Column The war on drugs isn't working. We need to medicalise heroin.

WE NEED TO have a very serious think about our drug policy because it is not working. While the use of other more discretionary ‘recreational’ drugs such as cocaine declined somewhat with the recession, there are as many heroin addicts now as there were at the height of the boom and drug crime has increased.

In the case of heroin addiction I believe that we should consider a radically different strategy: medicalising the problem. In short, I believe that we should provide the drugs in medical circumstances, to registered drug addicts, thus relieving the pressure to finance their addiction by criminal and anti-social behaviour which harms them, their family, and society in general.

I am not an instinctive liberaliser of drugs. I am against drugs – but I simply don’t believe that our current policy of adding more harm to the harm they cause has worked.

Heroin addiction is a major fuel for criminality in this country. The money which comes from the supply of narcotics helps finance the gangs that terrorise the poorer communities in our cities.

Opioid addiction is a problem which is increasing in small Irish towns. However we feel about that, opioid addiction and all of the problems which accompany it is something we will have to confront in the coming years.

When someone becomes addicted to an opiate, it profoundly affects the chemical landscape of their brain. When they lack the drug that their body craves, the addict becomes ill. Their symptoms include nausea, vomiting, cramps, insomnia, hallucinations, anxiety, panic attacks, depression, fever, and worse. An addict suffering this illness will do anything to relieve themselves of the effects of withdrawal, whether that be through thievery, prostitution, violence, dealing, or otherwise.

The treatment, in the acute sense, for those symptoms is to take narcotics to avoid going through withdrawal. In the long-term, the treatment is to rehabilitate them away from needing opiates. Looking at the figures, and having talked to addicts themselves, it is clear that what we are doing with methadone just isn’t working for many addicts.

Very few heroin addicts are engaged with treatment

The war we are waging on drugs appears to not be working, not only here in Ireland, but also internationally. This is especially evident in the case of hard narcotics such as heroin and morphine.

There are, by most estimates, twenty thousand opiate addicts in Ireland. About eight thousand are engaged in some way with the methadone programme, of whom about one third are heroin free. The Comptroller and Auditor General notes that about 100 addicts, or 1.25 per cent  of the total community who are seeking treatment participate in detoxification and follow-on rehabilitation treatment in any given year.

Since my election to the Seanad last year I have made it my business to look deeper into this problem. I’ve met with charities, drug counsellors, state services, psychiatrists, addicts in active addiction, addicts in treatment, doctors, volunteers, social workers, and all those good people who work on a daily basis with those whose lives have been consumed by addiction. After meeting the children of those whose lives were destroyed when the Dunne family dumped their drugs on Dublin, and finding them trapped in the same addiction of that stole their parents from them, I now think that we have to ask if there is another way.

‘We need to rethink our strategy’

I have been saying for some time now that we need to rethink our strategy in dealing with opioid addiction here in Ireland. We need to look at the evidence at what is working abroad, and see what we can do to ameliorate the effects that the scourge of addiction is having on our society.

My most recent comments on this issue followed from a discussion on the murder of Shane Geoghegan. Shane was a wholly innocent man, who was hunted down and executed by a 22 year old gunman who had confused him with a member of a rival gang. Shane was shot five times as he made his way home to his girlfriend, because he was a “big” guy like the intended target, his neighbour.

Every war has its collateral damage and on that night the collateral damage was a young man, the captain of his local rugby team. Perhaps if we were winning the war then losing young men like Shane could be justified, though I don’t know how.

Medicalising opiate addiction has been shown to decrease crime, decrease prostitution and decrease homelessness. It would enable us to redeploy Garda resources in other directions. It has been shown to improve the health of addicts, it maximises the retention of patients on health programmes, and the majority of those who enter into heroin-assisted treatment programmes graduate onto other regimes including methadone-assisted programmes and abstinence programmes. This includes those people who have failed to engage with the medical infrastructure to date.

The state should consider reigstering heroin addicts and helping them get treatment

Few things are as traumatic as having a family member succumb to addiction. The impact that they have on those closest to them can be devastating. Ideally the addict would learn to become abstinent, but I would like to see the introduction of policies which will reduce the harm of addiction on the addict and the family while they are travelling towards that goal. If removing the pain of theft from the family home, the fear of overdosing, and the dangers of disease and criminality from these families was all that could be accomplished, that would be no small thing.

I suggest that when somebody presents as an opiate addict, the state should consider registering them as an addict and they should have recourse towards heroin assisted treatment in a clean environment and under medically supervised circumstances.

In return they should lose certain rights. They ought not be allowed to be a member of the Gardaí, the armed forces or the health professions, and they should not be allowed to hold a driving licence. Their addiction already circumscribes their actions so their addiction ought not to impact negatively on the lives of others.

The cost benefit analyses which have been conducted in Switzerland show that while heroin-assisted treatment is expensive, it costs less than half the cost of policing, enforcing, and dealing with the medical consequences of the current regime.

Failing to do something about this problem will not make it go away. Only one in ten opiate addicts are heroin free and only a handful of them become methadone free. We need to build a system which attracts addicts, helps them get out of crime, reintegrates them into society, and has the resources to help those who want to get clean to get clean.

This is not a radical idea. Other countries have been doing this for years, and the evidence points towards some very positive effects in reducing the costs on society imposed by active addiction.

John Crown is a consultant oncologist at St Vincent’s Hospital in Dublin and a Senator representing the National University of Ireland.