Gareth has been an addict for more than 20 years. But he doesn't have to steal any more; instead, he visits his local, Home Office-approved heroin 'booth'. Max Daly investigates a radical new programme
Published: 16 December 2007
Around 80,000 people are currently on substitute opiate prescriptions in the UK. Despite Department of Health estimates that at least 15,000 of these are failing to respond to the treatment – they regularly "top up" with street heroin – only 300 are allowed "take-away" prescription heroin from a small pool of 46 doctors who are licensed by the Home Office to prescribe it.
Initial results from the £2.5m diamorphine project, being held at clinics in London, Brighton and Darlington, are very positive. The number of offences committed by people receiving heroin in this way fell from an average of 40 each per month to around six, while a third stopped buying street heroin altogether. The trial could spark the biggest shake-up in treatment since the start of oral methadone prescribing in the 1970s.
The room where Gareth receives his twice-daily shot of diamorphine has the sterile whiff of a hospital. One half is taken up by a row of four cubicles, each with its own chair, desk, mirror, bin-liner and disinfectant . There is a curtain on one booth to provide privacy. People are allowed a maximum of three attempts to find a vein; if they can't, they have to go intramuscular, under the skin or are given methadone to take home. Signs on booths read, "Have you washed your hands?" and "Have you cleaned your injecting site?"
The average dose given out is 400mg a day, twice the average prescribed by doctors at present. The diamorphine is bought from Switzerland – a far cheaper supplier than the UK – dispensed into individual doses and then drawn up in a syringe. "The effect has been dramatic in many users," says Dr Deborah Zador, a consultant physician in addiction involved in the trial at the London site. "Their physical health has improved, the majority report less criminality and there is a high reduction in street-heroin use." Those taking part in the trial are drug-tested once a week. Unlike other testing methods, this test can detect the difference between pharmaceutically prepared and street heroin.
Most of those in the trial are in their late-30s to early-40s, have been using heroin for an average of 15 years and have been through
an average of 10 years' treatment. Many are unemployed and without a stable home.
Since his swift return to custody after leaving borstal, Gareth's life of crime, drugs – and jail – continued until he was admitted to the world's oldest psychiatric hospital, London's Bethlem Royal, when he was 24. He stayed for a three-week detox and rehab, which kept him off heroin for over three years until a relationship break-up and his brother's death from a drug overdose pushed him back to it.
He ended up living on the Old Kent Road in Bermondsey, which by the 1990s had become London's heroin thoroughfare. "I lived in the thick of it. There were four or five dealers on every estate," says Gareth, who by this time had started injecting the drug. A year or two later, on the advice of the Narcotics Anonymous group he had joined, Gareth detoxed in Bristol and went on to start a new life away from London, in Bournemouth.
"I had a girlfriend who had a child, I had a good job buying and selling fake jeans and videos and I was on the way to buying a home," he says. "But I got complacent – I thought I could control the drug. From then on it was pure madness." He started using crack- cocaine alongside heroin. Within a year he was at rock-bottom. "I ended up standing on street corners with nothing – just the clothes I was stood in and my dog. It was the worst time of my life, it was hell. I tried to kill myself with a drugs overdose, but that didn't work because the drugs were so bad."
After a brief stint in jail, Gareth ended up back in London, living as a "Giro junkie" on his sisters' couch. "I would be sick for the four days I had no money. I wasn't prepared to go stealing; I didn't have the balls any more." A methadone prescription didn't have any effect, so Gareth had no choice but to use street heroin on top.
When he thought things couldn't get any worse, they did. He moved from his sister's house to a living-room with six other crack and heroin users, then to a "dingy, dark, wet, cold" derelict hospital and finally to a hostel "which was basically a block of flats full of drug addicts"; he ended up losing half his body weight and scratching around for clothes and drugs. It was then, in October 2005, that he became one of the first volunteers on the supervised heroin trial.
Since then, Gareth's life has entered unknown territory. "I began to reduce the street heroin and crack and keep appointments because I was not so scatty," he says. "It was a relief to find something that works psychologically, physically and emotionally – only street heroin had come anywhere close to doing that before. I've got money in my pocket, a nice flat, I passed my GSCE maths and I don't want to mix with other users. Now I class myself as someone who's on medication for an illness, not someone getting legal heroin. It's the only thing that has ever helped in my life."
But does taking heroin in such clinical conditions have the same effect? "I stopped enjoying the 'taking' side of it 10 years ago," he says. "The solidarity of junkie life is long-gone. I just wanted to take it on my own where no one could steal my stuff." Aside from the medical side of the trial, Gareth has benefited from being in regular contact with staff at the south London drug service to which the trial is attached. "It's the first time I've had somewhere to come and be told I've done well. You build up such good relationships you don't want to let them down."
At a cost of £15,000 per patient per year, the trial does have its critics who say it is simply a way of pandering to drug users cloaked in the guise of a scientific experiment. "If this trial had not happened, I would still be in a cycle of stealing, prison, detox and rehab – all of which costs the taxpayer money." Taxpayers pay around three times less for Gareth's supervised treatment than they would if he was locked up in jail.
"This place has saved me. It's made me want to be a fully fledged member of society. I pay for my shopping now, which is a big thing, because apart from drugs, I've never paid for anything. It's made me a productive citizen. I'll be paying taxes myself in two years' time."
Max Daly is editor of 'Druglink', and can be emailed at firstname.lastname@example.org
The law on drugs: How we treat addiction
The British approach to heroin prescription was established by the Rolleston Committee Report in 1926 and held sway for the next 40 years. Dealers were to be prosecuted, but doctors could prescribe heroin to users where withdrawal was judged to cause them harm or distress.
From the mid-1960s this liberal approach came under fire and only specialised clinics and selected doctors were permitted to prescribe heroin.
In the 1970s and 1980s, the emphasis shifted to abstinence and the prescription of methadone was introduced as a substitute for heroin. Only a small number of users are today prescribed heroin in the UK.
In the late-1990s, Switzerland began trials of prescribing heroin to users who had tried and failed on other withdrawal programmes, but with one key difference: instead of being allowed to take the drug home, where there was the risk of misuse or it being traded on, users were required to inject themselves in the clinic where they collected the prescription, under supervision.
The scheme was a success in cutting crime, helping users stabilise their lives and improve their health. It has since been copied in Germany, Holland, Canada and now Britain, where supervised injecting centres are operating in south London, Brighton and Darlington.