Pubdate: Mon, 26 Apr 2010
Source: Guardian, The (UK)
Copyright: 2010 Guardian News and Media Limited
Author: Randeep Ramesh
Bookmark: (Heroin Maintenance)
Bookmark: (Supervised Injection Sites)


Injection Rooms 'Would Cut Crime and Infection Rates' But Opponents
Warn of Slippery Slope

The NHS should offer heroin to drug addicts and open "consumption
rooms" where users can go to inject under medical supervision in order
to cut crime and keep public spaces free from dirty needles, the head
of Britain's biggest nursing union said today.

Dr Peter Carter, general secretary of the Royal College of Nursing
(RCN), said providing heroin on the NHS would cut crime rates and help
wean addicts off the drug.

Speaking in a personal capacity after a debate on the issue at the
RCN's annual conference in Bournemouth, he said: "I do believe in
heroin prescribing. The fact is, heroin is very addictive. People who
are addicted so often resort to crime, to steal to buy the heroin."

He said he was aware of the controversy over how chronic drug users
should be treated, but said: "It might take a few years but I think
people will understand. If you are going to get people off heroin then
in the initial stages we have to have proper heroin prescribing services."

The statement provoked an immediate reaction from academics and from
within the nursing profession, with many saying that this was a
"slippery slope" which could see the state subsidising other addictive
drugs such as cocaine.

However there is emerging research that this strategy can work. Pilot
studies run by academics at King's College's national addiction centre
suggest that allowing users to inject heroin under medical supervision
could cut local crime rates by two-thirds in six months.

Of 127 users involved in the pilots, three-quarters "substantially
reduced" their use of street drugs, while their spending on drugs fell
from UKP300 to UKP50 a week. The number of crimes they committed fell from
1,731 in three months to 547 in six months.

Users were offered a range of support, including psychological
therapy, and typically attended the clinic up to twice daily, seven
days a week. The cost was about UKP15,000 per patient per year, compared
with prison costs of UKP44,000 a year, researchers behind the pilots

Dr Carter said: "Critics say you are encouraging drug addiction, but
the reality is that these people are addicts and they are going to do
it anyway. I think there should be research into drug consumption
rooms - they have them in Sydney and Amsterdam."

Despite being derided as state-funded "shooting galleries", he said in
these two cities users had stopped injecting in places such as school
playgrounds and the stairwells of housing complexes.

Debating the issue at the RCN conference, several nurses agreed with
the approach. Claire Topham Brown, from Cambridgeshire, said providing
heroin on the NHS could cut the transmission of viruses such as HIV
and hepatitis and provide a "stepping stone" to get people off heroin
and on to the heroin substitute methadone.

However Gail Brooks, from the RCN's UK safety representatives
committee, opposed the idea: "Where would this stop? Cannabis,
cocaine, crack cocaine ... other substances? If you do this for heroin,
do you have to do this for every other drug out there?"

Some academics were highly critical of the approach, saying that it
would enter the realm of "social problem prescribing". Neil McKechnie,
professor of drug misuse research at Glasgow University, said:
"Prescribing heroin on the basis of reducing crime is risky territory.
It should be on the basis of clinical need ... in this case an
individual prescribed a medicine to reduce crime. It is an ethically
questionable proposal.

"We should be focused on getting users off drugs, not giving them
access to additional drugs. Certainly over the last 10 years of the
Labour government we have emphasised harm reduction over

In the runup to the election the major parties have all stressed the
importance of alternative treatments for long-term drug addicts.

Other experts said money should be spent on therapy instead. David
Green, director of the Civitas thinktank, said: "Money should be spent
on therapy approaches, rather than keeping users on drugs.

"One idea being piloted at the moment is using so-called 'opioid
antagonists' - drugs which make people sick if they take heroin. There
is a pilot currently underway in Harrogate, North Yorkshire, and it
takes five days or so for users to get off heroin."
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