Pubdate: Sun, 04 Jun 2006
Source: Sunday Herald, The (UK)
Copyright: 2006 Sunday Herald
Contact:  http://www.sundayherald.com/
Details: http://www.mapinc.org/media/873
Author: Bob Wylie
Bookmark: http://www.mapinc.org/heroin.htm (Heroin)
Bookmark: http://www.mapinc.org/find?136 (Methadone)
Note: Bob Wylie is a BBC Scotland correspondent. His Hamburg report 
will be broadcast on Radio Scotland's Investigation at 9.00am 
tomorrow. There will also be a special report on Newsnight Scotland 
on BBC2 at 11pm

ONE ANSWER

IF you go to Hamburg these days you can't miss the Blue Goals. They 
form a modern art masterpiece for the World Cup - 120 fluorescent 
blue goals on buildings all over the city. When the battle for the 
Jules Rimet Cup is in town, Hamburg will host three matches, 
including a quarter final. Frank Jerke says he can't wait. He'll be 
glued to the television and may even try to get a ticket for one of 
the games. Time was when that would have been unthinkable. Less than 
three years ago, Jerke was down-and-out, homeless, and hopelessly 
hooked on heroin.

It was around 7am when I first saw him on Hoegerdamm Street on the 
outskirts of Hamburg city centre. He's a big man. He stumbled off the 
bus and muttered "Morgen", as he passed me at the top of the steps. 
Downstairs he rang the bell at the Hamburg heroin clinic. Inside, he 
took a breath test to prove he hadn't had any alcohol and then he 
went next door into what they call the application room. There, under 
medical supervision, he was given a syringe with chemically pure 
heroin - diamorphine - diluted in water. He got up on a bed, dropped 
his trousers and injected it into his thigh. Head back and eyes 
closed for a few minutes then he got up, left the clinic and went to 
work in one of Hamburg's ship-repair yards. Same as he used to do all 
those years ago before the smack got him. "Everything is good now," 
he says. "I've got a nice flat of my own and a good job. Better." He 
laughed as he left. These days his teeth would be a credit to any 
toothpaste manufacturer.

Jerke is one of 500 drug addicts in Germany who are on the heroin 
pilot programme being conducted in seven cities across the country. 
Hamburg's is the biggest trial. German doctors looked at the success 
of heroin on prescription in Switzerland and the Netherlands and, 
after years of debate, the Bundestag accepted a pilot scheme should be set up.

The project began three years ago and was based on comparing heroin 
maintenance with methadone maintenance: 500 or so users were given 
heroin - they had to have failed on methadone in the past - and 500 
were given methadone. The results were published recently. On almost 
all counts the heroin group did better than the methadone group.

Dr Christian Haasen is the research director of the German trial. In 
his office, at the University of Hamburg he tells me in a matter of 
fact manner: "The differences between the heroin group and the 
methadone group are statistically significant. Those on heroin stayed 
in treatment longer and the drop out is less than the methadone 
group. They had much less illicit drug use, using street heroin and 
cocaine, and so have better health records."

He says he knew from the Swiss and Dutch trials that there would be 
differences but even he was surprised at the improvements made by 
those on heroin.

These positives also affect employment prospects. At the Hamburg 
clinic, 40 of the 90 clients going there for heroin are in work. 
Ludovic Leblanc, 32, is a waiter in one of the best Italian 
restaurants in the city. His take-home pay, with tips, is UKP2400 
(UKP1800). He's got a good flat in the city centre and looks every 
inch an aspiring head waiter when he's kitted out for work. Not bad 
for 15 years on heroin.

Leblanc goes to the clinic twice a day: before work and during his 
afternoon break. His employer knows. But in his kitchen 13 storeys 
above the River Elbe, I put it to him that, remarkable as his 
progress has been, he's still stuck on heroin. "No, I hope to be 
drug-free by this time next year," he asserts. He's on a quarter of 
the daily dose of heroin he took when he started at the clinic two 
years ago. "I couldn't have dreamed of that on methadone. After a 
year and a half on methadone the dose stayed the same and I would go 
to get street heroin almost every night."

DOCTORS at the Hoegerdamm clinic say one in 10 patients is on a 
sufficiently decreased dose to be described as "moving towards 
abstinence". But the study 's preliminary figures don't show any 
great difference between heroin and methadone in the numbers that end 
up drug-free. Drug deaths, however, are different. Since 2001 drug 
deaths in Germany have fallen by 40%, according to Haasen.

A policeman made the same point about Hamburg. Chief Superintendent 
Norbert Ziebarth is head of youth protection for the Hamburg police. 
At the rather imposing Polizeiprasidium HQ in the north of the city, 
he tells me that since the heroin clinic was set up, drug deaths in 
Hamburg have fallen from 101 in 2001 to 61 last year. The clinic, in 
a way, also allowed a police crackdown on what used to be Hamburg's 
open drug scene. There are no shooting galleries in parks or 
congregations of druggies in the central railway station on the scale 
there used to be. The police back the trial and its extension. "It 
works for the worst heroin users. We support it," says Ziebarth.

Not everyone is of the same view. The heroin clinic experiment was 
introduced by the Social Democrat government of Gerhardt Schroeder. 
Now the conservative CDU, led by Angela Merkel, are in power. They 
are altogether less enthusiastic about heroin on the state. I found 
that out when I met the Hamburg state minister of health, Dietrich 
Wersich. He disputes some of the findings of the German study and 
questions the costs of heroin on prescription - thus far three times 
greater than methadone.

"The results for the heroin group were only slightly better than 
those of the methadone group," he says, "and they may have been due 
to other factors than solely the prescription of heroin, like better 
social services support and things like that."

Wersich is also dubious about what he describes as the state becoming 
in effect a licensed narcotics dealer. "For us to give patients a 
daily kick on heroin cannot be seen as a permanent solution. Instead 
we have to work to get them drug-free and how can you say that's 
being done if the government is giving them a kick on heroin every 
day ... and besides, will the taxpayer be prepared to pay for this?"

This weekend The Lancet medical journal published a research study of 
the Swiss heroin clinics which have been running for 10 years. The 
study suggests the Swiss model is responsible for reduced heroin use 
in the long-term, and Swiss drug deaths have plummeted in the last 
decade. The Lancet editorial points out that in the same time the UK 
has had the highest drug deaths every year of any European country.

The last official figures for drug-related deaths in Scotland was 356 
for 2004. That was almost 50% higher than a decade ago. So, is it now 
time for Scotland to follow Germany and other European countries and 
introduce heroin clinics to give our worst addicts drugs on prescription?
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MAP posted-by: Beth Wehrman