Home Affairs Committee - Drugs: Breaking the CycleWritten evidence submitted by Philippa Matthews (DP025)

I write with regard to the Home Affairs Select Committee inquiry into current drug policy.

I will expand on the points that you are going to consider in your enquiry from the call for written evidence.

I would argue that whilst the country cannot obviously afford to spend limitless amounts on persons with drink/drug problems, that at present the bare minimum is being spent, and in the wrong areas (the majority I believe on salaries, of people who seem to do little but sit round drinking coffee and going out for a quick smoke!) The money that is being spent is not helping any Service Users, it is just appeasing the public that “something” is being done about our drug problem.

The people that the coalition have advising them on drug policy cannot even agree amongst themselves what constitutes good and ethical care, so how can the government proceed if it’s experts are at loggerheads all the time? David Nutt had some good ideas, but was quickly pushed back into the cupboard, although I appreciate that was the Labour governments doing!

Independent expert advice is a double edged sword, you will get ex addicts who will tell you that they way they “recovered” is the only way to do it, when in fact everyone is different, has different problems and needs personalised care. Any independent advice should be taken from a variety of sources, some with abstinence based views, and some with medically assisted recovery views, so the facts are balanced and not favouring one type of treatment over another.

If drug related policing does decrease in line with police budgets, this may be a good thing. Let the police target the “big fish” drug importers and the like, instead of hounding every poor addict as if they were Pablo Escobar! Our jails are full of people who really need help with their drug problems, and it is as easy to get drugs in prison as it is outside, so you can’t say that locking them up will in any way “cure” their addiction!

All the policies in the world will never reduce drug consumption, it is human nature to want to alter our consciousness. Take middle America for example; heroin and cocaine were near impossible to get hold of, so now they have a huge epidemic of methamphetamine and prescription pill addicts. Cut off the source of one drug, and people will just turn to something else. Even in the UK, as there has been a big clamp down on marijuana, as kids cannot get hold of it they are trying harder drugs instead, whereas if the marijuana was available, they would never have touched the harder stuff.

Public health should play the leading role in drug policy, after all, drug/drink addicts are supposed to be receiving medical treatment for their disease? And we are agreed that addiction is a disease?! Too many drug service providers act more akin to a probation service than the medical treatment facilities they should be. If patients in any other health care arena were treated as unethically and poorly as the addict population there would be a public outcry. It seems that public perception is that “They chose to use drugs, if they don’t like the treatment on offer, tough”. This is just not good enough and why retention of service users is dropping. It’s not dropping because the drug service providers have “cured” them, they are leaving treatment as they are being abused, treated unethically, and like a class of sub human.

This is not hyperbole, this is fact.

Far too many drug users are marked as criminals just for the fact that they use drugs, were drug treatment to be solely a health issue then recovering addicts would have an easier time of getting back to work as many of them only have possession charges on their criminal records, which any employer is going to baulk at and not employ them. Were it a health issue, the drug possession charges would not be on their record, and they would be able to find work far more easily.

This new abstinence based recovery agenda is already leading to more drug overdose deaths, as Drug Service Providers are “encouraging” stable maintained service users off their prescriptions.

In reality, “encouragement” has become coercion and bullying, and some service users do not have the resources to stand against the Drug Service Providers doctors decisions, and as such end up back where they started, on street drugs. Drug Service Providers do not care, all they care about is that they are discharging people off the books so their figures look good.

The relationship between alcohol and drugs is a very complex one. For example, in the area where I live, the local drug service was notorious for giving its clients sub-therapeutic doses of methadone, and as such the service users drank on top. This continued until they were addicted to alcohol too.

It has been proven that by giving service users proper dose of methadone that they are far less likely to drink or use other drugs on top of their prescription, yet many services still routinely dose service users at very sub therapeutic doses, and then wonder why the treatment is not working!

The comparative harm and cost of legal and illegal drugs. Alcohol, a legal drug, and tobacco, a legal drug are both cheap to buy and cost the lives of far more people than illegal drugs..

If illegal drugs were regulated, not contaminated with dangerous cutting agents etc then you would find health problems derived from illegal drugs would decrease. Crime would decrease as people would not have to pay criminal gangs extortionate prices to buy the drugs. The crime figures for burglary’s, shoplifting, muggings would drop instantly.

The way the National Treatment Agency (NTA) is tackling things at present is just not working. They have sent out decrees to all Drug Service Providers that they must follow this new abstinence based recovery agenda. Which is great, most people want to get off drugs. But for those on substitute prescriptions of Methadone and Subutex, and in some cases Diamorphine, these people are thriving on their substitute prescriptions, they have built recovery capital, and for the first time in their lives they are giving back to their communities and working, raising families.

These people have spend years, sometime decades of trying to achieve or maintain abstinence from opiates, but they cannot. There is a theory that when a person has used opiates for a period of time that it inhibits the brains endogenous endorphin system, leaving the person with anhedonia, unable to feel pleasure from the everyday things like food, sex, friendships etc, and must be maintained on a substitute opiate to avoid this crushing anhedonia.

Of course more research needs to be done on this, but the theory does stand up to scrutiny.

This abstinence based agenda wants to pull the rug out from under these people’s feet.

Fair enough, their drug service may well be able to get them off the books as “discharged drug free”, but how ethical is that when 3–6 months later those once pillars of the community are back to active addiction, homeless, jobless, with failing health, possible blood borne viruses, and not very much hope for the future.

With regard to so called legal highs, Drug Service Providers are woefully unequipped to deal with persons presenting who have problems with these. Some drug treatment staff do not even keep abreast of the scene, so they don’t even know what the legal highs are, or what the potential dangers are, or how to help a person come off them. If the Drug Service Providers do not know these facts, where is the person in need supposed to turn?

There will always be links between drugs and organised crime and terrorism, but unfortunately if there is a market for the drugs the drugs users don’t care that the heroin they buy could be funding Al-Qaeda cells or such like.

Drug addiction needs to be made a health issue, not a criminal one, or at least for the police to go after the drug kingpins, not some poor soul selling a small amount of drugs, not for any money, but just to feed his own habit.

The tactics that governments have used on the “War on Drugs,” have patently failed. It is time for some radical thinking, stop using palliation methods to appease the public, and start actually thinking outside the box.

Before we had methadone clinics, heroin addicts in the UK were prescribed (radical, I know) diamorphine. It was called The British System, and was the envy of other countries with opiate problems. Prescribing Diamorphine to heroin addicts meant that they did not get a secondary addiction (to methadone), and the success rates of people leaving treatment drug free was far better than anything we have now.

I am on a methadone maintenance prescription, I have a good career, nice house, family etc, so methadone prescribing does work, although the NTA would have you believe people such as myself do not exist. That all people on methadone prescriptions sit at home all day watching Jeremy Kyle and using their benefits to buy drink and drugs. Well, we do exist, but instead of hanging around Drug Service Providers every day, we actually get back to the business of living, you know, that thing that “normal people do?”

The problem is drug treatment providers try to rush people through treatment, or even try to persuade them to “cold turkey” detox at home with no medical intervention (well, medical intervention costs money don’t you know!). If people could go home, and come of opiates without medical intervention then there would be no need for any opiate drug service in the first place would there?

Drug Service Providers are trying to make their figures of service users leaving treatment “drug free” look good. Only for the same people to re-engage with the same service three months later with a far more entrenched habit, often injecting when they previously were not, and often now a poly drug user.

Most services under dose patients. A therapeutic dose of methadone is anywhere between 60–120 mg/day. Many patients are on 30 or 40 mg/day, a sub therapeutic dose, which is why they use other drugs on top, and drink on top.

In America and Canada where they dose patients according to how the patients feels (not what the Drug Service Provider doctor thinks they should be on) and they have more Methadone Maintenance patients who are back at full time work, don’t use any other drugs or drink, because they use a therapeutic system.

I know it’s a wacky thought, but they actually listen to the patient, and believe them, instead of thinking everyone using the services of a drug clinic is trying on some kind of scam, which is what happens in the UK, and is why service users feel that although they want to be honest with their treatment worker, they fear punitive measures, so how can a therapeutic relationship occur in those situations I ask you, when all the drug treatment staff fear every patient has ulterior motives?

In the UK a service user is assigned a “keyworker”, who you must see every two or so weeks. I fail to see how you can have a therapeutic relationship with someone who holds the power to reduce or withdraw your medication without your consent if you say something they don’t agree with.

Another problem is that a lot of drug treatment staff and doctors still see addiction as some kind of moral failing, they seem to think that if the addict “tried hard enough” they would easily be able to stop taking drugs.

We also still have Drug Service Providers doctors telling patients that withdrawal is no worse than a mild dose of the “flu”. Well, I’d like to see those doctors go through a opiate or alcohol withdrawal and then see how they really feel.

Many Drug Service Provider doctors work at treatment centres part time, and do General Practice the rest of the time, and whilst a lot of them are very good, a lot of them are not up to date with the latest scientific comings and goings with regards to addiction, newer “legal highs” etc.

Perhaps they should be made to attend a yearly “refresher” course, so they are up to date with the current trends. Another problem is that instead of doing what is in the patients best interests, a lot of them try to coerce patients into prescription reductions or detoxes that the patients really doesn’t feel ready for, or even want, but the patient is often from a marginalised part of society, and doesn’t feel able to “stand up” to an authority figure (the doctor).

Then when a patient says they are ready for a detox or residential rehab, well, you have to fight tooth and nail.

Service Users up and down the country are scared stiff to complain about the despicable service they get, for fear of being labelled a “troublemaker”, and life being made even more difficult for them.

If this were any other area of health care patients wouldn’t be allowed to be treated like this, but unfortunately it seems that a lot of people think we are lucky to get any kind of treatment, and as such should just be grateful for what we have.

Well, what we have at present is doing no one any good, it’s all about figures and facts, there is no focus on patient care, or what is in the best interest of the service user.

Perhaps if the NTA, the DOH and the government took a different approach to the issue of drug addiction, it would be a little more successful, and therefore the need to appease the voting public would not be so great.

Thank you for taking the time to read my thoughts, sorry it is quite a novel, but it is a subject very close to my heart that I feel very strongly about.

I hope any new drug policies are an improvement on the ones we have!

January 2012

Prepared 8th December 2012