Dose of reality fuels new initiatives to help addicts
Long-term addicts to get two free doses of heroin a day in a Danish scheme that could be replicated across the UK Danish drug users will inject heroin in clinics under doctors' supervision.
State-funded heroin is becoming a reality in Denmark, the latest in a small, but growing, number of European countries – including the UK – concerned with improving drug users' quality of life and reducing criminality.
Since 1 January, hundreds of drug addicts in the Nordic country have the right to receive two free doses of heroin a day, paid for by their health system. The offer is only for adult, long-term users for whom substitutes such as methadone and subutex have not worked.
"The aim is to improve their state of health, help them avoid committing crimes and stabilise their lives," explains Dr Anne Mette Doms at the Danish Board of Health, which supervises the project. "Quitting altogether is not a realistic option for most of these patients. For them, this will be a chronic treatment, as if you were treating a chronic disease." Addicts will need to attend one of five specialist drug clinics across the country, where they will inject diamorphine – pharmaceutical-grade heroin – under doctors' supervision. The drug will not be available on prescription so as to avoid resale on the street.
Danish authorities are in the process of setting up the clinics, registering the doctors who will work there, and finding out which drug companies they will source the heroin from. The £7.2m project is expected to be up and running by March.
The initiative was adopted by overwhelming consensus in February 2008, after all but one of the parties represented at the Danish parliament voted in favour of the policy – the only one against it was a tiny far-left party that did not oppose the project per se, but the way it was funded. Among those in favour was the far-right Danish People's Party, a movement not usually known for its progressive views: at the last general election in 2007, it described some Danish Muslims as benefit-scroungers and fifth columnists who threatened Danish democracy.
Some might think this initiative is not surprising in a country with a historical tradition of progressive, social democratic policies. But, just as in the UK, the drug debate has been bruising in Denmark. And unlike in Britain, where heroin is available on the NHS for some cancer patients, heroin as a palliative is completely forbidden in the Nordic country.
"Five years ago I decided I would not participate in yet another debate on drugs," recalls Preben Brandt, the chairman of the Council for Socially Marginalised People and an advocate of the policy. "It was too emotional, with different groups being very aggressive."
"The counter-argument was always 'you kill people by giving heroin' or 'with this initiative, you are telling people that taking heroin is OK'," he says. "It is very difficult to have a rational debate when you are arguing against beliefs."
The turning point came when results became available from experiments trialling the policy in other European countries, including Switzerland and the Netherlands. "The politicians became convinced that it could help those with the most severe drug problems," says Mads Uffe Pedersen, the head of the Centre for Alcohol and Drug Research at the University of Aarhus. "You could not argue against the (positive) findings." "The debate became more practical," agrees Brandt. "It was about what policies worked and which ones did not. It was no longer about morality."
Attitudes towards drugs addicts improved too. "Drug addicts in Denmark are less stigmatised," says Brandt. "They are no longer perceived as criminals who are a danger to society. They're seen as patients who have a disease they need help with. The new scapegoats in Denmark are the foreigners."
Could a similar initiative be possible in the UK? It's actually happening already, with three schemes taking place in Brighton, Darlington and south London, where long-term heroin users can inject drugs under medical supervision at specialised clinics. Early results indicate that the scheme has cut crimes and stopped street sales.
Crimes committed by the addicts involved in the scheme dropped from about 40 to six a month after six months of treatment, Professor John Strang, the head of the National Addiction Centre at the Maudsley hospital, told the Independent newspaper. A third of addicts stopped using street heroin and the number of occasions when the rest used it dropped from every day to four or five times a month, on average.
It remains to be seen whether UK politicians will expand the policy nationwide, especially if they fear a possible backlash from voters. But if British voters are similar to their European cousins, this would not be an issue. Last November, Swiss voters approved the scheme overwhelmingly, with 68% supporting the plan. And there has been no popular backlash in Denmark, following the adoption of the policy by parliament.
Source: www.guardian.co.uk 5th Feb.2009
