Heroin Clinics: The Aberdeen Council debate the prescription of diamorphine

The councillors of the city of Aberdeen are currently facing a question that has been in conjecture for many years. Should they prescribe injected heroin in specialised clinics to hardened drug users? The debate is underway among the councillors, and the proposals have had a mixed reception from the city’s residents, pharmacists and users.  In the Netherlands and Switzerland, where the process has been most capaciously trialled, the results have been very promising with substantial reductions in illicit drug use among those receiving the treatment, and a reported drop in crime committed by the addicts. In 2005 Swiss voters backed the scheme in a referendum. In Germany, a trial clinic found that patients treated with diamorphine, remained in treatment for longer, had better overall health and had a lower drop out rate than those patients on methadone. So why is there any speculation as to whether this scheme should be introduced?

Some leading medical critics of the scheme remain cantankerously unconvinced by the positive results of the trials, claiming that there is no evidence to suggest that the process has been successful. They believe that giving a heroin addict unlimited daily access to heroin can not be referred to as treatment, and as it would cost an estimated yearly sum of £15,000 per user, could hardly be justified when some NHS patients are denied access to cancer treatments. Previous trials of prescribed diamorphine have been followed up by cognitive behavioural therapy, psychotherapy and numerous other ‘add-on’ therapies to improve the rehabilitation process of a particular user. Merely providing heroin addicts with pure heroin is not, they believe, therapy enough in itself.  Many users are also wary of the idea, worried that due to the very nature of the drug, a prescribed dosage would never be enough and that this regulated system would act as a deterrent for users considering remission.

But it is this regulation and de-glamorisation of heroin use that the clinics are actively encouraging. One ex-heroin addict explains how ‘a user spends most of their day simply waiting for a dealer, getting the money together and finding a fix’, and argues that turning this habit into a regulated, mundane daily chore void of any thrill, would turn a number of addicts off the drug. What starts as an act of rebellion and escapism would be turned into a sickness which requires treatment. This controlled and psychological approach seems more progressive than simply dolling out an opiate substitute; especially one that has a longer physical withdrawal than heroin itself. Methadone also does not induce a high, and so it is little wonder that many of the users with gargantuan sized habits who are treated with it, are soon to be found back on the streets trying to score something that does. 

In 2005, the first British injecting clinic was opened in south London. It was reserved for heroin addicts who had been repeatedly in and out of prison for petty crimes, and who had failed on all other methods of treatment. Here they would inject themselves twice a day with a received dose of pharmaceutical grade heroin in a supervised environment. Since then two other clinics have opened in the UK with results which, according to Prof John Strang, head of the National Addiction Centre at the Maudsley Hospital, ‘sent a ripple of excitement through the addiction treatment community, which is unused to seeing progress with hardcore heroin addicts’. At these clinics, risks of overdoses and HIV or Hepatitis C transmission are minimal and the purity and subsequent safety of the heroin dose is maintained.

On the back of these facts, I would say that the Aberdeen councillors have a fairly easy decision to make. Yes, it may be a more costly process than methadone treatment, but it is a sum that is vastly outweighed by the cost of crime committed to fund drug use in the city. Yet even if the council realise that opening a heroin clinic is a realistic and necessary step to tackling Aberdeen’s hard drug problem, they will still have to convince the Scottish government. But at least the cogs have been put in motion.

written by George Clode