Wednesday, September 16, 2009

Heroin trials welcome - but the wait has cost lives

Transform yesterday wholeheartedly welcomed the results of the heroin prescribing trials (as reported by the BBC), and the understanding that these pilots would be rolled out further still – perhaps to four or five new locations.

However, as the RIOTT Trials are published to much celebration, what have we really discovered?

That problematic heroin users do better on legally regulated pharmaceutically pure diamorphine, than street junk - they steal less and their health improves

That should not be news to anyone. I realised during my third or fourth interview yesterday, that the feigned shock from radio presenters that the Great British Public would be funding heroin users ‘addiction’, should be as nothing compared to their real shock that we are all funding the prohibition that leads users to steal and compromises their health in the first place.

Whilst the presumed roll out is to be welcomed, one has to ask why it has taken so long to come to this conclusion. Evidence has existed for years that, for those assessed as having a clinical need, heroin prescribing will keep them alive, improve their health and wellbeing and reduce the collateral damage of their use to wider society. Indeed there has been a barely concealed sense of inevitability about these trials; the strong impression being that they were needed to provide political cover for a roll out, rather than to provide yet more evidence of the blatantly obvious.

Of course supervised use of legally regulated supplies of heroin significantly improve the lives of users, who otherwise have commit crime to raise money to score dirty drugs from gangsters, for consumption using dirty paraphernalia in marginalised and unsafe environments. The lesson here is that moves to take users out of the illegal market and into a regulated supply where drugs are quality controlled will produce the kind of outcomes we all want to see.

The fact is that thousands of long term dependent heroin users have died, or contracted serious diseases in the last three decades because of the failure of Government to maintain or develop heroin prescribing services. And, with the Department of Health playing badly strung second fiddle to the Home Office, much of the medical establishment has been complicit in this tragedy by maintaining a deafening silence.

But NHS heroin isn't the only way forward here; access to cheap smokeable opium from licenced outlets would also achieve significant decreases in crime and improvements in health, as it would also promote transition towards safer products, using behaviours, and using environments. We would hope too, that the next round of trials includes provision of oral morphine (and possibly other pill form synthetic and semi-synthetic opiates), which will be effective for many, and is also dramatically cheaper, and safer, than injectable dry ampules.

The substantially increased cost of prescribing injectable heroin, compared with oral methadone, must also be seen in the context of the Macfarlane Smith monopoly on the UK opiates market that the Department of Health buys from. That means that the UK pays well over the odds for our diamorphine (£12,000 a year per user), compared to the Dutch (£2000 a year for the same product). This artificial cost barrier has been a major political obstacle.

Finally, let us hope that these trials pave the way to more discussion of how best to control and regulate drug supply and use, beyond the limited numbers able to avail themselves of medicalised heroin. And that those members of the medical establishment who have held this initiative back, feel their consciences pricked and support a scheme that could save the lives of hundreds more in the future.


the prof speaks sh*te said...

I couldn't agree more. We've known all this for decades. In fact many researchers couldn't understand why on earth we needed the RIOTT study in the first place, given that it wouldn't be adding to knowledge (which, of course, it hasn't)...

Anonymous said...

It Sickens me that they stopped Dr Marks doing this in 1995 and now almost 15 years later there supporting it after huge needless deaths and misery.

keep up the good work transform.

steve said...

The Poppy is a weed it grows almost anywhere, in fact there are many poppy farms in the UK producing high grade opium for the pharmacutical trade. Therefore the cost of supply of dia-morphine should be no more than supermarket aspirin, 25p a day.NICE guidelines are artificially creating the high cost of IOT. Ms Dale Perera late of the NTA commented to me privately 'it will always be a minority treatment because of cost'. . NICE will scupper this & more lives will be lost.

the prof speaks sh*te said...

You make a good point, Steve, about the artificially inflated price of diamorphine. I think this has important implications for the Transform agenda. We are never going to be able to shift to a system of legal regulation of drugs like heroin without looking at the same time at how we regulate the licit pharmaceutical industry. The two are inextricably linked and indeed always have been.

Unknown said...

A bit of imagination produces nice possibilities for small farms and small specialty firms created to leverage the benefits from heroin-scripting to non-user individuals.

Also, a Mallinckrodt sales rep here in the Police States of America once told me they keep the methadone price artificially low, sort of as a public service and in recognition of the special regulatory status they have long enjoyed here over Schedule 1 drugs. Perhaps McFarlane-Smith could be induced to look at diamorphine similarly in the UK.