Grumpy Old Addict!

Classification of Drugs

2007-03-24T10:27:00.001Z

This week the media have been huffing about a new study reported in the Lancet.

Apparently it is some kind of news that alcohol and nicotine are in fact drugs and that they kill more people than all the other drugs put together. 90% of the total in fact.

The topic of how drugs should be legally classified and which are the most harmful seems to hold a wonderful fascination for us Brits and I am totally unsure as to why this is. You only have to see the ongoing debates about the classification of cannabis to see this in action. Everybody adopts a posture based on whichever bits of evidence, pseudoscience and folklore happen to support their own views and we call this "debate".

While I happen to agree with the article's conclusions I feel it raises larger questions:

Does anybody really believe that:

The government will take any notice at all of the report.
Anyone will actually change their behavior because of it.

I know that as a spotty faced 14 year old when I first came across "drugs" in all their myriad forms I did not stop to think what "class" they were. I had no intention of getting caught anyway. So far as I was concerned I saw other people doing them, they didn't seem to have turned into raving looneys the next day - that was all the evidence I needed. All the politicians, police and media who went on about drugs were all part of some huge amorphous "them" who were out to spoil my fun.

I suspect that these articles and the endless debate serves several purposes:

It enables people like me to endlessly discuss the issues.
It enables the government to claim that there is a debate going on.
It keeps drugs educators, the publishers of drugs educational materials and the police on their toes as they struggle to keep up with it all.

That's about it really - drugs treatment and prevention are nowadays an industry and I doubt if the ripples from all this really spread much further.

In the real world drugs policies are really driven by political and financial considerations - they are driven by "what wins votes" and earns money for the treasury.

We all do the world a great diservice if we pretend otherwise.

More putting out fires with petrol:

2006-12-17T18:11:00.000Z

There have been many press reports this week of the recent "discovery" that Dihydrocodeine, in the form of DF118's, is at least as effective as Methadone in "treating" opiate dependency. This is no discovery at all - all the addicts that I have mentioned this story to have yawned politely and made comments like "now tell me something that I don't know".

Of course any opiate or opioid drug will serve to assuage the symptoms of opiate withdrawal - whether or not giving an opiate user such a drug constitutes "treatment" is another matter. It seems that if a doctor in a drug service hands out Methadone for example then that is "treatment" - providing of course that reams of paperwork have been filled in and certain procedures have been followed.

If an addict was to buy the same amount of the same drug on the street - then this constitutes dealing and the supplier is liable to lengthy prison sentence - up to life imprisonment in fact!

In other words if a doctor does it then it's treatment, harm reduction etc and a good thing but if I do it then it's a very bad thing. Of course the addict's body would not differentiate between the "good" methadone and "bad" methadone - it would react exactly the same and the effects would be the same.

Coming back to DF118's - Doctors in the UK seem more than happy to hand this medication out like sweeties, I can remember doing a straw poll in a prison where I worked that showed that the incidence of back pain requiring Dihydrocodeine was around 20 times the expected average figure in the community.

On one hand these were young men in their 20's and 30's on the other hand many of them had a long history of drug dependency, however they all knew that Dihydrocodeine was an opiate type drug and they were not taking it to treat their addictions either, more to feed them.

The fact is that these drugs have changed hands on the streets for many years - with most of the supply being diverted from legally prescribed sources. Addicts have known about this, so have many drugs workers, counsellors etc.

I find it rather alarming that a "scientist" discovers what has been obvious to everyone else for years and suddenly it's a newsworthy piece of "new research".

So much for learning from our clients.

Yoof of today!

2006-12-09T12:19:00.000Z

We definitely seem to have entered the silly season in the run up to Christmas. In the past week I have received several inquiries from the press who all seem to think that I must have some kind of crystal ball or arcane knowledge about "young people". I have been asked about young people and AA/NA - “is it trendy for young people to go to 12 step meetings now that Lindsay Lohan has admitted that she is going to meetings?”

Who cares if it is “trendy” or not, they are missing the point – its about saving lives, not fashion! Is coronary care trendy? Are A & E departments trendy? I have to ask myself what kind of rarefied atmosphere do these guys live in? Have they put something in the water in Wapping?

Lindsay Lohan is living in California, I live in South Yorkshire. Young people in California do lots of things that haven't caught on over here – surfing for one – and there are huge cultural differences in the way addiction and recovery are viewed over here and there.

The end result is that young people do go to AA/NA meetings in the US – especially California, while over here in the main they don't.

Most “addicts” seem to turn up in NA at around the age of 30 and it's around 40 for AA. There are of course exceptions to this rule.

I believe that one of the causes of this is the marked reluctance on the part of treatment providers in the UK to properly diagnose alcohol and other drug use in young people.

In the main the attitude seems to be that alcohol and other drug use is symptomatic of developmental problems rather than a condition that requires proper diagnosis and treatment in it's own right. In fact there are very few services in the UK providing proper addiction treatment for “young people”. Our very politically correct practitioners prefer to treat the age rather than the disease.

Then I would say that wouldn't I? I am a grumpy old addict after all!

The next magic bullet.....

2006-11-25T21:42:00.000Z

There were several interesting news stories this week:

On Thursday The Guardian run a story reporting that the total social and economic cost of class A drug use is around £15.4 billion a year. The research was commissioned by the Home Office and also reported that 90% of this cost was accounted for by drug related crime.

The Guardian followed this up on Friday with another story which reported that the UK has 327,426 "problem drug users" and that the country spent £5.9 billion a year on illegal drugs.

These figures again came from the Home Office.

What is going on here - there are supposedly 181,000 people in "structured drug treatment" in England and Wales (NTA figures).

This represents around 55% of the Home Offices "total number of problematic drug users" (if the numbers in treatment in Scotland and Northern Ireland were taken into account the figure would be even higher!)

Sorry - but I don't believe a word of it! All the research that I have ever seen suggests that the percentage ""in treatment" at any one time is not likely to be more than 25 to 33 % of the total. If the governments research is right then they aren't commisssioning very effective treatment are they ? I mean if a minimum of 55% of all problematic drug users in the UK are in treatment and its still costing £15.4 billion?

Last year we were being told that each £ spent on drug treatment produced savings of £9.50. On this basis we need to be spending say an extra £1.5 billion a year - on top of the roughly half billion already spent. That would represent a 400% increase!

Spend £2 billion a year and the total cost in theory comes down to zero. Yeah well, thats not going to happen anyway - and it wouldn't work if they did spend the money because there will always be "treatment resistant" individuals.

Interesting to compare the Governments expenditure on drug treatment to the cost nevertheless. Interesting to see that we spend 10 times as much on illegal drugs as we do on treatment!

My final news story of the week was widely reported - the suggestion that we ought to consider prescribing heroin instead of methadone. A senior policeman suggested that this would reduce drug related crime - and guess what, he is right! He is after all a policeman, and it his job to reduce crime.

I suspect that this would be even more successful than he thinks - for one thing the bottom would fall out of the drugs market as the dealers could not compete on price and quality against the NHS!

My job however has always been about treating individuals rather than finding solutions to social problems such as crime and from the treatment point of view I would predict the following:

The numbers seeking treatment would greatly increase - many users do not seek treatment because they don't want methadone, it doesn't do what they want it to do. Many users who receive methadone on prescription use on top - for the euphoria that heroin provides and methadone does not!
Not many people would ever complete treatment "drug free" - although perhaps a few more would than now as the withdrawals are reconned to be less severe!

Either way don't for a moment believe that the Governments aim is to provide quality treatment for the individual - it isn't and hasn't been for a long while now.

It is to save money, to increase its popularity by reducing crime and to reduce the spread of blood borne viruses associated with drug use into the general community.

They really don't care if individual addicts sit in a corner and dribble while life passes them by if that is what it takes to achieve those goals (which are legitimate goals by the way - but not the only ones!)

To this end I suspect that prescribing heroin will be the next "magic bullet" which is going to achieve these goals!

We have now gone full circle and are rapidly coming back to the point where we were in 1966 - in 40 years there are now around 200 times as many heroin addicts as there were last time that prescribing heroin was official policy.

Prisons and Compensation

2006-11-23T09:53:00.000Z

I wonder how far back the time frame is for making claims against the Home Office for being forceably detoxed from drugs on admission to prison?

Your author had this happen to him on 5 or 6 occasions while he was using drugs himself. Personally I believe that if I had received the nearly £4,000 compensation that the Home Office has paid out to nearly 200 individuals I would have used it all up on drugs on release and would have probably have killed myself in the process!

I would be interested to see how many of the recipients of this compensation end up dead within a month of receiving their money or their discharge from prison - whichever comes first.

Although this is not a laughing matter I have to admit that I would smirk a bit if their relatives were then to sue the Home Office for gross negligence - I think that most people who know anything about addiction could have told them that giving large sums of money to a using addict is asking for trouble. Like giving them a loaded gun.

Apart from all this I would like to clarify my position on this issue:

I have no problem with the idea of providing addicts (whether to illicit or prescribed drugs) with a proper, medically supervised detox on admission into prison. I do have a problem with the idea of maintaining addicts on methadone while they are in prison. This idea has only come about because some bureaucrat within the NTA and/or the current UK drug treatment mafia decided that giving addicts drugs equals treating addiction. Certainly the figures for those in treatment would show a dramatic fall if all those individuals who are merely given drugs that help maintain their habits were removed from the statistics.

Apparently the individuals concerned also objected to being subjected to "drug treatment programmes" while in prison - they were apparently treated against their wills and this was aginst their human rights!

A little bit of clarification would help here:

Prison drug treatment programmes in England are actually accredited as "offending behaviour programmes" rather than addiction treatment programmes.

Personally I have never liked this as I happen to think it makes for bad addiction treatment which should be about sick people getting well, not bad people getting good - although I also believe that the offending behaviour will inevitably be looked at in the course of any effective treatment programme.

For so long as prison drug treatment are accredited as offending behaviour rather than addiction treatment programmes however then fine, give the prisoners the right to decline them. However the consequence of refusing to do an offending behaviour programme - be it drug treatment, a sex offenders programme, anger management, Enhanced Thinking skills etc - ought to be loss of all priveledges, home leave and parole! We all have a right to make choices in life - but our choices always have a price attached! Why should this be any different?

Personally I can't wait for all the alcoholic prisoners demand parity!

Free booze for all prisoners who can demonstrate an alcohol problem prior to coming into prison! Now there's a thought - the Home Office are discriminating against alcohol addicts!

Whitehall's "Spinball" Drug of Choice!

2006-10-31T17:29:00.000Z

There were two very interesting, yet contradictory, stories in the press this weekend regarding Methadone:

The Scottish press, in the form of Scotland on Sunday and The Scotsman, ran a story on Professor Neil McKeganey's research (from Glasgow University) which shows that only 3.4 percent of drug users who were prescribed Methadone were “drug-free” after 3 years as opposed to 29 percent of those who went into residential treatment.

Other differences were just as startling:

Of those who received Methadone:

29 percent were in employment or education.
47 percent said that they “felt better”.
91 percent admitted to committing crimes.

Of those who took the abstinence route:

59 percent were in employment or education.
79 percent said that they “felt better”.
13 percent admitted to committing crimes.

Professor McKeganey's research seemingly shows that Methadone “treatment” is only marginally better than no treatment at all.

There are apparently around 20,000 addicts receiving Methadone in Scotland.

Meanwhile in England the Sunday Mirror reported that 84,583 people were in treatment for Heroin addiction (in England). Caroline Flint MP (now the Health Minister, previously the Drugs Minister) reported that the figure had almost doubled over the past 2 years and that this was a sign that the government's drug strategy was a success.

It also reported “experts” as claiming that the true number of Heroin addicts could be 120,000 because many users “weren't receiving medical help” . We reckon that the real figure is likely to be at least double this – say 250,000?

Um........ We also note that the report talks about “medical help” - effectively prescribed Methadone. The article then went on to report that drug related crime had fallen by 16 percent from April 2004 to March 2006. It then trots out the old statement that “for every £1 spent on treatment £9.50 is saved in crime and health costs”.

Am I the only one to sense a contradiction here?

Either Scottish Addicts are very different from English ones (They are not – I have worked with both) or Scottish professionals are less competent than their English counterparts ( again we know that they are not) or something is wrong with the figures! Especially so when Caroline Flint's figures don't even seem to relly match up with those from the National Treatment Agency which last month reported 181,000 people in treatment for drug use! ( If 84,000 are Heroin addicts what are the other 97,000 doing?)

Could it actually be that someone, somewhere – perhaps not a million miles away from Central London – is massaging the figures?

If I have to chose between the 2 stories I would have to say that in my experience Professor McKeganey is the one that we should be believing! But Scotland and Glasgow are a very, very long way from Whitehall (unlike Baghdad and Kabul) so we very much doubt that anyone will take any notice whatsoever of this research.

"Evidence based Research" only counts when it says what they want to hear!

Booze & Drugs and Benefits!

2006-10-19T10:39:00.000Z

Recently several UK newspapers printed stories about the fact that around 49,000 "alcoholics" and 48,000 "addicts" are claiming incapacity benefits because of their respective conditions.

Not suprisingly there were 2 main lines :-

This is an abuse of the benefits system.
Are people being denied treatment and condemned to a life on benefits?

My first question would be "where are the others?"

Taking the drug users first:

According to the Home Office and the National Treatment Agency there were 181,390 people in contact with drug treatment services in England alone in 2005/6.

Taking the rest of the UK into account, as well as research that has suggested that perhaps 2/3 of problematic drug users are not in contact with services it would not be unrealistic to suggest that there could be 4 to 500,000 problem drug users in total in the UK. If 48,000 are receiving disability benefits what are the rest doing? Are they committing crime? In prison? Working? Claiming Jobseekers Allowance? Does anyone know?

Similarly it has been estimated that there are up to 3,000,000 people in the UK suffering from alcohol dependency. 75% of those have been estimated to be working - driving buses, airline pilots, surgeons - all sorts of things that include many different kinds of high risk situations.

Going back to drugs for a moment (I know that area best) we have employers introducing workplace alcohol and drug policies (including drug and alcohol screening) because of, at least partially, their responsibilities under health and safety legislation - and we have major government initiatives to get people in treatment back into work (often while they are still using Methadone).

Here are 2 examples:

I am aware of cases where individuals on Methadone have died in Road Traffic Accidents and the Coroner has been highly critical of drug services for not notifying DVLA of the facts (thats the agency that issues driving licenses for non UK readers).
In the same month I received a phone call from a drug service asking my opinion about an offer they had received to train their clients as bus drivers. (The clients were, in many cases, still on Methadone.)

Am I the only one who finds this contradictory? Personally I would rather someone received incapacity benefit rather than drove my bus or burgled my house for that matter! At least while they received effective treatment.

Lies, Damn Lies and Statistics!

2006-10-16T06:06:00.000Z

Just recently the National Treatment Agency for Substance Misuse put out a press statement - see the NTA website for details - trumpeting the fact that a key government target (doubling the number of people in drug treatment) had been achieved 2 years early.

There than followed a lot of detail about substances used, retention rates, ethnic groups etc. Important as this information is (or might be - if it was ever used for anything!) I then spent a very frustrating 30 minutes looking for anything remotely resembling outcome data. There wasn't any.

I finally went back to the NTA website and found another report released on the same day giving outcomes for the year before. It turns out that for the year 2004/5:

160,453 clients received 238,149 episodes of "structured care". (About 1.48 treatment episodes per individual!)
Opiate dependency accounted for 75% of presenting clients. This was comprised of Heroin (64%) and Methadone (8%) and other (3%).
57% of clients remained in treatment for 12 weeks or more. 52% of clients received treatment described as "prescribing modalities" and there was apparently an increased likelihood of these clients being retained in treatment. In other words we are more likely to retain opiate addicts in treatment if we give them drugs! Now there is a suprise!
Of those individuals "discharged" from treatment during the year 30% had successfully completed treatment. However when one looks at this 30% it turns out that only 6% (5,759 treatment episodes - not individials - are shown as being "Completed Drug Free". (You can be "drug free in the UK and drink 2 bottles of spirits a day - alcohol doesn't count!) 11 out of the 30% "successfully completing treatment" were "referred on" - in other words the individuals had not completed treatment at all! As for the other 13% who "successfully completed treatment" without being drug free I can only assume that they "successfully completed treatment" still using drugs!

A large part of the paper is about "factors associated with retention and succesful discharge". While I agree that the study of such factors is important this report makes comments like: "The proportion of episodes which were successfully discharged was greatest for those with Chinese clients (40%), whereas only 20% of those episodes where the client was Bangladeshi were successfully discharged". The numbers of Chinese and Bangladeshi clients "successfully discharged" were 29 and 143 respectively. I personally believe that making sweeping assertions about treatment outcomes based on samples this small is unjustifiable.

How many agencies (let alone non-english speaking workers) worked with these 2 groups? With numbers this small I would need convincing that the differences do not have more to do with the effectiveness of the agencies concerned, or perhaps even the effectiveness of a few workers, rather than the client's ethnicity! That the UK government bases it's "evidence based approach" to drugs treatment on such dubious logic which resembles an O-Level project rather than any real science is alarming! Where are the controls?

Lest I get so carried away here that I forget the point of all this - in the year concerned £457 million was spent on drug treatment (ignoring the money spent in prisons) and in England at least there is only evidence that 5,759 episodes of treatment ended with the client being discharged drug free.

That's £79,354 each! The total money spent could have bought something like 100,000 individuals for 13 weeks residential treatment in South Africa- yes, South Africa, and I am pretty sure that we could reasonably expect perhaps 50,000 of those individuals to have "Successfully completed treatment drug free".

Why do we let the NTA trumpet such appaling outcomes as some sort of triumph? It's actually more like a cause for despair!

Why no posts recently?

2006-10-15T15:32:00.000Z

I, along with many other ex users, did not escape completely "scott free" from my using career. During the course of it I contracted the Hepatitis C virus, although around the time that I got clean the term was not even known. This was because they were just about inventing the test at this time to recognise the virus. Up until this time there existed Hepatitis A, Hepatitis B and what they called "Non A, non B Hepatitis" which included Hepatitis C but of course also some other varities as well.

Around 1991 I first heard of hepatitis C as a consequence of my professional work. In fact I read a magazine article and recognised the symptoms and consequently went and had the test which proved positive. At the time most doctors had next to no knowledge of the condition and what information that there was available presented a picture of a "killer disease" which was lumped together with HIV as something that was almost invariably fatal.

My first meetings with the consultants did not go well. I had obviously done a lot of research on the subject beforehand - particularly on the treatment options, the side effects of treatment and it's efficacy. I found that the information that I was being given was less than honest and worse than that I left feeling that I was being treated as a guinea pig. I was being told that I would have to go to another hospital some 60 miles away 3 times a week (there goes my professional career) and that I had to have a liver biopsy - the risks of this were never even mentioned - and that I would be put on Interferon.

The possible side affects of Interferon were never raised. At this point I left and never went back to see that particular consultant. All the information that I was getting at the time pointed to the fact that there was a lot of research going on, particularly into combination therapies, and that with time treatment was going to improve.

It is perhaps worth pointing out that at this point I had never missed a days work, that I was very little inconvenienced and my perspective was that at that time the treatment seemed worse than the disease! I continued working full time and, apart from the odd liver function test, I never went near a doctor until 2003 when I had moved to a different part of the country. This time the doctors were a bit more open with me and yes, the treatment had moved on and combination therapies were now on offer which seemed to offer much better outcomes.

My only problem was that I had just landed a Senior Managers job so I really didn't want to get involved with such a "heavy duty" treatment at that time!

I duly went ahead and worked full time in a a very stressful post for a couple of years. I coped OK but the job was very political, the team was very dysfunctional and the pressure started to tell. I finally quit for a variety of reasons - the Hep C formed only a very small part of it - around 9 months back. Since then I have been more or less self employed as a consultant.

However I found myself somewhat lacking in energy, perjaps lacking some concentration - in general just not what I used to be. But then I told myself, I am 61 years old so I am bound to be slowing down a bit.

Around a month back I was going away for a few days, I thought before hand that I was fighting off a cold - nothing too much to worry about. On arriving at our destination (I was accompanied by my wife) I more or less collapsed and spent the next three days flat on my back in the motel room unable to eat, without sufficient energy to move more than a few feet and sleeping around 18 hours a day.

On the 4th day my wife ended up calling a Doctor who promptly ordered me into hospital.

There then followed another three days of "Doctor knows best" - it was fairly obvious to me that the symptoms that I was experienced were related to my liver - but of course I was only the patient so nobody was going to listen to me. Similarly when I told them that they wouldn't be able to get bloods out of my arms they had to know better (nobody has managed to get a straight forward blood sample out of my arms in 25 plus years - when you inject yourself with drugs every few hours for many years you tend to make a mess of your veins. I certainly did - but then the most junior nurses seem to have that "medical arrogance" that discounts my 40 years worth of experience of finding veins in my arms and we have to have a very painful 15 minutes before they come to believe what I say is true!)

Finally I discharged myself - after promising to ensure that I continued treatment back in my home town. After all my wife was stuck 300 miles from home, as was I, and the rest of my life was going to the dogs while they dreampt up mre and more tests to subject me too. I have no problem with the tests - but as the hospital I was in was not in a position to provide any treatment whereas my local one can do both the tests and provide treatment I preferred to go home.

Since arriving home the majority of my symptoms have vanished. I now believe that I did catch some sort of "opportunistic virus" which hit my weakened liver and which I have now fought off. It has never the less been a salutory reminder for me and I am stil pursuing my treatment options.

I have been left unable to do very much for the past month - I have been unable to stay out of bed for more than about 4 hours at a strtch - hence the lack of posts. I am now however slowly regaining my strength. It has become evident to me that at least part of my "grumpiness" has been related to the state of my liver.

It has also become evident to me that although I still care about all the topics that I write about here I cannot afford to get too worked up and stressed about them as, in my present state, the resultant stress will be likely to have health consequences for me. In short "the "grumpy old addict" needs to lighten up a bit for his own sake.

I shall miss "self richeous anger" - it's been a lifelong friend, but it is a luxury that I can no longer afford.

National Treatment Agency for policy abuse

2006-09-06T10:11:00.000Z

I have recently been sent an e mail about a forthcoming one day conference in Leicester about future arrangements for Residential (tier 4) treatment here in the UK. All official statements are now pointing to the fact that it is now policy to improve access to residential treatment.

The government’s initial "bright idea" was to give large sums of money to the NHS to open new units, this might sound like a good idea until you realize that all the existing units have empty beds. The Problem is not so much one of capacity as of commissioning arrangements. Whether one gets residential treatment here in the UK seems to depend on several factors, most of which are financial rather than based on any real assessment of clinical need.

The process takes so long and is so convoluted that there are no doubt deaths each year because of either the time it takes or because individuals are so put off that they don't even bother to try to access residential treatment.

I could go on about this - but what struck me about the flyer was that the NTA were asking me to donate a day of my time and pay £165 for the privilege of helping them to save money! As a consultant in the field who actually has many ideas as to how the system could be improved I find this attitude patronizing. Just what sort of business do they think we all run? Do they really expect hard pressed, highly skilled professionals to pay to have their brains picked?

The biggest block to progress here in the UK is the fact that all policy is ultimately driven by political considerations. The NTA and the UK government are only going down this road now because all their previous attempts at "quick fix" treatment approaches have failed dismally and they are now desperate to achieve some real outcomes rather than ending up with 10% of the UK population on methadone for the next 30 years!

Evidence Based Treatment

2006-08-26T14:27:00.000Z

Evidence based treatment.... how often do we hear the phrase and what does it actually mean? It is supposed to mean that treatment is based on "what works" and that "what works" has been scientifically validated by research. However.....

Here in the UK we consistently ignore evidence that does not suit the political agenda. There is a wealth of research on the effects of addiction on the brain - using various brain imaging techniques - that demonstrates that the effects that drugs have on the brain and which show that the human brain does not show signs of recovery until a considerable period of abstinence has passed. Without going into a small book this research has considerable imlications for the treatment of chemical dependency. Walk into 100 or so alcohol and/or drug agencies up and down the country and ask if any of the staff are even aware of this research and you will find not.

This week an American psychiatrist was quoted as saying that the brains of compulsive gamblers also show similar abnormal scans and it is also a known fact that Naltrexone has been researched in the US as a potential treatment for compulsive gambling.

We also know that there is a distinct correlation between the availability of "addictive" substances and behaviours and the number of people exhibiting problems. Do we take all this evidence into acount? Do we hell - it just doesn't suit the governments agenda! Lets roll out 24 hour drinking and loads of casinos. Then act suprised when the number of people with alcohol and gambling related problems goes up! It will, the all the evidence predicts that it will - but we will ignore the evidence when it doesn't suit us!

Consider the so called "assessment" of individuals with alcohol and other drug related problems. There is a wealth of evidence that shows that there is substance use, substance abuse and substance dependency. The evidence also shows that these are distinct conditions with distinct needs in terms of treatment. Do all alcohol and drug services then actually sit down and diagnose which of these groups an individual falls into? No most do not, and consequently most treatment is inapropriate not to mention ineffective. Why is this? Because dependency requires intensive skilled (and often residential) treatment and the system is generally speaking not geared up to provide this.

It is easier for services to train staff to deliver MET or SFBT (it requires a short 3 day course in many peoples eyes!) than it is to train staff for the year or so required to deliver abstinence based services.

Don't get me wrong - I have nothing against Motivational Enhancement Therapy or Solution Focussed Brief Therapy - with the right individuals at the right time there is no doubt of it's effeciveness. For the rest of the client group however is a sentence to failure and dissilusionment with treatment.

Lets carry on then, blame the clients when treastment fails and concentrate on what is usually economics rather than the real evidence!

The price of drugs......

2006-08-22T19:22:00.000Z

News reports in today's press state that the price of heroin per gram is now £40 as opposed to £60 a few years back. The general drift of the articles is that Britains streets will now be "flooded with cheap heroin".

Its interesting to note that when I got clean in 1986 the average price was around £60 to £80 per gram. I guess that if you take inflation into acount then in real terms the price is even cheaper now comparatively speaking.

While I have no doubt that there is a direct relationship between availability and usuage I don't think that the picture is quite as simple as the economic model suggests.

I cast my mind back to when I started using heroin in the early 1960's:

After a couple of initial hits which were obtained by buying from "friends" who had legal supplies I pretty quickly decided to get "registered" as they called it in those days and to get supplies from a doctor. I would not only be able to have heroin legally but I would have more - always a good idea if you are an addict!

You might think that it was hard to find a doctor - it wasn't, there were about half a dozen in London who would more or less prescribe to anyone who walked through the door with the requisite cash (about £5) for a private prescription and who said that they had a heroin habit. It was so easy that I not only walked out the door with a prescription for heroin - I had one for cocaine as well! (The doctor asked if I used cocaine as well as heroin - I am an addict so what was I going to say? In reality I had never even used cocaine up until this point.

The whole scene in these days revolved around Boots the Chemist in Picadilly circus in Central London. (It was open all night and you could cash a prescription at a minute past midnight!). Pretty soon I was swoping doctors trying to get a bigger prescription and there was even a period when I was getting Methedrine on prescription as well! Yep, you read that right - heroin, cocaine and methedrine on prescription!

I can't say that my life was very manageable around this time or that I was functioning well - I wasn't - and all this was shortly to come to an end.

The end came when the Government acted on the recommendations of the 2nd Brain report which came out in 1965. You see there had been a panic - the number ok known heroin addicts in the UK had gone up to the dizzy heights of around 2,000! (A very large proportion of those actually came from Canada and the USA because of this setup!) This was enough to trigger a panic. (I bet that the "powers that be" would be more than happy with 20,000 today.)

So the law changed and all the prescribing stoped. It was decided that "psychiatrists in special drug dependency clinics" was the way to go.

Why am I telling you all this history? Because up until that point I had never seen street drugs on sale in the UK.

I can tell you however that within a couple of weeks I was buying heroin from the Chinese community in Gerrard Street.

The price? £1 a bag initially. After a police crackdown the price went up to the dizzy heights of £70 for a quater ounce. What I believe happened was that the government legislation actually created an economic climate which made it profitable to import drugs. There was plenty wrong with the so called "British System" but at least the market was dominated by dodgy doctors rather than Gangsters and in fact the gangsters couldn't compete with the "dodgy doctors" plus Boots the Chemist.

The moral? There are now between 150,000 and 300,000 heroin addicts in the UK and the "experts" who presided over this disaster are still in charge! In what other field could the scale of the problem increase 150 times over and we would still listen to these people?

Alcohol and other drugs......

2006-08-21T22:59:00.000Z

I had a telephone call from a well known National newspaper today asking if I could give any details of anyone that I knew of who had died of a heroin overdose recently - the idea was to establish some kind of a link to the price of heroin coming down.

What is it in this country? More people die of overdoses involving Methadone- prescribed or otherwise - and admitedly usually used in conjunction with other drugs than heroin. However all the total drug deaths pall into insignificance when compared to alcohol and tobacco related deaths.

If one teenager takes an ecstasy tablet and dies then its all over the media for a few days, but I have yet to see the same sensational headlines about the 100 or so alcohol related deaths each day. That might well change however as thanks to the "National Alcohol Harm Reduction Strategy" and longer opening hours the numbers are rising rapidly.

It is very interesting to contrast the differences between the Alcohol and Drug Strategies however...

For Drugs: We must reduce the supply and we will lock up the suppliers for life for preying on the inocent victims.

For Alcohol: It is the consumers fault for not drinking sensibly and we will involve the suppliers in writing the strategy and do all that we can to make it easier to obtain supplies in the name of consumer choice!

Of course the Government taxes alcohol and tobacco but not drugs. Could there be a connection we wonder?

Why do the media fail to see all the inconsistencies and lack of logic in all this? Uhmm? Answers on a postcard please!

Welcome!

2006-08-21T12:11:00.000Z

We now live in strange times - SAGA were recently offering cut price tickets for the latest Rolling Stones concerts and there were many of us who, in the 60's never really made plans on being around now.

The Rolling Stones are themselves now more brown corderoy than brown sugar and on the same day that the Daily Mail published pictures of old geezers like me attending a Rolling Stones concert in London on another page they carry an article on the shenanigans surrounding Pete Doherty and Kate Moss - suprise, suprise they have been using drugs - yawn!

I do have to wonder what planet the Daily Mail lives on - do they really believe that this will shock anyone from my generation? It wont.

As for Pete and Kate - wake up to the fact that your life isn't going to get any better while you carry on doing what you are doing. If you are lucky you will find recovery and live long enough to be a "grumpy old addict" too.

Thats if the so called "experts" don't enable you to kill yourselves first. What another dead Rock Legend? Wow, that would impress me - not.