Is the anti-drugs strategy working?
Updated on 26 February 2008
On the day the government's ten-year anti-drugs strategy is published, our home affairs correspondent Andy Davies meets a heroin addict who's desperately trying to beat her habit.
It used to be known as Cold Turkey - now they call it the 'Rattle' - the point at which someone withdraws suddenly from heroin to go entirely drug free. More than one hundred thousand heroin addicts receive treatment in Britain but most are now encouraged in another direction - to swap heroin for a replacement drug.
Channel 4 News has learned that 85 per cent of all heroin users in treatment in England are now being prescribed powerful substitute drugs like methadone.
On the eve of the publication of the government's new ten-year drugs strategy, our home affairs correspondent Andy Davies has been filming with one of the minority addicts who decided to swap the methadone script for 'The Rattle' .
Case study: Jill McCarthy
Jill has been a heroin addict for much of the last four years. Her muscles are wasting, she has lung damage, needle scars from wrist to elbow, her teeth are rotting, and recently she had pneumonia. She's 29 years old and wants desperately to get clean.
But she's opted not for the government's favoured approach of using prescribed heroin substitute drugs.
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Instead she's on a crash detox course.In just one day she took herself completely off heroin - with no substitute opiates - and 4 weeks on she's still struggling with withdrawal symptoms.
This detox is taking place not in hospital, not in rehab, but at home in Milton Keynes - with her medical supervision left largely to her untrained Mum
"When she's undergoing the detox her bed had to be changed every twenty minutes some nights." - Pat McCarthy, mother
"It's really, really, really hard to stay motivated. Some days you just get up and your emotions are very raw. Everything's different. Everything tastes different." Jill McCarthy
This is the second time that Jill has attempted a crash detox. As well as the chronic insomnia, the nausea and diarrhoea, she has aching limbs, acute bouts of anxiety and she's restless. Any sudden relapse now could result in an overdose.
Amazingly, the only one who seems to be in charge of this risky procedure is her 62-year-old mum, a course manager at the Open University. She is effectively supervising the detox programme, despite having no training and no-one talking to her about the best methods.
The Methodone method
Two miles away in a treatment centre a very different approach to heroin addiction is taking place in the government' s preferred approach - where addicts aren't going for the immediate drug-free detox option. They're being given controlled drugs to replace heroin - medically prescribed opiates such as subutex and methadone.
The green elixir of methadone has helped fuel a quiet revolution in drugs treatment in Britain.
It was the last strategys aim to get more addicts in treatment - an extra 100,000 a year now get help. At least half of them with substitute drugs like methadone. Prescriptions in England alone have almost doubled in the last ten years. The efficacy of such an approach, say the government can be seen, in falling drug-related crime rates. But some question whether the overall treatment strategy has become far too simplistic.
Jill's detox is now in its fifth week. The news isn't good. Her mum found a small carry bag with a syringe in it and believes she may have used something in the previous days. It was an old needle, said Jill, nothing to worry about.
In Milton Keynes as in the rest of the UK, There are, its thought, as many hard drug users now as there were ten years ago, with access to even cheaper drugs. Reducing supply was a key aim of the last strategy but - in this respect - little has changed.
Jill's sister Rachel was also a heroin addict. She died of a methadone overdose 8 years ago. Jill tried methadone treatment herself several times but it didn't work for her. Which is why she's gone for the - detox, abstinence based, drug-free approach. But she says she's found it harder to get help doing it this way.
Facing the Rattle
At the critical point of heroin withdrawal - the so-called 'Rattle' - Jill and Pat went to their GP for help. He referred them to the community drug centre. The centre said she'd have to wait five weeks for an appointment. So Pat - in desperation - called the local Primary Care Trust begging for help. They simply referred her back to her GP.
Jill did eventually get an appointment at the drug centre after three, not five weeks but she was only offered limited counselling sessions. Her mother is angry that she's not had any help in supervising her daugther's detox.
"This process has been managed by me. I've harangued the doctor to give her the drugs. It's me that's been dictating what medication she's been getting. I'm not qualified to do this. But I've done it because I'd do anything to get her what she needs to get off the drugs" - Pat McCarthy
Others also believe the system is increasingly biased in favour of directing addicts onto methadone.
And today the National Treatment Agency revealed to Channel 4 News that of the 140,000 heroin and opiate users in treatment in 2006/2007 a staggering 85 per cent were on substitute drugs - and just 15 per cent abstinence based programmes.
'The hardest services to access are the services that help people stay drug free'Mike Trace - International Drug Policiy Consortium, chairman
Of those on substitute drugs less than a third were having their prescriptions gradually reduced.
"I think we have ended up with a slight imbalance. The hardest services to access are the services that help people stay drug free, which is a bit ironic when we had the opposite problem 15 years ago." - Mike Trace - International Drug Policiy Consortium, chairman
The government's National Treatment Agency declined to be interviewed for this film. They issued a statement instead:
"There are more people in drug treatment than ever before - choice and quality of treatment has also improved and waiting times have fallen dramatically.
"We have always advocated a balanced system - compared with ten years ago there is no evidence to suggest that it is more difficult for problem drug users to access abstinence-based services."
Jill is now two months into her detox. She's on a waiting list for more counselling. She says she's still clean of drugs - but, ominously, both for her and her mother, her heroin cravings are back.
