Posts Tagged ‘ prohibition ’

What about heroin?

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.

1. Decriminalise.

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.

Cost Implications

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.[1] As the average cost of housing someone in prison is £32,358 [2], 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.

[1] – Home office Statistical bulletin, 2004, Drug offenders in England and wales
[2] National Prison Service Figures

the war on drugs is a war on women!

Ok, everyone here knows i have issues with prohibition of drugs; drug prohibition drives the lucrative market underground, into the hands of violent criminals and away from accountable organisations. Since the first UN Drug Convention in 1961, which was annexed into UK law, and then formed into the 1971 Misuse of drugs act, drug use has risen by 300%, and use of more dangerous drugs like heroin has risen by 1000%. The UK government spend £19 billion on drug motivated crime that is an unnecessary symptom of prohibition. (Transforms statistics). Indeed, prohibition of drugs maximises the harm they have on our society, by putting them in the hands of unregulated, unnaccountable dealers peddling substances of unknown purity, to anyone who they can persuade to take them.

At the NUS LGBT conference, I made a speech on drug law reform comparing the prohibition of drugs to the prohibition of that stalwart of feminism, abortion. Both have similar consequences, by putting the practice underground, it causes people to accept more dangerous services in desperation, and users of those services face similar outcasting from their communities, and often find themselves disenfranchised for making a decision about what to do with their own bodies. After making this speech, I was called ‘appalling’ by another delegate for making this comparison.

This got me thinking, how else does the prohibition of drugs oppress women?

Firstly, one of the more obvious effects of drug prohibition on women, the forcing of them into sex work. In 1999, the number of women prostitutes numbered 80,000, this number is estmated to be much higher now. 95% *of those women have a problematic drugs habit, 78% of them are heroin addicts and the number of crack addicts among prostitutes are growing fast. (Home office figures). Im sure you all know, prostitution is dangerous work. More than half of UK women in prostitution have been raped and/or seriously sexually assaulted. At least three quarters have been physically assaulted. 68% of women in prostitution meet the criteria for Post Traumatic Stress Disorder in the same range as torture victims and combat veterans undergoing treatment (Ramsey et al 1993). The mortality rate for women in prostitution in London suffer is 12 times the national average (Home Office 2004a). The most tragic thing here is that the problem of women entering prostitution to feed a drug habit is a symptom of our governments prohibition laws, and thus completely unnecessary. In a system of substance control and regulation, quality controlled heroin/other hard drugs could be prescribed to addicts, making the need to engage in sex work to pay dealers go away. Not only would this benefit the women involved, but a Swiss study of 1300 heroin addicts, showed that prescribing heroin to addicts caused crimes in the test areas to drop by 60 per cent since it began in 1994 (Swiss Federal Office of Public Health).

A quick glance of Home Office figures show that 25.3% of white women and 51.3% of black and minority ethic women are in prison because of non-violent drug offences (dont get me started on why the drug war is racist!). According to the Ministry of Justice, the latest figures (from 2 days ago, no less)show that 4299 females/women are staying at her majesty’s pleasure. According to ‘Women in Prison’, one of the biggest complants by women prisoners is the way the prison system is structured; women are often sent to large prisons away from their families.And, in the words of one woman: ” Many women are thrown out of prison without anywhere to live, with no job, only £46 in their pocket and no real means of survival. If they put you in a hostel and you are an addict, it is usually full of drugs and alcohol, so you have no chance of going straight. There is little or no support for you outside, so the government has just thrown all the money it cost to put you in prison down a hole, as those who are repeat offenders have little chance of surviving outside”.

Having a stance of prohibition causes people to be afraid of asking for help if they need it, because of fear of legal consequences for doing so. This affects women disproportionately, as often they are primary care givers to children and other relatives and often dont ask for help for fear of having them removed from them. 12-step programmes like Narcotics Anonymous don’t usually take any figures on gender, but basic observational evidence suggest that women are massively underepresented in NA, and, to a lesser extent in Alcoholics Anonymous – probably due to alcohols more legal, and therfore more ‘acceptable’ status, as well as it being a less harmful drug than heroin and crack in most cases – . This in turn affects their chances of recovery (already so low with only 1 in 10 staying clean for 5 years or more for addicts entering the programme), as women need to talk openly about the context of their problematic drug use, often in the presence of other women as that context is so often gender based. Without a decent network of other women addicts to draw support from, the chances of recovery can be very low indeed.

The UK drug treatment scene is currently geared up for an outdated idea that most problematic drug users are heroin using men, which has lead to a national shortage of female/women drug workers, women only rehab centres, women only open prisons, and other services. At the moment, the government is considering a £1 million investment into furthuring these services, which is way too little.

One of the reasons why women who have a problematic drug use issue dont ‘pop-up’ on the radar as often as they statisitcally should, is that they often have to engage in another, less obvious, type of sex work to feed their habit. Anecdotal evidence suggests that women (especially younger, prettier women) end up with dealer boyfriends, and with having a regular supply, dont enter the realm of ‘officialdom’ in terms of stats for accessing services. However, just like 1950’s men holding the pursestrings from their housewives, these dealers can often control when, where, and what type of drugs these women take, and how often they take them. Now, as you can probably imagine, dealers arent necessarily the nicest of people and there are a surprising amount of stories of dealers coercing women into having sex with them in return for their next fix. Taking drugs out of the hands of dealers by controling and regulating the market would stop these women being exploited.

When it comes to taking drugs, women have always been seen to be cautious and men as reckless, and so drug using is more acceptable for men in this male dominated culture. Male establishment still divides women into good girls and bad girls, and drug-using women are always the latter. Women often have more to loose as a result of taking drugs (and the drug war) and have a higher rate of being disowned from their families than drug using men.

So, in short, not only does the system of prohibition force women needlessly into dangerous prostitution, but our societies patriarchal bias means that women face discrimination every step of the way, having a higher chance of disownment, having a rougher time in prison, and, when they get out, not being able to access the services they need to stay (or indeed, get) clean. I think its time that the problem of drug prohibition is placed squarely on the feminist agenda, and i think its time for a real feminist campaign against the oppression of women, against patriarchal bias, and against prohibition.

*This figure is disputed by the English collective of Prostitutes. Other studies has placed the figure between 7o- and 98%. Anyhow, the figure is high.