The voices of heroin users

Published October 2004

Partially published in The Guardian, October 2004

In a case that may prove to be a turning point in the treatment of Britain’s blackmarket drug addicts, the General Medical Council is due today to resume its hearing into charges of serious professional misconduct against every prescribing doctor at one of the country’s leading private drugs clinics.

The hearing – the biggest in the history of the GMC – pits hard-liners from the NHS and the Home Office against seven private doctors from the Stapleford Centre, including its founder, Dr Colin Brewer, his recently retired deputy, four full-time doctors and one who no longer works there. If they are found guilty, the clinic which cares for more than 200 addicts in London and Essex, is likely to close. The hearing opened in February but was stalled when Dr Brewer, aged 62, fell ill.

The Guardian has obtained letters from scores of Stapleford patients, written earlier this year as the threat to their clinic became clear. Some are middle-class professionals – company directors, shop owners, a chartered accountant, several journalists – while others were born and remain in poverty. All are long-term addicts. In the noisy debate about drugs, these are the silent voices.

Here, for once, they speak out – about being forced into crime and prostitution to find money for their drugs, about the harsh and humiliating world of National Health drug clinics, about their extraordinary revival once they finally found specialist private doctors who knew how to care for them and, above all now, about their alarm at the prospect of this care being stolen from them by the GMC, forcing them back into the hazards of the black market. Collectively, these voices are a chorus of condemnation for this government’s drugs strategy. As one veteran heroin user, with a 30-year habit, writes: “There are many injustices in this society, but every now and then, one comes across one so immense, so unfathomable and so wrong that it leaves you gasping.”

A single letter from a man in Essex captures the outline of the story: “I am 49 years old, and for the past 20 years, have been addicted to opiate drugs. I suppose I can only blame myself for this state of affairs and have had to take desperate measures to keep myself from the awful state of withdrawal of drugs.  I have worked hard to support my habit and yes, from time to time, have broken the law to alleviate the terrible suffering with which I have been afflicted. From being a street junky in Amsterdam in the beginning of the 1980s, I have lost all my veins from injecting and suffered every indignity and gone without food, clothing, shelter in order to buy my next fix. I’ve been arrested, jailed, beaten up, stolen from.”

He describes how the NHS denied him effective treatment. “Then I found Dr Brewer (founder of the Stapleford). I’ve been attending his centre for eight years approx. I now own my own house, in a quiet small town. I have two cars, am married with two children, who are doing well at school, I haven’t missed a day’s work except for minor illness for eight years. I don’t know any drug people any more. My hair tests have always been negative. And all this I owe to the Stapleford doctors.”

Addressing himself to the GMC and the government, he writes: “I was once irresponsible. Must I and my peers pay for the rest of our lives for this? Must these caring doctors suffer punishment? Please, sirs, let us addicts be treated as individuals without the constraints of the state tying their hands. Give them the freedom to do their jobs. They are the experts, they have no ulterior motives except care. I know what it’s like to be hounded by the state. Please, please I implore you drop the charges and let them carry on doing what they do best – helping.”

The letters describe how the Stapleford doctors prescribed patients either the drug of their addiction – heroin, amphetamine or codeine – or  an approved substitute, such as methadone for heroin or dexedrine for crack. This regular ‘script’ became the key to a new life, as one patient explains: “The only way for me and others like me to live normally is to find a solution to the continual, unchanging, all-encompassing need for a daily fix of drugs. When this need is granted by a script, it bestows the gift of stability and gives rise to many possibilities. I am able to work, cook, pay my daily bills, read, write, paint and enjoy my life. Take away the regular security and stability of a script and an instant collapse is precipitated. The only reality, the only need, the only concern is for the drug. All else takes a place so far behind as to be virtually out of sight. This is why men and women lose their children, their integrity, their jobs and their homes and why many end up in prison.”

By contrast, the most common and the most passionate theme of the letters is the failure of the National Health drug clinics to offer this kind of long-term ‘maintenance prescribing’ in a form which allows users to leave the black market and build new lives. They describe how the NHS clinics impose a ceiling on the amount of methadone which they will prescribe, thus pushing users back onto the blackmarket; how the clinics generally expect the user to rapidly reduce their dose even if they are not ready, will cut off the prescription if the patient is caught using other drugs or breaking any clinic rule, and frequently will supply only 24-hour prescriptions, so forcing users to visit the clinic every single day, preventing them working and compelling them to stay in touch with other users.

The letters speak of repeated NHS failure: “I am 40 this year and over the decades have seen many friends fail or die due to inadequate maintenance from NHS clinics… Most of the doctors who scripted me would only give me 150 mg of methadone for fear of being struck off. I was using far more than this…. I was being reduced which I couldn’t cope with. This led me to buy ampoules of methadone on the black market. This put me at risk of arrest which soon followed… They will not be flexible with their drug policies, hence they cannot or will not treat me.”

They speak too of humiliation in the NHS: “I was made to feel like the backside of society…… I’m not really sure why the counsellors at this clinic were there. Perhaps being able to bully and belittle people in some way gave them some sense of power….Not even alcoholics are treated with the same disdain even though their illness is essentially the same.” A woman who was addicted to codeine describes how she queried the treatment which an NHS doctor was suggesting. “He said ‘Well piss off and don’t waste my time then.'”

A mother writes about her son’s experience in the ‘revolving door’ of the local NHS clinic: “He was given a dose of methadone for daily maintenance, but it was not enough to quell  his cravings, so he was using heroin too. When he failed their drug tests, his methadone was withdrawn in a draconian manner, and the dealers had their client back. The only one winning in this situation was the dealer.

“In desperation, I sent him to a clinic in America, based on the Narcotics Anonymous 12-step programme. He left within a week. I put him in the Priory to be detoxed. He was back on heroin within days of leaving. His habit escalated, and his behaviour at home became intolerable: jewellery, cash, cameras, anything of value was stolen to be sold for drugs. This behaviour caused chaos in our lives, particularly for his younger brother. I felt I had no choice but to ask him to leave home, but I did so with a knife in my heart. I was terrified that he would die from heroin or neglect his diabetes regime, but I was torn beween the needs of my two sons. I would have crossed the road to avoid him because he looked what he was – a hopeless drug addict. We wept together because we could see no way out.”

She says her son was diabetic: “It seems to me that addiction is the only area of medicine where the patient is penalised for a worsening condition. No doctor ever suggested that he should have his insulin withdrawn and be made to feel a total failure if he could not control his diabetes.” Another parent considers the government’s claims to be offering treatment for all users: “As anyone who has an addict in the family will tell you, these plans are pie in the sky.”

Against this relentless picture of NHS failure, the letters paint portraits of success for those who reached the Stapleford and were given stability: the chartered accountant who had lost his job, spent three years in prison and another six in chaos but who is now running his own company and about to get married; the man who first used heroin while serving a nine-year prison sentence and then went back to prison for drug-related crime and is now working, looking after his children and has stayed out of trouble with the law for four years.

Men and women who were chaotic are variously “now training as a mortgage advisor… now working as a local government civil servant…  just got a 2.1 at university…. now a qualified psycotherapist… now earning £40,000 a year… now  working as a manager for a computer company.” Some have used counselling and detox implants to stop all drugs. Others are on long-term maintenance prescriptions, gradually cutting their doseage as their strength returns. An amphetamine addict who is now stabilised, writes: “I cannot believe that four months ago, I was looking for a piece of tubing which would fit over my exhaust pipe, and writing farewell notes.”

And yet, these same patients now speak of disaster as they wait to see whether the GMC will judge the Stapleford doctors under the strict rules which restrain the NHS clinics, or by the wider test of whether or not they have acted for the health and welfare of their patients. “The prospect of changes at the Stapleford centre are totally distressing for me. As well as being detrimental to my physical well being, mentally it is freaking me out. I have nowhere else to turn.”

A journalist writes about her partner: “He, like all long term users, is too old to suffer the pain of cold turkey – he has spent too many years with artificially high endorphin levels. The near torture of withdrawal plus the loss of his chosen support network could only trigger a morale collapse of a degree where his returning to street drugs would seem almost sensible – certainly it would hardly make him feel worse about himself and his future, merely underlining his sense of failure and alienation.”

Several women agonise about what will happen to their children if they are forced back onto the blackmarket, with its risk of illness and imprisonment. “I’m so terrified of losing my script. I can’t see a future. Is my future on street drugs? I’d rather die than go back on crack. I cannot imagine how much street heroin I would need just to stop withdrawal. I wish I was articulate.”

One user voices the thought which recurrs through many of the letters: “I am now at my wits’ end. Every night when I go to sleep, I do not wish to wake up, hoping to die peacefully in my sleep. I have tried to commit suicide several times in the past, but knew it was a selfish thing to do to my son, but if I am to be thrown into the abyss of scoring illegal drugs, I feel that death is the only choice left to me.”

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