Is there Methadone in their Madness?

I can’t say that I have ever been much of a fan of Russell Brand. Up until last week I always reckoned he was a representative of the kind of over hyped celebrity that our tabloids so love to waste news print on. He certainly never made me laugh, but maybe that is because I am a grouchy old git from the north. However I was intrigued to tune in to his documentary about drug addiction in Britain and what answers we might find to this endless crisis. Before the programme I probably shared Peter Hitchins’ world weary cynicism about the BBC signing up a wayward celeb to make a supposedly serious piece of work.

Well, I was pleasantly surprised.

Russell used his hour well and came up with an eminently balanced and rational view of the god awful mess we have got ourselves in over these last forty years.

The big question is always the same one: what in the name of Christ are we going to do about heroin? Throughout my adult life the very word ‘heroin’ has had the ring of unspeakable badness. It is the daddy of evil drugs. Wicked and dirty and deadly. It’s odd to think that this sinister sounding word was once upon derived from a German version of the word ‘heroic’. Mankind has dabbled with the sap from poppies for hundreds and hundreds of years. We have learned it can do things for us that no other plant can come close to. It can take away pain from both our bodies and our minds. In the time of the Industrial Revolution when science was all the rage, the pharmacists seemed to conquer a new Everest every year. They discovered cures for most of the diseases that had kept the average span of a poor person’s life to well under fifty. One by one the mass killers were cracked – Dyptheria and TB and Rickets and Cholera and Typhoid. The new drugs that were brought forth to send these diseases packing were nick named the 'heroic' drugs. And so it was that in 1898 the Bayer Corporation of Germany came up with what they were sure would become the most heroic drug of them all. Heroin. Diamorphine. The ultimate version of the poppy plant's magic. A hero of a drug that could master the very worst of pain.

It was tested to the maximum degree in the field hospitals of the Great War where it brought relief to the millions of men who were burnt and shrapnelled and blown up in the trenches. And it worked. Just like it still works. Try telling someone in the last gasp of cancer that heroin is a bad thing.

From the very get go, the pharmacists figured out that heroin could also have a pretty profound effect on the brain. Back in those days chemists sold concoctions for the over worked housewife. Old Ma Betty’s Pick Me Up! Elegant bottles filled with sweet, syrupy liquid. A spoonful a day to give a bit of a lift! And some lift it must have been as many of these potions were laced with heroin and cocaine. It soon became apparent that all too many grand ladies were getting a tad over fond of their potions and the pick up mixtures were made illegal.

For the next seventy years heroin was mainly the preserve of artists. Just like opium always had been. Smack addicted artists have always tried hard to harness their talents to tell the rest of the world all about the nirvana of the poppy and let’s face it they have done a pretty good job all the way from Coleridge to the Stranglers. Never a frown on Golden Brown. Comfortably Numb. Oh, it’s such a perfect day..I’m glad I spent it with you…..

Then in the early 70’s the great and good, lead by the visionary Richard Nixon, decided to launch an epic War on Drugs and thereby put a stop to all the wickedness. In 1970 we had under 500 registered heroin addicts in Britain. Then we declared war on the poppy and threw the kitchen sink at it and what a towering success our four decade war has been: we now have over 300,000 addicts.

The mess we have got ourselves into simply beggars belief. Conservative estimates suggest that the drug problem now costs us upwards of £20 billion a year. The organised criminals who we have handed the franchise to end all franchises now control one of the mightiest industries on the planet. Only oil and weapons command a greater share of world trade than illegal drugs. In a recent UN report, it became clear that on the day after Lehman Brothers crashed there were a number of other banks that were about to go the same way. Someone, somewhere had to go to the counter and stick the thick end of a trillion dollars into a deposit account. On that desperate day it became clear that there was only one set of people on the planet who had that amount of ready cash – the drug cartels. And so a dirty deal was done. They were given a once in a lifetime opportunity to launder all their cash in one go whilst a blind eye was turned. They duly took the offer with both hands and rescued the banking system. Over the last few weeks the extent of the abject corruption in the City of London has slowly started to come into focus. Once upon a time Britain doubled its national treasure by punting opiates to the Chinese. Now we focus our skills on being the finest money launderers money can buy. No wonder London is such a magnet to those at the top of the crime cartels. The concept of My Beautiful Launderette is now represented by the shiny glass towers of Canary Warf.

In the 80’s we all started to get scared to death by heroin. By now it had moved from the artsy parties of Soho into the sink estates of Thatcher’s post industrial wilderness. And it became clear that with heroin came Aids. Edinburgh was the epicentre and Trainspotting brought it to national attention.

And so it was that two words entered the lexicon of the war on drugs. Harm Reduction. To stop the spread of Aids, we tore up the rule book and reluctantly decided to offer heroin addicts a free of charge substitute care of the NHS.

Methadone.

Methadone is a synthetic version of heroin that offers many but not all of its unique qualities. It will take away physical pain but it does not provide the kind of mental nirvana that Lou Reed captured in ‘Perfect Day’

The NHS methadone mantra has never really changed over the last twenty five years or so. Methadone saves lives. The theory is really quite simple. Heroin is really, really addictive. Once you get a habit you need a hit every few hours or so. If you don’t get what your body needs, you will get really, really ill. A rattle. Cold Turkey. You’ll vomit and shit yourself and feel sicker than sick. And very few human beings have it in them to get through these gnawing days of hell so they will go to almost any lengths to get that next fix. They’ll shoplift and rob their families and commit fraud and prostitute their bodies. Anything for the next dunt. No clean needle? Doesn’t matter. The guy you are sharing with is HIV positive. Doesn’t matter. There is a chance that the smack you have just scored is contaminated with Anthrax. Doesn’t matter.

To combat this, we decided offer a choice. Heroin is unbelievably expensive and only available from organised criminals. So here is a way out. You can have a daily dose of methadone which is free at the point of use and available from the NHS: our national treasure.

At first we promised three or four months of methadone. Just time enough to bring stability to a chaotic life. An escape from the clutches of the organised criminals. Then there would be help to slowly reduce the daily dose down to nothing at which point the addict would be abstinent and spruced up and ready to take a place in society. On this basis it has to be said that Methadone can be a genuinely good thing. We have worked with many clients who found methadone helped them to get some stability into their manic lives. Once they were released from hellish daily routines of committing crimes and then frantically seeking out the next hit they were able to put their fractured lives back together. This is when the methadone programme is at its best, especially when there is lots of help available for someone to reduce their daily dose and then become abstinent. No arguments whatsoever with that.

Sadly the reducing and becoming abstinent idea seems to have got lost somewhere along the way. Once the politicians started throwing hundreds of millions into drug treatment they ordered their minions to collect proof that the investment was indeed bearing fruit. The NHS was asked to provide evidence that the cash was making a difference. How many drug addicts do you have in treatment? And this soon became the be all and the end all. In the early days, anyone on the methadone programme was expected to provide piss tests to prove they were no longer using any wicked illegal drugs as well as their legally prescribed methadone. When they failed a test, they were chucked off the programme and they would have to wait a few months to get another chance. The message was clear. It’s methadone and nothing else or it’s nothing at all. Simples, as a Meerkat would allegedly say.

But this presented a problem to the NHS, for a person kicked off the programme meant one less name on the list of drug addicts ‘In treatment’. And that was not good. For in our brave new world, numbers are everything. And without numbers on your side, you put yourself in danger of being down sized. Of being cut. Of becoming an efficiency saving. So a new philosophy emerged. No longer was it deemed a good idea to put a heroin addict on a brief stabilisation programme and then help them to abstinence and a new life. Nope. No good. That meant less people ‘in treatment’. Instead it was deemed a better idea to prescribe higher and higher doses and thereby lock more and more into the system.

At First Base we started to notice this about five years ago. All of a sudden, any client who asked to have their level of methadone reduced was told that such an idea was quite impossible. They were told that they were not ready. That to reduce their prescription would be to put them in danger. Methadone would keep them safe and the more they took the better. We tried to raise this at various meetings only to be shouted down and told in no uncertain terms that we were trouble causing, bumbling amateurs who were pretty well a disgrace to humanity for daring to suggest such a wicked thing.

Then one day we received an invitation to attend a meeting of a Select Committee up at the Scottish Parliament where the methadone can was due to be kicked around the room. The NHS fielded a truly formidable spokesman in the person of a tweed suited Dr Watson. Seldom in my life have I seen a man hold his corner with such unshakeable confidence. Professor Neil Mckegany, who played a role in Russell Brand’s documentary, tried all he could do discomfort the good doctor.

“Dr Watson. In England 29% of those on the methadone programme come off the drug every year. In Scotland that figure is 4%. Why such a difference?”

The good doctor swatted away the question much like King Vivvy Richards once dispatched bouncers over the midwicket boundary. He agreed that 4% was indeed a problem statistic. 4% in his opinion was 4% too many. Nobody should come off methadone. Methadone prescribed to heroin addicts should be seen in the same light as insulin prescribed to those suffering from diabetes. He was also worried that the average prescription of Methadone in Scotland was 49 ml a day. (10ml would be plenty enough to kill you and I in under a minute, unless you are a heroin user of course, in which case you’d be fine and dandy) In his view it would be much better if the average prescription were 200ml a day, enough to flood the neuro-receptors of the brain and drive away the desire to use ant other drugs ‘on top’. The fact that 200ml a day is generally enough to render a human being into a Jeremy Kyle watching zombie capable of nothing more than a daily shuffle to the chemists seemed to be of little concern. At least they were to be safe Zombies.

We quoted the good doctor’s thoughts to NHS representatives at local meetings. We had questions which we felt were perfectly fair. You see, when a heroin addict first visits a treatment centre, it goes something like this. OK. We can help you and this is what we will do. We will get you onto the methadone programme and over the first few weeks we will ease the level up until we find the right mark. Then we will let you stabilise things for a few weeks. Then we’ll have a look at helping you come reduce your prescription and get yourself abstinent and clean. Now Dr Watson had categorically revealed that such talk was in fact a big fat lie. In our view there needed to be a new and different narrative. We felt the conversation should have gone along something like this. OK. We can help you. We can give you a free of charge methadone prescription which means that you can stop robbing shops and prostituting yourself and free yourself from the grip of organised criminals. However there are some downsides you need to consider. If you decide to take this road, it will in all likelihood mean that you will need to visit your local pharmacy every day for the rest of you life. Also you need to know that methadone is very acidic indeed. It will eat away at the enamel on your teeth and in the next two of three years there is a good chance that most of them will go brown and drop out. Now if you are happy with both of these downsides, we can go ahead and get you hooked up. It seemed to us that many might not be over keen on the idea if they were given these facts. Unfortunately the minions of the NHS didn’t quite see it that way and we were shouted down and told in no uncertain terms that we were trouble causing, bumbling amateurs who were pretty well a disgrace to humanity for daring to suggest such a wicked thing. Oh well. So much for that.

And so the madness just grew and grew, all in the name of getting as many names as possible onto the ‘in treatment’ list to be e mailed to the government once a month. In Scotland we now have well over 20,000 citizens ‘in treatment’. It is scary how far this whole thing now goes. A couple of years ago I spent a couple of soul destroying hours in the local Sheriff Court on the day of the ‘Drug Treatment and Testing Order’ hearings. This is a relatively new thing. Let’s say you have been a heroin addict for five years and slowly but surely your criminal record has got out of hand. You’ve been given fines and not paid them. You’ve been given community service and not turned up. You’ve been picked up and told off and ticked off and issued dire warnings and none of this has had the slightest effect. And so the time has finally arrived for you to be sent to prison without passing go and collecting £200. But wait! There is one last chance in the saloon. You are offered the chance of a DITTO – a Drug Treatment and Testing Order. If you sign up to be take treatment and be tested twice a week for wicked illegal drugs for a set period of time, then you can avoid prison. All in all, a pretty sound idea, especially if it can save us the £5000 a month it costs to lock an addict up. Once a month you have to stand up in front of the sheriff to hear a report from the treatment centre as to what your twice weekly tests have shown. Oh dear, oh dear. I’m afraid you tested positive for naughty, wicked heroin. All bets are off! So it is jail for you sunshine and you will not pass ‘Go’ and you will not collect £200.

But it wasn’t like that. There were about 15 cases to be dealt with. The accused would shuffle into the dock and hang their head. At which point their lawyer, thanks to £100 or so from the Legal Aid fund, would stand up and address the Sheriff. They would tell a tale of woe in which their client had got a bit down and depressed and spent their dole money on a couple of bags of smack. But they were quick to assure the Sheriff that their clients were really very sorry indeed and would try harder from here on in. They really would. And the Sheriff would let out a sigh and continue the case for another month. Every single one of them. Not one had managed to stay clean. Not one got sent to jail. A few lawyers earned a few hundred quid for a few minutes work and world moved on. But at least those in the dock were very much ‘in treatment’. They were taking their methadone every single day.

A few weeks after my afternoon in the DITTO court, a lad came into the Agency with a different kind of tale of woe. He had been on the smack for over five years and was sick to the stomach with it. His family had disowned him and he was very much at rock bottom. When he was offered a DITTO, he jumped at the chance with enthusiasm. Here was his chance to put it all behind him and start a new life. Once he had agreed to the offer, he needed to keep two appointments. First he called round to the Criminal Justice people and signed on the dotted line to promise to attend all appointments. He agreed that if he missed appointments he would be sent to jail. Then he made his way to the NHS treatment centre who would look after the day to day treating and testing side of things. They told him that things would be absolutely fine and that they would get him started on his Methadone programme. Oh no he said. He explained that he had always promised himself that he would never go down the Methadone road. He wanted to keep his teeth and not be tied to going to the chemist every day for the rest of his life. No way. Not that. He explained that he wanted to make the very best of his DITTO. He wanted to do his cold turkey and get tested twice a week for a year to prove to his family that he was clean of all drugs. Good idea surely. The kind of outcome we all want.

Nope.

They told him that it was Methadone or nothing. They had a duty to keep him safe. He said he didn’t want Methadone. He just wanted to get clean. And to stay clean. They told him that he was just wasting their time. So he went back to court where the Sheriff shook his head sadly and regretted the fact that treatment had been refused. A refusal of treatment meant that the offer of a DITTO was no longer on the table. And so it was that my man was packed off to jail. For nine months. For refusing to take Methadone. Now if that ain’t scary, I don’t know what is. Doesn’t it smack just a teensy weensy bit of Soviet Russia to you? Or does that kind of thing not really count when it comes to dealing with junkies? Maybe so.

At least over 60,000 of our fellow Brits are being kept safe by the NHS thanks to their daily dose of Methadone. That was what a GP patiently pointed out to Russell Brand when he asked the same questions we have asked over the years. Her body language suggested she considered him a trouble causing, bumbling amateur who was pretty well a disgrace to humanity, but she managed to smile for the camera.

But there’s a problem.

It was highlighted rather vividly last week when the Scottish Government released the annual figures for drug deaths. 585 deaths. A figure that has basically doubled over the last few years. Dead from Valium – 190. Dead from Heroin – 220. Dead from Methadone – 275. Hang on a minute. Run that by me again. I thought the idea behind prescribing all this Methadone was to keep people safe? That’s right, isn’t it? So how come it has killed more people than any illegal drug? How come it has killed almost as many people in Scotland in twelve months as British soldiers killed by the Taliban over the last ten years?  How come the treatment designed to keep people safe ends up topping one in every hundred?  But we mustn’t ask such questions. For the NHS is a national treasure and our doctors are wise and they know best. And they are doing a terrific job. Just look at the figures. Look how many addicts are ‘in treatment’! Over 20,000! Only trouble causing, bumbling amateurs who are pretty well a disgrace to humanity would dare question such an epic achievement.

So that’s you and me both Russell.

It seems there is indeed Methadone in their madness.