Posts Tagged ‘heroin’

The thing about drugs ARGH SCARY is that it’s difficult for a lot of people to have a sensible conversation about them.

They can be a genuine nightmare, after all. Becoming physically and psychologically dependent on heroin DEATH DOOM DESTRUCTION is no doubt a horrifying experience, and can lead to every single aspect of a person’s life crumbling if they don’t get help. And that’s not even the most insidious drug CRYSTAL METH WILL RAPE YOUR BRAIN widely available today.

And yet, many people seem unwilling to even think about drugs FLEE IN TERROR any further than the knee-jerk reaction that they must all be wiped out and obliterated utterly. But making decisions based on nothing more than the immediate, gut reaction and scary ideas that flash into people’s minds whenever drugs SAVE THE CHILDREN are mentioned might not be the most helpful strategy. They’ve been around for centuries; they’re unlikely to seize any more of a stranglehold over the planet if we take five minutes to think about what might actually work.

As always, it pays to be wary of fundamentalism. If eliminating the presence of drugs completely is the only acceptable course of action, you have to wonder why people are so convinced that this is necessarily a good thing in itself. There’s nothing intrinsic to any particular chemical compound to render its very existence unacceptable. It’s about their capacity to do things that are bad.

The war on drugs – if it’s not just a blind ideology that’s completely lost track of the effect it has on real people – should really be a war on drugs’ capacity to fuck you up.

And so if a campaign against drugs isn’t going to just barrel on with a zealous, zero-tolerance approach which completely disregards its results, it needs to pay attention to what strategies tend to reduce drug use, and what tend to exacerbate it.

Which is why it’s a shame that nobody in the UK or the US seems to be serious about doing that.

Possessing any drugs for personal use was decriminalised in Portugal nine years ago. Before then, drug use had been going up. Since then, it’s gone down.

There really does exist a middle ground between incarcerating half a million people for drug offences and replacing the Presidential inauguration with a cocaine party. It’s just not true that if you let your mind contemplate loosening your drug policy even for a second, waves of swarthy opium dealers will be battering down your door to haggle for your 8-year-old son’s pocket money.

You can make some changes, find some new ways to offer treatment, and keep some laws in place – as Portugal has done with trafficking – and things can get better. Teenagers will be less likely to start taking drugs if you dare to deviate from the accepted orthodoxy that all drugs are always terrible.

If you care, that is. But as Johann Hari excellently points out, some just seem to be set on raving manically against anything that sounds like it should fall into the category they’ve chosen to label MOST DEPLORABLE EVIL EVAR. The mephedrone fiasco is a fine example of the standard route that the discourse seems to take.

And if people are simply dead set against more effective campaigns on principle, because the most vitally important thing to them is that they’re not seen as being “soft” on the problem of drugs, then I can only conclude that they don’t really care how many people are taking drugs and killing themselves. If either harm reduction or respect for personal liberty was as high a priority as the perceived adherence to accepted dogma, they’d consider other options based on what works.

(The title is a Brass Eye reference, incidentally, partially explained here.)

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I’m still on something of an annoying journalism kick.

That’s a kick against annoying journalism, I mean. It’s not annoying that I’m blogging about journalism more these days. At least, I’m not annoyed about that.

Stories like this one, however, do annoy me somewhat, because it’s about something I feel like I know just enough about to be able to comment on. Specifically, it’s about people taking drugs while in prison.

(Yeah, how gangsta does that make my life sound? Probably quite a lot less now that I’ve just attempted to use the word ‘gangsta’ so casually. Sigh. I am so white.)

The gist seems to be that a Conservative think-tank disapproves of drug addicted patients being given opiate substitutes like methadone while in prison. But they don’t seem to have a clear idea on what should be done instead.

One of the things I learned pretty soon in my time working in an addictions centre is that most heroin users really don’t want to be heroin users. Whatever you might think of the war on drugs, and the campaign to scare people out of taking them, one thing that’s true is that heroin can seriously fuck you up. And a lot of addicts know this, even as they start shoplifting or selling sex or breaking into cars to get money to buy more heroin.

Heroin’s really quite moreish, you see.

But methadone is pretty handy stuff, because for a lot of people a small regular dose of it will dramatically reduce the intense, uncontrollable craving that heroin leaves you with.

This is useful, because getting physically or psychologically dependent on heroin is very easy. And there are reasons why so few addicts choose to just voluntarily not have any more of it. These reasons include tremors, sweats, cravings, nausea, vomiting, hallucinations, fits, blackouts, and delirium tremens, among others.

None of which is much fun. This is why people who have started using heroin are often inclined to use more heroin. And this is why there exist structured treatment programmes to help these people.

So criticising the system which “maintains rather than halts” prisoners’ drug habits rather seems to be missing the point. Providing a substitute prescription means people can stop having to acquire heroin through their own means to deal with their addiction, and can start engaging in a more complete treatment programme, which includes things like counselling sessions and psychological advice on how to stay clean.

Most of this think-tank’s “Coming Clean” report (PDF link) seems to be focused on the problem of illegal drugs being smuggled into prisons, rather than the approach to substitute prescribing. This is obviously a significant issue, and I don’t feel equipped to tackle it in much depth, but I wonder if getting prisons completely drug-free isn’t essentially as doomed an ideal as the rest of the “war on drugs”.

In the bits that do focus on substitution, they seem mainly concerned that patients aren’t being mandated to detoxify from all drugs fast enough. But it’s not clear why reducing their doses of medication in a substantially reduced timeframe is always going to be a good thing.

There should certainly be emphasis on reduction with an eventual goal of abstinence, but the fact is that this might not always be clinically indicated, and bringing down someone’s dose of methadone with the aim of having them clean within two weeks could end up being counter-productive. If it’s too fast for them to handle the change, their cravings will flare up, and they’ll go back to taking heroin. (I hear that’s not hard to do, in prison.)

I didn’t have to look far to find an example of the Daily Mail being outraged at the “limitless free drugs” available to prison inmates. It’s not an especially raving or offensive article by their standards, but there’s still less of an understanding of substance misuse issues than you might naively hope for from serious journalism. Nobody’s “admitting defeat” here. The goal is still a safe reduction of harmful activities as much as it ever was.

“The new strategy has all the hallmarks of keeping addicts addicted,” they declare, without ever explaining what any of those hallmarks are, probably because it’s bollocks. A two-week detox doesn’t stop you being addicted to heroin, and often it’s simply not the most effective or practical way to achieve abstinence.

According to this same article, “two-thirds of all crime is drug-related”. A staggering proportion of the people who end up in jail are there because of, for instance, “acquisitive crimes”, necessitated entirely by the urgent need to obtain more drugs. I’m not going to get into the argument for legalising everything here, but surely the thing to offer heroin addicts that’s most helpful to everyone is to keep them out of a situation where the best option for them is to use some more heroin.

And sometimes simply detoxifying them safely and giving them a stern talking to about how drugs are bad isn’t the best way to do that. When I said that heroin was moreish, I was using understatement as a comical device. I hope that was clear. Heroin is highly addictive, and helping people to stop taking it any more is difficult. In the centre I work in, there are regular group meetings and one-to-one counselling sessions, and the team regularly liaise with other departments who organise things like social activities, gym memberships, childcare, and safe housing. This is all important if you want it to be worth people’s while staying clear of the stuff they’re addicted to.

This is quite long already, and I don’t quite have the energy to carry on ranting just now, about the popular dehumanising portrayal of all drug users as hardened criminal scum who made their own choices and should have to live with them. Suffice it to say for now that this view is deeply unfair. Maybe I’ll go into that another time.

Okay, I have just noticed one more thing to moan about here though:

Some inmates do try to give up drugs, but prison is the wrong place, from a physical, psychological and practical point of view, for addicts.

If they had somewhere more suitable to go, the prison population would be reduced by almost half.

Hmm. Imagine for a moment that the government actually introduced a scheme to take half of all current inmates out of the prison system, and gave them an inpatient detoxification in some clinical centre especially set up for their treatment.

Can you imagine the response of the Daily Mail and its readers to such outrageous taxpayer-funded coddling?

Anyway. It may not be a traditional unicorn chaser, but the Guardian have an article about prison drug treatment which I found a nice relief after all that.

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