Scottish Drugs Forum
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THE recent call by former Deputy Justice Minister Richard Simpson for a Scottish heroin prescribing pilot has helped shed light on the most vulnerable chaotic group of problem drug users who find it difficult to engage with existing services.
SDF has supported a heroin pilot for Scotland since 2004 after the announcement was made to conduct UK pilots in England. Our view remains that the nature of Scotland’s drug problem is distinctly different from London or Manchester and therefore a Scottish pilot would enhance our knowledge of what could work for those who are failing to engage with existing services for whatever reason.
The arguments against have been predictable if somewhat confusing. Objections on moral grounds have been confused with objections on the grounds that the pilot would be too expensive, given the cost of pharmaceutical heroin and the high level of medical support costs. There have also been objections on the basis that we need effective methadone programmes in place before we should be looking at anything else.
What is evident from the Swiss, Dutch and German programmes is that heroin prescribing works for a population that have been unable to sustain engagement with existing services – the average age of participants in Switzerland is 33 and 39 in Holland.
This older population is at greater risk of overdose and death due to the health damage inflicted over the long-term on their bodies. They are also the population who have had numerous episodes of prison custody and have frequently fallen out of treatment.
We need some new thinking in terms of how to engage with this population and some thought must be given to making the existing methadone services more accessible and person-centred - models such as the Lothian low threshold service need to be explored.
However, there will always be people for whom methadone does not work and for this population we have at present very little to offer. Heroin prescribing has to be an option worth pursuing.
There is concern in some quarters that we are sending out the wrong messages. But surely the main point should be about following evidence-based practice – in short, what works.
The evidence is increasingly strong from Europe and beyond that heroin prescribing can be successful. What’s more, public opinion in countries which have implemented programmes is behind it – for reasons of reduced public nuisance and reduced crime. Responses to the issue on the BBC website indicate that public opinion is also starting to change.
Perhaps introducing heroin prescribing in Scotland is not yet a vote winner but it appears that it is unlikely to be a vote loser. And this may be enough to tip the Executive into action after the next election.