter is that the man who is credited as being the ‘Father of modern surgery’, Dr. William Halsted, was using quite heavily all through his eminent career with most of his colleagues not noticing. He managed not only to hold down a steady job, but to rise to the top of his profession. Why? Because he had access to a steady supply of good quality drugs, something which heroin maintenance treatment would provide.
12. Shooting Galleries
Kind of related to Heroin Maintenance, but Shooting Galleries are basically places where people can go to have supervised injection facilities. This massivley reduces the harm associated with IV drug use (such as HIV, collapsing veins, etc.), and can often simultaneously serve as needle exchanges.
The implementation of the above steps could involve a lot of money. Just where is this money going to come from? Should tax payers stump up the cash for selfish drug users?
The answer is YES. Currently, we spend a hell of a lot of money on punishing drug users. It costs between 5 and 6 times as much money to put a keep a person in jail, opposed to the cost of providing a heroin user with maintenance treatment. Out of the 105,570 people arrested in 2004 for drug offenses in England and Wales, 85% of the were arrested for simple possession. 11% of those were given a custodial sentance. That equates to around 9900 people in prison for possession of drugs. As the average cost of housing someone in prison is £32,358 , so we would save £320,344,200 in one fell swoop. If we decriminalised drugs and allowed regulate businesses to take the place of street dealers, we would save another £52,606,924 just from not having to put the dealers in jail. If you think of the VAST amount of money that we would save from not having to waste police time and resources on drug offenses, that would make a massive saving. According to Transform, the cost of drug motivated crime in Britain as a result of prohibition is costing the taxpayer £19 billion, a third of all UK crime cost.
So, it seems the money is there.
Social Effects of Decriminalsation.
1. Less Crime
Obviously, taking drugs out of the hands of dealers and into the hands of accountable businesses would massively reduce crime, especially violent crime as a result of dealers squabbling to control illicit markets. In fact, harsh prohibitionary ‘crack downs’ on drug crime actually are associated with creating more crime, moving crime to a different areas and initiating territorial disputes which often get violent.
In terms of heroin, crime is reduced massively in an area where heroin prescription/maintenance is present, as people no longer have to find the money to pay dealers. A swiss study found that in the areas where Swiss heroin maintenance programmes were readily available, drug dealing was low, as was property crimes lower than average and possession of other (non-heroin) drugs by the participants.
2. Less Drugs
Many people would imagine that legalising heroin would cause more people to use it, but the ‘medicalisation’ of heroin seems to have had the opposite effect in Switzerland, where the average age of people popping up on the radar for using heroin is getting lower, and the age of those people getting higher, suggesting that less new people are getting into drugs as a result of its medicalisation/decriminalisation.
3 Less Harm
I think the above steps showing harm reduction techniques adequately show that the harm associate with heroin (and other drug) use can be greatly reduced if drugs were decriminalised.
 – Home office Statistical bulletin, 2004, Drug offenders in England and wales
 National Prison Service Figures