AS Neil McKeganey and Jim McIntosh rightly emphasise in their essay (September 18), helping heroin addicts to break their habit is often ''fantastically difficult''. Most need an enormous amount of assistance to overcome the huge disadvantages created by their years of addiction. While it is essential to have services that can help addicts stop taking drugs altogether, the vast majority are simply not ready to take such a big step.
This largely explains why, in Glasgow and elsewhere, the commonest treatment for heroin addicts is currently a daily dose by mouth of the heroin substitute, methadone. Most people on methadone have already tried repeatedly to come off heroin and failed. For them, it is either methadone or chaos.
Few doctors prescribing methadone are under any illusion that, in itself, it is a cure for heroin addiction. It is, however, the most successful means we currently have of helping many heroin addicts to extricate themselves from the crazy treadmill of stealing and buying and using drugs which can totally dominate and ultimately destroy their lives. While on methadone, many regain control over their drug use and recover their health.
They then have the time and possibility to rebuild their lives. This may involve breaking away from their addict friends, developing new interests, learning new skills and finding a job. Easy to say, difficult to do.
Where McKeganey and McIntosh totally miss the point is in their prescription of employment and better housing as alternatives to methadone. Nothing could be further from the truth. They are complementary.
Housing departments, hostels for the homeless, social work services, and most drug projects strongly support the methadone programme precisely because it enables them to work far more successfully with clients, disentangle their problems, and help them to enrol on college courses, arrange tenancies, and prepare for work. Trying to do this with a chaotic drug user is virtually impossible.
The prescription of employment and better housing for stabilised and recovering addicts is in fact a key part of the Greater Glasgow Drug Action Team's Strategy, launched last month. (McKeganey is himself a member of the team.) Considerable efforts are now being made through the Government's New Futures and New Deal schemes and other initiatives to give stabilised or recovering addicts the opportunities to enter the world of legitimate work.
But at present the number of places on these schemes is tiny compared with the hundreds who might benefit. Much more needs to be done by central and local government and the business community to give addicts the prospect of a tolerable future without drugs.
There is unequivocal evidence of the short to medium-term benefits of methadone, when properly used. Further research into its long-term impact is indeed needed. However, it is already clear that whether or not people on methadone succeed in coming off drugs depends on many other factors such as self-esteem, optimism about the future, and a sense of having a stake in society. We can prescribe, but can we deliver?
Dr Laurence Gruer,
Consultant in Public Health Medicine,
Greater Glasgow Health Board,
350 St Vincent Street, Glasgow.
September 24.
YOUR front-page article (September 22) about the 107th drug-related death in the Strathclyde area poignantly drew attention to what has now become nothing short of an annual cull of young people in Scotland.
I use the word cull carefully as every one of these deaths could have been avoided if the Government had the courage to implement harm reduction policies treating heroin addiction as a medical illness, not criminal activity.
It is tragically ironic that the following day's edition of BBC Online reported the successes in Switzerland that have been made in stabilising the lives of a thousand heroin addicts there through a carefully monitored programme of prescribing pharmaceutical heroin free to registered addicts - a policy so effective that in a national referendum in 1997 it was endorsed by an overwhelming majority.
Drug deaths among those addicts on the programme are at zero as they have no need to use black-market heroin with all its impurities, unknown strengths, and destructive criminal lifestyle. If this type of programme had been implemented in Scotland nearly all of these107 young people whose lives are tragically over might still be alive today.
This makes it all the more galling that unrepresentative individuals such as Maxie Richards and Gaille McCann of MAD - who regularly receive space in your publication to spout ill-informed nonsense against harm-reduction programmes - are paraded as if they are representative of those among us who want to see something effective done to help heroin addicts and the communities they live in.
In the future, as the drug death toll inevitably rises because of Government inaction, let's hear the voices of sanity and reason on this issue rather than the usual chorus of hysteria, prejudice, and political opportunism.
Kevin Williamson,
Drugs Spokesperson,
Scottish Socialist Party,
17-23 Calton Road, Edinburgh.
September 24.
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