BAD PRACTICE IN PRESCRIBING

Comment piece by MELANIE REID, The Times, 3 October 2008
(this story has not been edited/altered by Addiction Today).

"The methadone lobby has built a pharmaceutical holding pen that keeps addicts addicted"

This year's award for Least Impressive Interviewee on National Radio goes to Paul Hayes, head of the Government's drugs treatment agency. Yesterday, on the Today programme, he inadvertently revealed one of the reasons why drug addiction remains a blight.

Mr Hayes, CEO of the National Treatment Agency for Substance Misuse, was jobsworth personified: complacent, patronising and absolutely unable to explain why only 3 per cent of the 200,000-plus addicts are cured each year.

Like so many big cheeses in the drug rehabilitation industry - paid for by us - he appears to be a committed apologist for the policy of harm reduction and the use of methadone to stabilise heroin addicts.

Fact is, harm reduction drug strategies have become a self-serving, self-perpetuating state industry. Instead of helping drug addicts to become drug free, as 80 per cent of them would like (figures, incidentally, from a survey by Mr Hayes's own organisation), official policy has created a pharmaceutical holding pen in which the UK's addicts can be coralled at a cost of £300million per annum.

This industry employs more than 150,000 people in “drug action teams”; makes fortunes for the manufacturers of methadone; gives lots of research money to academics; and is a nice little earner for GPs and pharmacists too. It's just a shame that we pay for it.

The only other people it may not be helping quite so much are its customers. Once on heroin substitute, they may be trapped in limbo for years without being offered a chance to become drug free. The industry doesn't care: it sails on like an ocean liner, with a generation of drug users on board.

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Harm reduction has become a pharmaceutical monster. Half the £500million that the Government spends on combating illegal drug use in England is devoted to prescribing an alternative addictive substance. And one which is now abused as a street drug.

It costs as much to maintain an addict on methadone for a year - £2,800 or more - as it does to put him on the average abstinence programme for one month. Two months is usually sufficient to get most people off drugs. Abstinence programmes are proved to be seven times more effective than methadone. Yet the average stay on methadone is five to six years and some people have been on it for 25 years.

How did we get into this ludicrous situation? Within the world of drugs policy there is an ideological fault line. On one side is harm reduction, as endorsed by offical policy; on the other, abstinence, the view of the non-PC minority.

Less than 2 per cent of addicts are being offered the possibility of abstinence. The charity, Addiction Today, reported this week that 12 rehabilitation centres would be closing because of lack of referrals.

Professor Neil McKeganey, of the Centre for Drug Misuse at the University of Glasgow, says that harm reduction has its origins in the 1980s, when the Government feared that HIV was going to infect the general population and constituted a much greater threat than drug abuse. Needle exchange became official policy and treatment services were given a bright new agenda: they didn't have to worry about getting people off drugs. The idea of abstinence receded into the distance.

"Once on methadone, they may be trapped for years"

As well as being supported by Margaret Thatcher, harm reduction appealed to the liberal consensus. Drug workers tend to be compassionate people: they liked the gentle approach.

But that was then. Thirty years later drug use has proliferated, eclipsing all predictions of HIV infection. Now there are more than 225,000 people in the UK getting treatment - the tip of the iceberg. Forty per cent of addicts are infected with hepatitis C; up to 400,000 children live with parents who are adicts; and 80 per cent of methadone users are continuing to use other drugs. Harm reduction has failed spectacularly.

Astonishingly, the National Treatment Agency does not have a target number of addicts to get off drugs. Yet its survey of 12,000 users in 2007 found that 80 per cent of heroin users and 50 per cent of methadone users wanted to stop all drug use.

Street drugs are a lifestyle choice. Being a taxpayer is not; and it is harder to be tolerant of the rotten choices of others when one's hard-earned money is spent subsidising them long-term. Clearly, a sea change in strategy is needed, though the vested interests are enormous. The Conservatives would like to steer policy towards abstinence. But then, it is said, so too did Tony Blair and Gordon Brown when they came to office, only to be beaten down by the powerful methadone lobby. The Scottish Government is shifting away from methadone, but there is resistance.

Mr Hayes, meanwhile, is on record claiming that his way is supported by a powerful body of evidence. (Of course it is; we funded most of it.) “We must convince the public that money spent on drug treatment is money well spent,” he said. Frankly, he's got his work cut out.

Comments

[Caroline Cole]

Well done Deirdre for showing the video of Craig Ferguson, his challenge to the 'joke' of addiction is powerful and compassionate - and it underlines what works, unlike the nonsense Paul Hayes claims.

[Ann Marie]

Please refer to an article by Dr Aamer Sarfraz et al (2008) which gives a global overview of the methadone prescribing to complete the picture. There is ample research evidence to suggest that methadone has its place in opiate addiction treatment and anyone denying that place is oblivious to hard science.