Heroin 'scripts: reading between the lines.

Two contrasting views of our heroin problem were highlighted recently. The first came from Howard Roberts, Deputy Chief Constable of Nottinghamshire, the latest in a line of senior serving officers calling for heroin on prescription to cut drug-related crime. Such comments always make headline news, as they should coming from such an unlikely source. Surely the police would hold fast to a zero tolerance attitude to drugs? Thankfully not. Many officers take a pragmatic view of drug addiction and know the value of effective treatment. Currently a handful of older users receive heroin on prescription. So what are the prospects for an extension of heroin prescribing? The government has been dragging its feet: the guidelines on heroin prescribing are so proscriptive that virtually nobody qualifies and we still have to wait for some results from the Maudsley Hospital heroin trials.

But even if heroin does become a regular part of the substitute prescribing regime, it is unlikely that there will be a procession of users clutching scripts on their way to the chemist. Firstly, we live in an era of accelerating medical accountability and litigation and with UK opiate prescribing especially, the ghost of Shipman looms large. Added to which, if we do follow the Swiss or Dutch models, then users can expect a very high degree of supervision which will be hard for many even with the heroin carrot.

The other view of heroin takes us to the start of the opium trail. Calls for the extension of heroin prescribing invariably lead to calls for the Afghan crop to be legalised which it is suggested, would mean much cheaper heroin for treatment, plummeting drug-related crime and an end to traffickers' profits.

It is wise never to say never and the argument sounds compelling, but the current state of Afghanistan make it hard to visualise what a successful business plan for such an enterprise might look like. The UN and World Bank this week published a report on the Afghan drug industry both commendably detailed and remarkably frank, particularly noting the often counter-productive results of counter-narcotics activity. This was followed by an episode of Channel 4's 'Unreported World' which established that arms dealing, drug trafficking and corruption are rife through the ranks of officialdom in areas far removed from Taliban influence.

What the programme and the report underline is that before anybody gets too excited about the idea of legalising heroin, they need to realise that the opium industry in Afghanistan is incredibly complex and deeply entwined in the political, cultural, social and economic fabric of what is essentially a lawless, poverty-stricken country ravaged by a generation of conflict.

http://www.unodc.org/unodc/en/press_release_2006_11_28.html