Many heroin users lead ordinary lives by jennyyingdi

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Contents:                                                            Drugs in society
1. Heroin users’ ordinary lives   & Afghanistan’s opium supply       How can we make a rational decision about whether drugs are
2. Release cares for injectors                                       good or bad, when we’re all drug takers? Professor David Clark
3. 2004 in headlines                                                 takes the definition of a psychoactive drug right back through
5. Needle exchanges;              & Prejudice against heroin users
                                                                     history, and reveals how politics, economics and the media all
6. Cannabis – one year on
7. Young People                   8. DANOS                           play their part in shaping people’s attitudes. Society will only
                                                                     make progress when it learns to address substance issues openly
                                                                     and realistically, he suggests.
Many heroin users lead 'ordinary lives'                               ‘The sufferer is tremulous and loses his self command; he is
                                                                     subject to fits of agitation and depression. He loses colour and
A study of heroin users that claims the drug can be taken            has a haggard appearance… As with other such agents, a
without jeopardising health or holding down a job, has been          renewed dose of the poison gives temporary relief, but at the
contested by many drug workers and agencies. David Shewan            cost of future misery.’ From a medical textbook published in
and Phil Dalgarno from Glasgow Caledonian University                 1909. (See end of article to discover the drug.) People have been
conducted a four-year study of 126 long-term heroin users. Most      taking psychoactive drugs to change their state of consciousness
of the 'ordinary people' studied were married and employed, and      for thousands of years. Man has discovered psychoactive drugs
none were in treatment. The majority had gone through higher         serendipitously, has cultivated them deliberately, and has been
education, showing that a class A drug user can achieve              producing them in laboratories, even in suburban homes.
educational qualifications comparable to non-drug users,             Many people consider that only a minority take psychoactive
according to the researchers. The findings revealed that although    drugs. However, in his excellent book Living with Drugs,
there were many heroin users with problems, there were also          Michael Gossop points out that drug taking is ‘almost a
many who led a normal life. 'Some drug-related negative health       universal phenomenon, and in the statistical sense of the term it
and social outcomes had occurred on a lifetime basis, but            is the person who does not take drugs who is abnormal’.
ongoing problems were rare and heroin was not a predictor in         While some people might react strongly to the idea that they are
either context,' said Dr Shewan. The researchers stated that they    a ‘drug taker’, drugs come in various forms other than illegal
were not saying heroin use was safe, but had aimed to                substances such as heroin and cocaine: nicotine in cigarettes,
investigate the largely unexplored area of controlled drug use.      alcohol, and various prescription drugs used for problems such
Psychological and social factors that came to light from the         as sleeplessness, depression and anxiety.
study could help to inform theory and practice in dealing with       Even tea and coffee contain a drug – caffeine.
addiction, they suggested. The study is published in a week          So what is a psychoactive drug? The World Health Organisation
when the new Metropolitan Police Commissioner said cocaine           defines a drug as ‘any chemical entity or mixture of entities,
use was commonplace among the UK's middle classes, who               other than those required for the maintenance of normal health
were apt to 'drink less wine and snort more cocaine', provoking      (food), the administration of which alters biological function and
further debate on which drugs are deemed 'socially acceptable'.      possibly structure’. A psychoactive drug is a drug that affects
                                                                     the brain to produce alterations in mood, thinking, perception
Afghanistan: every reason to keep up                                 and behaviour.
                                                                     The positive effects of psychoactive drugs are the pleasurable
opium supply                                                         mood states they induce and their ability to reduce negative
All 32 provinces of Afghanistan are now growing opium                mood states such as anxiety.
poppies, professor of international drug policy, Cindy Fazey told    However, psychoactive drugs may also produce negative effects,
delegates at Release's 'Drugs University' conference. Prof Fazey,    such as the paranoia and delusions caused by excessive use of
of Liverpool University, explained the country's 'perforated         amphetamine.
borders', which made an escalating supply impossible to control.     Society has clung to the notion that some psychoactive drugs we
2004 had been a record year for opium production, and narcotics      use are ‘good’, whereas others are ‘bad’.
had become the main engine of economic growth. A harvest of          Heroin is a ‘bad drug’ and heroin users are often classed as
4,200 metric tonnes had been produced, despite bad weather           deviant or abnormal. Tea and coffee are ‘good’ drugs – although
reducing yield by 28 per cent. A good summer could increase          most people do not consider them as drugs.
this to 7,000mt this year. A look at the figures demonstrated the    Alcohol is a ‘good’ drug, even though we are becoming
appeal of growing opium poppies. Opium was worth $4,600 per          increasingly aware of the risks that can be associated with its
hectare in 2004, against $390 for wheat. The British government      misuse. Tobacco is rapidly shifting from being a ‘good’ drug to
had offered just $1,235 per hectare not to grow poppies. Opium       a ‘bad’ drug.
exports were up 22 per cent in value and gross trafficking profits   Librium and valium, which can be obtained on prescription to
up 69 per cent, explained Prof Fazey. Farm profits were down,        alleviate anxiety states, are considered ‘good’ drugs. This
but trafficking profits up: was this down to better organisation,    situation is complicated though, because these same drugs
or not losing as much to confiscation?, she asked. Stopping the      become ‘bad’ drugs if used by people who also take heroin or
trade was proving impossible. Incentives to farmers didn't work.     amphetamine.
Labs could easily go underground and operate in smaller,             Librium and valium are also known to be addictive.
mobile units. Traffickers, warlords, tribal chiefs and farmers       The ‘good/bad’ drug distinction sometimes becomes
would unite and fight to protect their income - going on past        synonymous with ‘safe/dangerous’. Society would have us
experience they'd win, said Prof Fazey. Other campaigns were         believe that good drugs are all safe, or at least relatively safe,
proving disastrous. Using fungus and herbicides destroyed other      whereas bad drugs produce bad effects and are not safe.
crops, and substituting other crops was not a viable option. Oil     However, as Michael Gossop points out, it is here that society
and gas were a key reason for governments stalling: Afghanistan      has problems, because ‘scientific questions about the actual
needed to be kept stable, without threat of war, to enable           effects of a particular drug become entangled with issues of
pipelines to run through the country. Beyond politics and            personal morality and subjective beliefs’.
economics, 'why would a peasant go to earning half their normal      It is important to note that the ‘good/bad’ and ‘safe/dangerous’
income?,' asked Prof Fazey. There was no evidence to suggest         classifications have varied across time, and from culture to
that the uncontrollable supply would be tackled effectively.         culture. Some drugs which are illegal today were commonly
                                                                     used in the past legally, often for medicinal purposes. Some                                                                                     Page 2 of 8

drugs deemed illegal in Western society are used for religious         discriminatory measures, which would not be tolerated if
purposes in other cultures.                                            imposed on any other section of the community.
It also needs to be emphasised that the ‘safe/dangerous’               The tension between law enforcement and healthcare in the field
distinction does not hold up to scrutiny. Many more people die,        of addiction is nothing new. Ever since drug policies have
either directly or indirectly, as a result of using tobacco, alcohol   received attention from governments – for almost a century –
and prescription drugs than all illegal drugs combined.                there have been differences between the ‘hawks’ and the ‘doves’
Throughout history, societies have developed laws to regulate or       leading to a protracted debate around which ministry should lead
control the use of certain drugs. One would like to believe that       on the internal implementation of drug policy and control. Was
these laws have developed objectively, in an attempt to reduce         it a matter for the law or for medical practitioners? The use of
the heath and social problems caused by drugs. However, a              criminal justice coercion appears to do little to improve the
closer look reveals a more complicated picture – ideological,          effectiveness of treatment. All evidence suggests that an
political and economic interests play a major role.                    effective harm reduction approach is one where drug treatment
People in society today have a set of attitudes towards drugs and      interventions are both managed and delivered by health care
drug taking, that are often shaped by the popular media. As            professionals in a manner that seeks to restore basic human
Gossop points out, ‘the term “drug taker” is used as a                 dignity to people with drug problems.
condemnation, as a way of identifying someone who is involved          The last significant radical change in drug policy was the
in a strange and deviant way of behaviour. There is a continuing       introduction of a group of public health interventions, namely
reluctance to face up to the fact that drugs and drug takers are       the supply of sterile injecting equipment, of the mid-eighties that
part of everyday life’.                                                led to the UK having one of the lowest HIV/AIDS prevalence
We live in an inconsistent society. On the one hand, we tell our       rates amongst injecting drug users. Why do we hear so little now
young people not to take drugs and keep away from people               about the current epidemic of hepatitis C amongst this very
selling drugs. On the other hand, doctors and others are               same group? Could it be because unlike HIV, Hepatitis C does
constantly encouraging us to take drugs produced by the                not Users’ rights – who cares? ‘With an increasing emphasis on
pharmaceutical industry – some of which are addictive – for a          achieving performance targets, drug users are being pressurised
variety of conditions. Moreover, while we tell young people that       to accept treatment options, which may be totally inappropriate
certain illegal drugs are dangerous for their health, we ignore to     for their needs... and when they subsequently fail, find that the
a large extent the bad effects that alcohol has on health.             punishment tariff has been heightened.’ Legal | human rights
Psychoactive drugs have always been part of life – and they will       and civil liberties IN SEPTEMBER 2003, I reached a turning
always be present. Substance misuse is not going to go away.           point in my life. I was a solicitor with 3 years’ postqualification
Society needs to recognise the problems caused by substance            experience under my belt, working at Mishcon de Reya, a
misuse and deal with them in a realistic and open way. We also         prosperous and well-respected commercial law firm in the West
need to recognise that many problems caused by drugs are               End of London. I was good at my job and had the luxury of
intimately related to other factors, such as social deprivation and    working with colleagues whom I loved and admired.
social exclusion. Society needs to address these problems.             It may seem illogical, therefore, that I decided to leave that
The drug is coffee! Michael Gossop’s book Living with Drugs is         career behind and join the drugs charity Release to become
essential reading for people interested in learning more about         Head of Legal Services. A few of my colleagues -
psychoactive drugs. It can be obtained from Amazon books for           contemporaries of mine who didn’t know me well - certainly
£17.99.                                                                seemed puzzled by the news. While polite and full of good
                                                                       wishes, I sensed that they did not understand why anyone would
                                                                       want to make this kind of career move. Our work at Mishcon’s
                                                                       was conducted in a frenetic atmosphere of intellectual rigour and
                                                                       debate, adrenaline and fun. We were full of ambition. We were
                                                                       constantly striving for excellence, and were generously
Who cares? – Release cares.
                                                                       rewarded for our hard work. Why would anyone want to leave
                                                                       all this for the ‘soft’ and (for many) obscure world of legal
appear as likely to enter the non-injecting population in any          services for drug users? Yet the colleagues who knew me well,
significant way? We hear instead, with regular monotony, about         and those who didn’t but were older and wiser, seemed to
‘new initiatives’ to break the link between drug use and crime.        understand my decision. I was as ambitious as my
These initiatives invariably trample on the rights of individuals      contemporaries, but not for the goal of partnership in a
and have little, if any, real impact on the problem. The               commercial law firm. I enjoyed the challenge of legal work, but
compulsory testing of arrestees who are suspected of being drug        found commercial litigation frustrating. I felt that my clients
users, drug testing and treatment orders (DTTOs), restriction on       were not getting the best out of me, and that my talents would be
bail, enforcement of anti-begging legislation and the recently         better deployed in working towards different goals. My
introduced Drug Intervention Programme (DIP) are amongst a             voluntary work as a student had revealed a passion for trying to
raft of measures using coercion to force drug users into               help people to realise their worth and get the best out of
treatment.                                                             themselves. This was not an ambition that I could fulfil without
Worryingly, the increasing complexities of legislation mean that       a career change.
most workers, including those directly employed in enforcing           I had confided this dilemma to one of my closest colleagues
these new criminal justice initiatives, do not have the expertise      some months previously. He accepted my resignation with
to properly advise their clients as to the potential implications,     pleasure for me – knowing that this was an opportunity I had
particularly those associated with human rights and civil              been longing for.
liberties. With an increasing emphasis on achieving performance        Another kind, older colleague had noticed my restlessness and
targets, drug users are Who cares that drug users are treated          impatience, and had been gently needling me for some time to
fairly by the criminal justice system? Release does, says              understand where my ambitions lay. Having heard of my
Sebastian Saville, Director of the non-judgmental agency behind        resignation he asked me, ‘Are you doing something sensible?’
the ‘bust card’ and first ever national drugs helpline An              He was satisfied with my response – Release was a sensible
unprecedented use of the criminal justice system as part of the        move for me. Another senior colleague reacted with nostalgia,
domestic ‘war on drugs’ (or more accurately drug users) has            saying that he envied me for making a move that he had wanted
meant that users are being increasingly subjected to punitive and      to make at my age, but somehow had never managed before                                                                                     Page 3 of 8

financial responsibilities (children, mortgages…) made it seem        in which I hope we send a message to our clients about their
impossible.                                                           value as individuals.
The relief that I felt, as soon as I had made the                     My colleagues are talented, conscientious and deeply committed          29      November         2004      |   to their work. I have learned an enormous amount from them
drinkanddrugsnews | 11 being pressurised to accept treatment          already. It is also a source of satisfaction for me that the lessons
options, which may be totally inappropriate for their needs (not      I have learned in private practice have brought something
that they will have been canvassed about their needs). When           valuable to the organisation. I am pleased with the decision I
they subsequently fail, those individuals find that the               made in September 2003, and look forward to another fulfiling
punishment tariff has been heightened.                                year at Release.
Those who enter the prison system find that what few rights they      Katy Swaine – Head of Legal Services
might have had are now suspended. Those who are on
prescribed substitution therapy are often arbitrarily denied
treatment (and suffer severe withdrawals).
Detoxification is of variable quality and in some areas does not
even meet the most basic agreed national standards. Equally, for
those who wish to break away from the drug using culture,
barriers such as workplace drug testing and the requirement for
                                                                      2004: A year in headlines
criminal record disclosure make their attempts at rehabilitation       April: Nick Davies continues his series of thought provoking
back into society extremely difficult.                                articles on the criminal justice system in The Guardian. The
In the past there were a number of crusading individuals and          Home Office confirm that underage youths will be used by
agencies that were prepared to advocate on behalf of drug users       police in sting operations to catch shops and pubs which sell
and campaign against the crude use of the criminal justice            alcohol to minors.
system. However, the government’s determination to appear             May: The Royal College of Physicians of Edinburgh calls for
tough on drugs, the contract culture and the increasingly             considerable extra resources to improve detection and treatment
political management of treatment services has made it difficult      rates for hepatitis C. The Observer claims that ‘soaring levels of
to publicly express disquiet at the drift away from a health and      cocaine use among young British professionals have led to a
social care agenda and challenge the effectiveness of the current     record number of deaths’. Drugscope reveals that police sniffer
strategy.                                                             dogs are being used regularly in more than 100 secondary
This increasing web of legislative complexity that is weaving         schools in England and Wales to search children for drugs. But
treatment and punishment so closely together is potentially so        ‘supermice’ may replace sniffer dogs: ‘He wears no mask or
destructive – particularly when the links between drugs and           cape, but America’s next super-hero could turn out to be a
crime may not be as straightforward as previously thought. The        genetically modified Mighty Mouse with a sense of smell
political imperative of sounding tough on drug use must not be        10,000 times stronger than normal.’ The Guardian editorial
allowed to undermine what we already know – that delivering           claims that obesity will soon supersede tobacco as the greatest
treatment in an atmosphere of fear is not as effective as in one of   cause of premature death in this country.
care.                                                                 June: A majority of people across all social classes back a
Whether we like it or not, for the foreseeable future, treatment      workplace smoking ban according to an ASH survey. The health
for drug users is going to be increasingly delivered via the          secretary, John Reid, says that smoking is one of the few
criminal justice system. Rigorous checks and balances that            pleasures left for the poor on sink estates and in working men’s
provide crucial protection to the some of the most vulnerable         clubs. British Airways is to test its 47,000 staff for drugs and
within this system are necessary. Indeed, they are the                alcohol, following embarrassing incidents in which pilots have
responsibility of a modern and caring society.                        been arrested for drunkenness.
Sebastian Saville – Director Why I left commercial litigation to      The effective strength of cannabis consumed in Britain has
work for Release decision to go, was proof that it was right. And     remained stable for the past 30 years, according to the European
so it has turned out to be. There could not be a more interesting     Monitoring Centre for Drugs and Drug Addiction. The Chair of
or challenging time to work as a lawyer in the drugs field. My        the Police Federation claims that there is still widespread
first year at Release has seen the introduction of the Anti Social    confusion about how to treat blatant cannabis smokers who went
Behaviour Act 2003, as well as the growth of the Drug                 beyond ‘acceptable behaviour’ in public.
Intervention Programme (formerly CJIP) and an increased               July: UK universities and the charity Cancer Research UK sign
interest in drug testing, not only in the context of criminal         a joint protocol on good practice for universities on the issue of
justice but also in the workplace and even in schools, not to         funding of research by the tobacco industry. A lottery winner
mention the reclassification of cannabis.                             who scooped a £9.7m jackpot is jailed for five months after
My work on the helpline and in our legal outreach services            breaching a drugs testing and treatment order. David Blunkett
brings me into daily contact with drug users and their families       warns that heavy drinking has fuelled a culture of ‘thuggery and
and friends. It allows me to witness firsthand the impact of          intimidation’. Research shows that 41 per cent of Britons
drugs and anti-social behaviour legislation on people’s lives.        support cannabis legalisation, but only 8 per cent endorse the
This encompasses a huge range of issues, from concerns about          view that adults should be free to take any drugs they wish. The
travelling to the United States because of a conviction for           Independent claims that ministers are considering a radical
possession of cannabis twenty years ago, to homelessness              scheme to vaccinate children against future drug addiction.
resulting from the closure of premises under the Anti Social          Guardian investigation discovers that the Ministry of Defence
Behaviour Act. These experiences inform Release’s                     has been buying a new stimulant in bulk.
commentary on changes in the law, whether through                     August: The US blames Britain’s ‘lack of urgency’ for its failure
government consultations or debate in the media.                      to arrest the booming Professor David Clark looks at how the
Our core role at Release is to provide expert help to callers and     popular press covered a range of issues related to substance use
clients who can’t get it elsewhere. Helping clients to resolve        and misuse.
problems such as debt and homelessness is central to harm             January: Cannabis reclassified from a Class B to a Class C drug.
reduction. Striving for excellence in our professional services,      Guardian survey reveals widespread confusion and
and treating our clients with the same degree of respect as would     inconsistencies about how the police will enforce the new law.
be accorded to a client of a commercial law firm, is another way      Tennis player Greg Rusedski tests positive for the steroid
                                                                      nandrolone – claims 47 other players had elevated levels. Report                                                                                    Page 4 of 8

claims that only one prison out of 138 in England and Wales has        tangible effect. Thieves escape with a phial of allegedly drug-
a recognised alcohol abuse programme in place.                         tainted urine from an Olympic gold-medal-winning horse.
February: The Scotsman runs a week’s worth of articles on              NTA officials are accused of misleading ministers and inflating
‘Alcohol: A National Excuse’. The country’s leading alcohol            the number of problem drug users in treatment programmes. The
experts not only dismiss Scottish Executive claims that alcohol        Duchess of Northumberland has been given permission to grow
consumption has remained stable for two decades, but                   drugs – cannabis, opium poppies, tobacco, coca plant – in her
emphasise the considerable problems arising from excessive             world famous public garden. The American ‘supercop’ brought
consumption in Scotland. The Observer editorial calls for reform       in by the Home Office to cut Britain’s crime rate warns that the
of women’s prisons, emphasising the problems of suicide, self-         nation’s binge drinking culture is spiralling out of control and
harm, drug abuse and mental health problems. Research in               fuelling an epidemic of violence outside pubs and clubs that
Glasgow casts doubt on the mental and physical tasks that police       threatens to overwhelm the police An underworld contract has
have been using for three years to try to crack down on what is        been taken out on one of the drug dogs operating at Manchester
feared to be an epidemic of drug driving. The average UK               prison because it has become too successful.
household spends more each week on alcohol to drink at home            December: BALCO boss Victor Conte claims he provided
than on fresh fruit and vegetables, according to the Office for        superstar athlete Marion Jones with a steroid and a variety of
National Statistics.                                                   banned drugs leading up to the 2000 Olympic Games in Sydney.
Tony Blair announces that schoolchildren will be subjected to          Medicines regulator decides there is no evidence that the class
random drug testing. The Guardian claims that recreational drug        of antidepressants known as SSRIs (selective serotonin reuptake
users are turning to a new generation of psychedelics, obtained        inhibitors) causes increased self harm, but says such drugs are
from the US via the internet.                                          too readily prescribed. Inquiry is criticised for looking at
March: A report by the Academy of Medical Sciences calls on            summaries provided by drug companies, rather than the full
the government to take immediate measures to cut drinking to           clinical trial data.
1970 levels. The report points out that per capita consumption of      The Guardian reports that giant coca plants found in Colombia
alcohol has risen by 50 per cent in the UK since 1970, whereas         are probably due to aggressive fertilisation or natural mutations,
in France and Italy it has more than halved. The Prime                 rather than being due to drug traffickers trying to develop
Minister’s Strategy Unit launches the longawaited Alcohol              genetically modified cocaine bushes. Next day, The Independent
Harm Reduction Strategy. A British Medical Journal editorial           reports that Colombian government officials claim that drug
calls it “the dampest of squibs”. Greg Rusedski cleared of taking      cartels have developed a genetically modified giant coca "tree"
the steroid nandrolone.                                                that produces eight times the usual cocaine crop and is capable
May Nov June Jan April March Oct Feb opium trade in                    of withstanding herbicides used by the anti-drug agencies.
Afghanistan. Kostas Kederis, the Greek athlete expected to light       Some quotes on the topic of the year: Alcohol ‘Household
the Olympic flame, and Katerina Thanou miss drug tests, fake a         surveys, which a lot of these statistics are based on, grossly
motorcycle accident, spend several days in hospital recovering,        under-report total alcohol consumption.
and then withdraw from the Olympics. Study reveals that one in         For one thing, the really heavy drinkers are never in when
50 people in three major English cities are injecting drugs. Same      researchers call – they are always at the pub.’ Johnathon Chick
study suggests that only one in four drug misusers are in              in The Scotsman ‘Scotland has had a problem for years but
treatment programmes. The Office for National Statistics reports       we’ve never really faced up to it. As a nation, we make excuses
4,767 deaths in England and Wales between 1993 and 2002                – it’s not our fault. All the characteristics of the individual
involving antidepressant overdoses. Around 80 per cent of these        alcoholic can be applied to the culture as a whole.’ Dr Stuart
deaths were recorded as suicides.                                      Hislop in The Scotsman ‘A strategic programme is needed now
September: Foreign Office launches a campaign warning of the           to curb the nation’s escalating level of drinking in the interests
dangers of becoming involved in drugs abroad. Survey suggests          of both individual and public health. The country has reached a
that one in four young women who regularly go to clubs and             point where it is necessary and urgent to call time on runaway
pubs had their drinks spiked last year. Six out of 10 women sent       alcohol consumption.’ Academy of Medical Sciences ‘Which is
to jail while they await trial are acquitted or given a non-           more dangerous: the new drugs on the block or the oldest drug
custodial sentence, a report reveals. Drugs charities accuse the       on the market? The British Crime Survey shows a mere 16 per
government of abandoning plans to set up a network of doctors          cent of violent acts by strangers are prompted by drugs; but 53
prescribing pure heroin to addicts. Study shows that Glasgow           per cent by alcohol. Similarly with domestic violence: 12 per
has at least 60 pre-teen heroin addicts, and there could be many       cent are drug-related, alcohol 44 per cent.’ Guardian editorial
more. Market research suggests that British women aged                 ‘Why then are we all so complacent? One reason is that it’s our
between 18 and 24 drink more than women of that age in any             favourite drug. Most people in England drink, and many of us—
other European country.                                                including prime ministers, journalists, judges, doctors, policy
October: Turning Point claims that a lack of joined-up services        pundits, and medical journal editors—like to stack it away.
in health and social care is costing Britain more than £7bn a          Righteous indignation about ecstasy is easy because we don’t
year. The General Medical Council resumes its hearing into             use it and don’t want to.’ British Medical Journal editorial ‘The
charges of serious professional misconduct against doctors             giants of the drinks industry must start sharing the risk that
writing prescriptions for people with a drug problem at a leading      alcohol poses with a share of their huge profits, to support those
private drug clinic. Conservatives claim that they will undertake      who become dependent on alcohol.’ Peter Martin, CEO of
a 10-fold expansion of drug treatment programmes. The                  Addaction ‘The problem with politicians, is that they want quick
Scotsman claims that Scottish jails will give heroin injection kits    results.
to prisoners to combat the spread of deadly diseases. In Scottish      But this is not something that can be solved quickly. It requires
study, almost 60 per cent of clients said the only thing they were     cultural change. Too often this government has looked like it’s
aiming for was abstinence from drugs, when they were asked             thrashing around looking for a solution.’ Ian Hutchison of
what change in their drug use they were seeking to bring about         Saving faces about alcohol From The Guardian: ‘I had watched
on the basis of coming forward for treatment. The scale of gun         British drinking levels rise throughout the 1990s with increasing
crime becomes a major concern in the press.                            alarm,’ recalls Griffith Edwards, professor of addiction
November: The communications regulator Ofcom brings in new             behaviour at King’s College, London. ‘I was very keen to have a
rules to regulate alcohol advertising. The Institute of Alcohol        more scientific discussion about alcohol. But the most
Studies claims that the rules are cosmetic and likely to have little   extraordinary process evolved.’ Edwards, together with fellow
                                                                       board members, argued that to counter the harm caused by                                                                                  Page 5 of 8

alcohol, Britain would have to reduce its overall consumption.       and liver cancer. On the basis of these statistics Hepatitis C is
‘The civil servants looked aghast. They said “no” and consulted      very probably the single greatest threat to the health of drug
other experts,’ Edwards says. Sir Richard Doll was solicited for     injectors in the UK that we face today.
an alternative view.                                                 Fifteen years ago the government and other authorities were
‘The alcohol-related cirrhosis figures are shocking,’ he says.       thrown into a panic at the possibility that HIV may spread
‘Drinking in moderation is fine, even good for you, but we are       amongst injecting drug users. To stem the possible spread of
drinking ourselves to death. Every scientific committee I have       infection the conservative government took what many saw as
ever sat on has concluded that reduction in harm caused by           the most radical decision of its period in office and authorised
drinking can only be achieved by reducing our overall                the development of needle and syringe exchange schemes
consumption. It just doesn’t work to target a minority. The only     throughout the UK. The boldness of that decision can be gauged
people I have seen recommend this is the strategy unit.” And the     from the fact that even today, in many states in the US, needle
quote of the year...                                                 and syringe services remain illegal.
‘It’s a big injustice, I have never used banned substances –         But how effective are needle and syringe services at doing what
honestly. All these people who crucify me on TV are the same         they were set up to do? Our lack of knowledge in answering that
people who wanted to be photographed with me after every             question is in part a result of the circumstances out of which
success.                                                             needle and syringe services were borne. These services arose out
But after crucifixion comes resurrection.’ Greek athlete Kostas      of a mixture of panic and campaigning enthusiasm on the part of
Kederis Sept July Dec July Aug                                       those championing the harm reduction approach. Needle and
                                                                     syringe exchange have become the very hallmark of harm
                                                                     reduction and in that regard have taken on a rather hallowed air.
                                                                     We simply ‘know’ that they are working and the only question
                                                                     that remains is one of whether they are giving out enough
                                                                     injecting equipment to enough people. Nevertheless the HCV
Shooting Up                                                          figures make uncomfortable reading in raising the possibility
                                                                     that our key approach to reducing the spread of blood borne
 well into the millions and there are calls for this number to be    infections amongst injecting drug users in the UK has failed to
increased even further.                                              reduce that particular harm.
We need to know how many of these needles and syringes are           I recently watched video footage of drug injectors ‘shooting-up’
being successfully returned, or safely disposed of, both             filmed by a research team led by Professor Avril Taylor from
nationally and locally, and we need to recognise the danger that     Caledonian University. The video footage shows drug users
discarded injecting equipment can pose in a situation of such        injecting in the most appallingly unhygienic circumstances and
widespread HCV infection.                                            sharing needles with a careless disregard for their own health
To be sure needle and syringe services face a daunting               and the health of others.
challenge. Are they expected to develop long-term relationships      Here was the answer to why HCV has spread so rapidly and so
with their clients or to respond to the rapid turnaround of the      widely amongst injecting drug users – and these were
client who wants to pick up injecting equipment and be on their      individuals living in a city with a long standing network of
way with a minimum of fuss? How far can staff who are giving         needle and syringe exchange services. Giving a drug user a
out injecting equipment be expected to also be encouraging drug      clean needle does not in itself reduce their risk behaviour. If we
users to move away from injecting? We have never really              ever thought that it did it was because we confused the clean
clarified what we expect our needle and syringe services to do       plastic packaging that the needle and syringe comes in with the
and for that reason alone we have probably undermined their          much tougher challenge of changing drug users’ risk behaviour.
effectiveness.                                                       We need to look closely at our needle and syringe exchange
We are facing a national crisis with HCV. It is a crisis which       services to find out what kinds of service they are providing and
over the next few years will see thousands of drug users             to assess how good they are at changing behaviour. We need to
progressing to serious and in many cases life threatening illness.   know whether individuals are being encouraged to inject more
It is also a crisis that has happened during a period when we        safely and to move away from injecting altogether. Needle and
have been more alert to blood borne infections than at any time      syringe exchange, however, is not simply about reducing
in the past. Reducing the spread of HIV has been rightly             individual harm but also about reducing harm to the wider
embraced as a massive achievement on the part of needle and          community. The number of needles and syringes being given
syringe exchange. HCV infection may come to be seen as a             out by exchanges is Time to look at needle and syringe
failure on a similar scale.                                          exchange? ‘These services arose out of a mixture of panic and
Shooting Up – Infections among injecting drug users in the           campaigning enthusiasm...
United Kingdom 2003 – An update, Health Protection Agency,           Needle and syringe exchange have become the very hallmark of
October 2004.                                                        harm reduction and in that regard have taken on a rather
Neil McKeganey is professor of drug misuse research at the           hallowed air.’
University of Glasgow How effective are needle and syringe
exchanges? Are people being encouraged to inject more safely –
and are they being encouraged to move away from injecting
altogether?, asks Prof Neil McKeganey The field of drug abuse
is full of shattering statistics. One of the most striking is the    Prejudice against users of heroin
finding that as many as 40% of problematic drug users within          People who misuse heroin and other drugs often present for
the UK may have contracted Hepatitis C infection.                    treatment with other problems, including health, social and
At the end of 2003 there were some 38,352 cases of Hepatitis C       criminal justice problems. They are often unemployed.
infection registered at the Communicable Diseases Surveillance       Helping heroin misusers involves more than helping them
Centre of which as many as 90% may have become infected as a         become drug-free. Aftercare is required to prevent relapse.
result of sharing non sterile injecting equipment. The true          Rehabilitation involves helping the person deal with the
number of drug injectors who are HCV positive however is way         problems that accompanies their drug misuse, including their
beyond that figure.                                                  lack of employment.
As many as 80% of those who have acquired Hepatitis C are at         The heroin using lifestyle is often portrayed in very negative
risk of developing serious health problems including cirrhosis       ways by the popular media and it is likely that many people                                                                                    Page 6 of 8

form a negative stereotype of the person who has used this drug.      considered to be responsible for their unemployment as it was
In fact, heroin users in treatment will often refer to the            considered not to be their fault.
prejudices they have experienced from other people. Such              These findings demonstrate a clear negative prejudice towards
stereotypes and prejudices can impact negatively on a client’s        heroin users and former users. Open-ended questions revealed
already fragile self-esteem, impairing treatment progress. They       anger towards these groups, whilst subjects associated these
are also likely to make it more difficult for heroin users and        groups with having a poor work ethic and poor family values.
former users to gain employment and be integrated (back) into         They were also perceived to threaten a range of factors (e.g. law
mainstream society.                                                   and order, family values) in British society. Heroin users and
Given the efforts that governments in the UK are making to            former users were considered to be responsible for causing and
integrate former problem drug users back into mainstream              solving their lack of employment.
society, it is surprising that so little attention has been focused   One of the most striking aspects of our research was the
on issues such as prejudice and discrimination. As far as we are      similarity in negative attitudes that people had towards former
aware, there has been no published research on these topics in        users of heroin, compared to current users of the drug. In fact,
relation to substance misuse.                                         we have also conducted research with people in a Welsh valley
We therefore initiated a research project to look at how              community which shows a similar prejudice towards a
prejudiced our society is towards heroin users and former users       hypothetical former user of heroin who had been in treatment
of the drug. We were also interested in people’s attitudes            for six months.
towards the employment of users and ex-users of heroin. Our           These findings emphasise the need for our society to take a
initial study was conducted in University students. For               serious look at the attitudes that many of us have towards people
comparison, we also looked at students’ attitudes towards             who have experienced problems with heroin. We need to
disabled people.                                                      enhance awareness and understanding of substance misuse – and
Each of 141 subjects completed a questionnaire containing open        increase compassion and sympathy – if we are to overcome
and closed questions which referred to either users of heroin,        these prejudices and facilitate the passage of former problem
exusers of the drug, or disabled people. Each experimental            drug users into employment and mainstream society.
group comprised over 40 subjects.                                     ‘One of the most striking aspects of our research was the
Subjects were first asked to indicate their general attitude toward   similarity in negative attitudes that people had towards former
heroin users, former heroin users and disabled people on a            users of heroin, compared to current users of the drug.’
thermometer-like scale ranging from 0 (extremely unfavourable)
to 100 (extremely favourable). Analyses revealed that heroin
users (23.0) and ex-users (41.5) differed significantly from the
neutral condition on the thermometer (50), with attributes being
unfavourable in each instance. In contrast, there was a
                                                                      Cannabis: One year on
significant favourable attitude towards disabled people (72.9).
Subjects were asked about their emotions and feelings towards
the three groups. The most prevalent emotion towards heroin            The doctor Dr Clare Gerada, Royal College of General
users was anger (56% subjects), followed by sympathy (29%)            Practioners’ drugs misuse unit Risks from cannabis are mainly
and pity (27%). Results were mirrored by the students’ views of       associated with long-term use – harm to the lungs for example,
former users, as anger (45%), compassion (29%) and pity (26%)         from smoking cannabis, either on its own, or with tobacco. It
were the most common responses.                                       can lead to acute and chronic bronchitis, lung cancer and asthma
In contrast, the most common responses of students towards            and is also associated with mouth, tongue and stomach cancer.
disabled people were compassion (48%) and sympathy (21%).             There are also the mental health risks, especially schizophrenia.
When subjects were asked their views of the ‘values and               The risks of schizophrenia are increased if a person is at risk
customs’ of the three groups, nearly half of the groups thought       from psychotic illness and if they begin to smoke cannabis from
that heroin users (45% of subjects) and former users (49%) had        an early age.
a poor work ethic. Only 12% thought this of disabled people.          The substance misuse worker Stacy Bunting, with the
The second and third most prevalent perceived values for heroin       Gloucester Youth Offending Service In the year since
users were poor family life/values (37%) and criminal activity        reclassification little has changed for young people using
(31%), whilst they were poor family life/values (35%) and poor        cannabis. The prices have stayed pretty much the same, quality
health (14%) for former users. These issues were of minimal           is the same (whatever your dealer tells you), generally it’s sold
relevance to subjects commenting on disabled people.                  using imperial measurements although I have come across some
Subjects were asked to rate whether members of the three              young people talking in metric.
groups threatened or promoted various factors in British society.     The law has made little impact. Most young people view
Heroin users and former users were deemed as threatening              cannabis to be the least harmful of all the illicit drugs, and ‘it’s
health, law and order, family values and personal safety, whilst      not as bad as drinking alcohol or smoking fags’. Some young
disabled people were seen as promoting these factors.                 people are allowed to smoke cannabis at home as parents feel
Surprisingly, ex-users were considered to Negative stereotypes        this is safer, or have parents who feel that it is not an issue.
of heroin users can interfere with their chances of successful        Most young people now seem to understand that cannabis is not
treatment. Prof David Clark reveals the results of research on        about to be legalised, but do not seem to care about being
attitudes to users and former users of the drug.                      caught. Young people are often surprised when they are arrested
Prejudice against users and ex-users of heroin threaten family        for possession (as they are under 18); they have the impression
values and law and order just as much as current users of the         any cannabis will confiscated and they will be cautioned.
drug.                                                                 For some, being arrested seems unfair and ridiculous.
Subjects were then asked their views on the unemployment and          Being arrested has not changed any attitudes.
future employment of the three groups. Both heroin users and          The politician Mo Mowlam, ex cabinet minister, speaker and
ex-users were considered to be responsible for their                  author Britain’s existing drug laws do not make sense. All the
unemployment and for solving the problem themselves. Subjects         drug legislation needs to be overhauled, but here I am only
also thought that it was not other people’s fault for heroin users    going to deal with cannabis.
and exusers’unemployment, and it was not up to others to help         Cannabis should be immediately legalised. And not just as it is
them solve their trouble. In contrast, disabled people were not       in the Netherlands. The whole trade needs to be legal from
                                                                      growth, processing, marketing and consumption.                                                                                     Page 7 of 8

It is very likely that most people reading this will have come
into contact with cannabis; either taking it themselves or
                                                                       Communicating to young people
knowing people that do. And most people will be aware that the          Haroon Riaz should know how to get through to kids.
types of people who take cannabis are very different, ranging          Having worked with 13 to 18-year-olds for the last three years,
from young teenagers who often take it because it is easier to         he has had time to work out what makes young people tick and
buy than alcohol, to respectable middle aged professionals.            has managed to attract response worthy of a Frank award for
Indeed it is not that unusual for parents to introduce their           good practice from the Home Office.
children to cannabis.                                                  Through schools, youth groups and nightclubs – in fact anyone
Cannabis is not seen by most people as a danger either to              who will listen – Riaz asks for a slot to put his campaign
themselves or to society.                                              message across. This might be through going into schools and
At the present time there is much discussion about binge               getting kids to compile a ‘drug book’, with facts and figures
drinking and the harm that excessive drinking is doing to our          about drugs and their harmful effects; it might be through
society. Alcohol however is legal.                                     offering to organise football. Whatever the format, the young
Cannabis is not, although it is certainly known not to have the        people can be reassured that the message will not be rammed
same adverse effects on society, in terms of violence both on the      down their necks.
streets and at home, and to Do people understand the law on            ‘We aim to give them structure – information on drug laws and
cannabis? Do they understand it’s not legal? Is it safe? Did the       harm reduction messages,’ says Riaz. ‘The information is real
law go far enough? DDN asked for views, a year on from its             and they can make an informed choice.’ A tier 2 service, the
reclassification from a Class B to Class C drug.                       ‘keep it real’ programme is funded by the community and safety
one’s health as alcohol. But there is no serious call for alcohol to   partnership of Atcham borough council. Riaz says he got the
be made illegal. The example of what happened in the United            inspiration for his activities by talking to young people and
States when they tried prohibition in the nineteen twenties is         thinking about the local area.
sufficient to dissuade anyone from advocating such a policy.           ‘Shrewsbury is a big place with plenty of music clubs where the
The problem with all drugs, and this includes alcohol and              kids hang out. We pioneered clubs doing a lot more with local
cigarettes, is that their existence is demand driven. It is because    youth.’ What the kids don’t know, when they travel from miles
someone wants to buy them and consume them that they are               around to see a band or DJ, is that the supporting act will be
supplied. And if they are not supplied legally, then there is          Haroon Riaz and a quick ‘keep it real’ talk.
sufficient money for their supply to take place illegally. This is     ‘The nightclub has been packed within 10 minutes with another
particularly the case with such hard drugs as cocaine and heroin.      couple of hundred outside waiting to get in,’ he says. ‘They
But cannabis is slightly different; it is supplied illegally but is    don’t realise until they get there that they’re going to have a
not a drug of great interest to professional drug dealers. There is    drug awareness evening.’ The delivery might be fun, but the
not enough money in it.                                                message is deadly serious, according to Riaz, who mentions a
Much is grown at home. Indeed the usual distribution system for        girl of 13, who is ‘snorting cocaine already’. He has to appear
the drug is through regular users buying more than they need           nonjudgemental about her choice to become involved in drugs,
and then supplying it to their friends. The truth is that very many    he says, but encourages her to talk about why she takes the drug
otherwise respectable people are drug dealers.                         and discusses the effects. It’s not easy to make somebody that
This is an absurd situation. An activity, which is very common,        young realise the harm she’s doing to herself, but hopes that the
much enjoyed and relatively harmless, is made illegal. Why?            messages are taking root. It’s a step in the right direction, he
The main reasons advanced are that cannabis is harmful to our          believes, to welcome her to information sessions, knowing that
health and therefore should be banned. This is hardly consistent       any revelations are protected by a confidentiality clause.
with are attitude to other activities that people do for enjoyment,    If peer pressure works all too strongly to get young people into
skiing or playing rugby for example. Both can result in                drugs in the first place, Riaz enjoys harnessing it to get them
considerable physical harm but we would not consider banning           involved in group activities, whether sports, theatre or music. A
them. Why then ban cannabis? But the principal reason for drug         particular local success, and one which attracted the attention of
legalisation is not to make a libertarian argument, it is how to       the Frank award, was a community outreach project that
best manage a human activity that we cannot stop, in order to          captured the imagination of ‘a load of kids who hang around on
benefit the individual and society. In the case of cannabis,           street corners’.
making criminals out of large numbers of otherwise law abiding         ‘We asked them what they wanted to do,’ says Riaz.
citizens makes no sense. Let’s make it legal, tax it and use the       ‘They said they wanted to cut a CD. So we teamed up with
revenue for something more useful than drug dealers’ profits.          Soundscape music studios. It was expensive – but very popular.’
                                                                       The expense of incorporating drug awareness messages into the
                                                                       music sessions was worth it, he believes. After the sessions, kids
                                                                       would go onto the drug awareness websites at a rate that amazed
                                                                       A heartening spin-off for Riaz, has been the calls he’s had from
                                                                       other areas of the country, asking for hints on staging similar
                                                                       ‘Inner city projects call up all the time. They’re still working on
                                                                       their strategies,’ he says, crediting the autonomy of being the
                                                                       project’s ‘one man band’ as the source of his momentum, as
                                                                       well as the root of a lot of hard work. He can do in weeks what it
                                                                       might take bigger organisations to do in years, he says, just by
                                                                       picking up the phone and offering a bespoke service that will
                                                                       work well in a particular environment.
                                                                       Riaz is equally keen to spot mutually beneficial partnerships,
                                                                       teaming up with trading standards to help prevent the sale of
                                                                       cigarettes to underage smokers and offering a message to young
                                                                       people that would otherwise fall on deaf ears.                                                                                    Page 8 of 8

The offer of a communication network has certainly caught on,         substance use using recognised theoretical models " Help
with an increasing flow of referrals from social services, schools    individuals address their substance use through an action plan "
and youth services.                                                   Counsel groups of individuals about their substance use using
‘We don’t have to do much advertising now,’ says Riaz, who            recognised theoretical models.
began by sending out flyers to attract attention.                     For details of local centres offering the NVQ/SVQ in Health and
A key success factor must surely be Riaz’s enthusiasm for the         Social Care level 3, contact the relevant awarding bodies: " City
project, spurred on by his surprise at its momentum.                  and      Guilds         "      Edexel
‘When I go down town now, I’m greeted by parents of the kids " SQA In the second of
we’re helping,’ he says. It makes me realise we’ve done much          our series to give a working knowledge of the Drugs and
more than I thought we could.’ Keeping it real Providing a fun        Alcohol National Standards, Trevor Boutall explains DANOS-
way of learning is the only way to get messages across to young       based qualifications.
 people, says Haroon Riaz of the ‘keep it real’ drug awareness        Federation of Drugs and Alcohol Professionals Accreditation
project in Shrewsbury.                                                Following a pilot process at the end of last year, the Federation
‘A particular local success, and one which attracted the attention    of Drugs and Alcohol Professionals (FDAP) is about to launch
of the Frank award, was a community outreach project that             its new Professional Certification scheme, which is also based
captured the imagination of a load of kids who hang around on         on DANOS, but goes further than the NVQ/SVQ.
street corners.’                                                      To become a Certified Drug and Alcohol Professional,
                                                                      practitioners will need to demonstrate their competence in 10
                                                                      core DANOS units. The first four of these are identical to the
                                                                      NVQ/SVQ core, the additional six being: " Relate to, and
                                                                      interact with, individuals " Promote the equality, diversity,
                                                                      rights and responsibilities of individuals " Support individuals
Drugs    and     Alcohol                            National          who are substance users " Assess and act upon immediate risk of
                                                                      danger to substance users " Make use of supervision " Carry out
Occupational Standards                                                assessment to identify and prioritise needs.
Credit for competence DANOS – the Drugs and Alcohol                   To be certified under the scheme, practitioners will also need to
National Occupational Standards – describe the standards of           demonstrate they are competent in at least one additional
performance expected of all those working in the drugs and            specialist unit, selected from a choice of a further 14 DANOS
alcohol field and the knowledge and skills they need to be            units.
effective in their work. They can be downloaded free of charge        For more details of FDAP’s Drug and Alcohol Professional
from                                                  Certification scheme, contact FDAP at .
Over the past year and a half, Skills for Health has been working     Other DANOS-related training and qualifications There are over
closely with the National Treatment Agency for Substance              300 training courses and qualifications linked to DANOS on the
Misuse (NTA), the Drugs Strategy Directorate (DSD), Alcohol           Learning Resources Database on
Concern, DrugScope, the National Assembly for Wales,                  Most of these focus on developing students’ underpinning
educationalists, employers and service users to develop a             knowledge and skills, rather than assessing whether they can
strategy to give credit for competent performance to DANOS            actually perform competently in the workplace.
standards through nationally-recognised qualifications.               However, a number of Higher Education Institutes (HEIs), such
National and Scottish Vocational Qualifications (NVQs/SVQs)           as Bath, Leeds and Leicester universities, are currently
The first of these qualifications, just launched by awarding          exploring ways of integrating the assessment of workplace
bodies like City and Guilds, Edexcel and the Scottish                 performance into their substance misuse qualifications, and the
Qualifications Authority (SQA), is the NVQ or SVQ in Health           National Open College Network and the NCFE awarding body
and Social Care level 3.                                              will be reviewing their drugs and alcohol qualifications this
This qualification can be widely used across the health and           year.
social care sectors as a certificate of competence. It is ideal for   2005 will see a growth in the choice of DANOS-based
those working in the drugs and alcohol field who do not hold a        qualifications suitable for practitioners at all levels, including a
professional qualification.                                           new Continuing Professional Development Award, being
Experienced staff will not need to do extensive training – they       developed by Skills for Health in partnership with awarding
will find that, through the NVQ/SVQ, they can get accreditation       bodies, to help those with professional qualifications but no
for their prior experience and learning.                              experience in the substance misuse sector quickly to get up to
All candidates, wherever they are working, are required to take       speed and prove they can work competently and safely to meet
four common core units: " Promote effective communication for         service users’ needs.
and about individuals " Promote, monitor and maintain health,         Next Month: DANOS-based Recruitment, Development and
safety and security in the working environment " Reflect on and       Retention – the Middlesbrough Experience.
develop your practice " Promote choice, well-being and the            ‘There are over 300 training courses and qualifications linked to
protection of all individuals (those working with children and        DANOS on the Learning Resources Database...
young people take an alternative unit: Promote the well-being         Most of these focus on developing students’ underpinning
and protection of children and young people).                         knowledge and skills.’
To complete their qualifications, candidates select four optional
units – from a choice of 40 DANOS units – which are most
appropriate to their work role.
A project worker, for example, might choose the following
units: " Support individuals who are substance users " Assess
and act upon immediate risk of danger to substance users "
Carry out assessment to identify and prioritise needs "
Contribute to planning, monitoring and reviewing the delivery
of service for individuals.
A counsellor, on the other hand, would choose a different set: "
Contribute to planning, monitoring and reviewing the delivery
of service for individuals " Counsel individuals about their

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