We must kick our methadone habit

Drug addicts often do not really need the heroin substitute that they are prescribed

By Theodore Dalrymple

It is unusual for politicians to face up to the obvious, but the Scottish Executive seems for once to have done so: it has recognised what has long stared it in the face, namely that dishing out methadone to drug addicts is not the answer to their problems or to the problems that they cause society. A different approach is needed.

Perhaps in 100 years historians will wonder why so many of the governing elite, from senior doctors to Cabinet ministers, persisted for so long in the belief that doling out methadone was the answer. The explanation, I think, will be that they wilfully misunderstood the nature of the problem.

Many years ago I used to dole out methadone like the best (or the worst) of them. This was before I thought at all deeply about the question of drug addiction and accepted uncritically all that I had been taught about it by doctors senior to me. I began to change my opinion when I worked in prison where it was the clinical policy to give addicts methadone. I noticed that, far from creating an atmosphere of contentment and satisfaction, it created one of perpetual tension and irritation. Shortly after having been prescribed a dose, the prisoner would return and say, in an intimidating fashion: "It's not holding me, doc, it's just not holding me," and sometimes announce that, unless he was prescribed more, he would end up attacking other prisoners, and then it would be the doctor's fault.

In Scotland the great majority of addicts prescribed methadone by their doctors never stop taking it, and most of them take other drugs as well. A particularly dangerous combination of drugs is methadone and benzodiazepines (drugs such as Valium), and yet drug clinics and other doctors persist in prescribing this often fatal combination - largely, I suspect, because they are too frightened of their patients to refuse them anything.

The number of people admitted to hospital having taken a dangerous overdose of methadone (556 in 2006-07) is greater, proportionately, than the number of people admitted to hospital having taken a dangerous overdose of heroin (1,530 cases). In Dublin recently, more people have died of methadone poisoning than of heroin overdose. The supposed cure causes as many problems as the supposed disease. If addicts prescribed methadone are given the opportunity to divert it on to the black market, they will: which suggests that they do not really need it in the first place.

In France, addicts are often prescribed a different drug, buprenorphine, which soon became the street drug of preference in Finland, to which it was illegally re-exported by the addicts. More recently, a huge epidemic of buprenorphine addiction has occurred in Georgia (the ex-Soviet republic), numbering scores of thousands of addicts, who take buprenorphine diverted from France. If the addicts really needed the drugs, they would take them rather than divert them on to a black market.

In the prison in which I used to work, a buprenorphine tablet that had been prescribed for an addict to alleviate the symptoms of withdrawal from heroin on arrival in the prison, and which an addict had put in his mouth and spat out for sale to another prisoner, was known as a "furry" because of its rough surface. Again, this suggests that addicts did not really need what they were prescribed, and that the whole basis of prescription was flawed.

The fundamental error that the Scottish Executive has now admitted is in having regarded addiction to heroin as a technical medical problem, to be solved by technical medical means. But that old approach amounts to a surrender to blackmail: give me what I want or I will continue to behave badly and to hold you responsible for the ill-effects of my own behaviour.

Suppose we gave money to burglars to induce them to stop burgling. No doubt most of them would stop for a length of time depending upon how much we gave them. But this does not mean that money is the treatment of the dreadful disease of burglary, or because we prevented certain individuals from continuing to burgle it means that we had reduced the disease of burglary in society as a whole. Rather, we would have encouraged its spread.

This is precisely the logic that has been applied to drug addiction. Just how precisely is evident from the Government's recent declared policy that clinics should now give drug addicts money or other rewards for not taking drugs (as least as proved by drug-free urine samples, something experienced drug addicts have long learnt to provide). This is the first time in the history of medicine, so far as I know, that bribery has been considered a medical treatment.

Contrary to what everyone supposes, withdrawal from heroin is not a serious medical condition - unlike, say, withdrawal from alcohol when it results in delirium tremens (the DTs). The suffering is grossly exaggerated and, in so far as it is genuine, is largely produced by anticipatory anxiety that is itself the consequence of years of mythologising the fearsomeness of withdrawal.

Addiction to heroin is a medical problem only to a minor extent, which is why predominantly medical means will never solve the problem. Most of Britain's 300,000 addicts are drawn from broken families, have a poor education, are without much hope for (or for that matter fear of) the future and have no cultural life, intellectual interests or religious belief. Delusory euphoria - the paradise at three pence a bottle that De Quincey described in his Confessions of an English Opium Eater - is the best that they think that they can hope for in life. This is not a medical problem. Where addiction is concerned, it is time to throw physic to the dogs.

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Boozy Britain

What we surely need to address is why vast swathes of young people - and their parents and grandparents, too, I expect - find being so intoxicated that you can't stand up the very acme of fun. We've all done it: I had my stomach pumped once when I was a student (I know - classy), but most of us aren't madly keen to keep on doing it.

I fully understand the joys of the three-hour lunch: I love sitting in the sunshine with a chilled bottle of white wine; I have no reformed drinker-style notions about the evils of booze. Drinking until you're giggly and feel like singing is very nice. Drinking until the room starts spinning and you want to throw up isn't. What I can't get my head around is why such vast numbers of people believe it is and that it is what you must do to have a laugh.

I was walking back from St Leonards in East Sussex to Hastings a few months ago, at about three in the morning, after a party. We detoured via a chip shop near the sea front because we were starving.

Here is what we saw at the chip shop: 1) a young man, who had been glassed in the face, trying to buy a kebab; 2) two extremely drunk young men standing outside (near some sick) trying to start a fight with, as far as I could tell, any random person; 3) two girls aged about 15, completely inappropriately dressed (because, sorry, and do exercise your female rights to cram your pallid flesh into whatever porno costume you like, but if you're going to stagger about pissed at three in the morning, take a coat and wear it) clutching each other and barely able to stand up; and 4) another young girl, outside the chip shop this time, being felt up by some bloke as she was vomiting.

The thing is, having been at a party until 3am, my companions and I were also drunk. But, Jesus, not that drunk. Why would you do that to yourself? In what way is it fun to be glassed, semi-raped or puke down your dress? Does anyone seriously wake up in the morning and think: "Top night"? Statistics tell us they must, in vast and increasing numbers.

I happened to be in Hastings, but I expect a version of the hideous scenario above plays itself out everywhere. I know young people in the countryside are so bored there's nothing for it but to drink, have sex (but apparently not understand how contraception works. Why not? - it's not exactly challenging) and take drugs, and I suspect that the more remote the community, the more intense the boredom and the more extreme the partaking: there is actually something intensely provincial about drinking to excess.

It has nevertheless become shorthand for being "one of us", recognisably a member of the great tribe of pissheads, up for a laugh. The liberal elite, in their usual moronic, tragically out of touch way, thought that endlessly printing photographs of David Cameron and Boris Johnson at Oxford in full Bullingdon rig and banging on about toffs would freak out voters and send them scurrying gratefully into the arms of the Socialist Workers party. As we know from the past few weeks - this one included - it didn't quite work that way. Well, d'oh. Okay, so they're wearing funny clothes - but they're also doing what the nation likes doing best: getting bladdered. The whole raison d'etre of clubs such as the Bullingdon is drinking to the point of oblivion. It is also the whole raison d'etre of vast swathes of the country.

It has become as outre in some circles to use the word "underclass" as it would be to call homosexuals "arse bandits" or black people "nig-nogs". We keep telling ourselves that the lovely, admirable, hard-working, morally upright (there was a time when it was the nation's conscience as well as its backbone) working class still exists and a few horrid bad apples are spoiling the barrel. This is simply not true. The old working class exists, but it is on its last legs, and the underclass that has replaced it is on the rise - angry, desperate, broke and broken, culturally and morally barren, passing on their poor, empty lives to their children and grandchildren. No wonder they drink to oblivion - wouldn't you?

The fact of the matter is that the binge-drinking problem is largely an underclass problem. Teen pregnancies are largely an underclass problem. Teenage crime is largely an underclass problem. Child neglect - we live in a country where a little girl allegedly starved to death in her own home last week - is largely an underclass problem. Our collective problems are largely underclass problems.

Could somebody not just come out and say it, before another generation floats away to its doom on a sea of alcopops? The underclass was made, not born. Nobody asks to live in poverty, with no hope, no ambitions, no possibility of betterment, and the belief that the most fun you can have is to drink yourself into early cirrhosis. I know they're hard to love, but really - do we owe these people no responsibility whatsoever? Don't cut the price of their dreadful gut-rot: help them.

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