Thursday 14 April 2011

The Great Heroin Crash by Peter Simonson

  • Five month drought the longest on record
  • Purity drops to record low from 32 per cent to 13 per cent
  • Rogue high purity batches may already have triggered several overdose deaths, as treatment services around the country brace themselves for more fatalities.
EXCLUSIVEBy Peter Simonson and Max Daly

A snapshot Druglink survey carried out among frontline drug services, senior DAT staff, police and service users in 18 towns and cities across the UK has found the heroin drought is widespread, ongoing and the most severe of its kindon record.All areas covered in the survey – Penzance, Torbay, Bristol, Cardiff, London, Canterbury, Birmingham, Manchester, Liverpool, Stoke, Sefton, Manchester, Redcar, Leeds, Middlesbrough, Newcastle, Blackpool, Glasgow and Edinburgh –reported that street heroin was of an unusually low quality. According to unpublished figures gathered by the Forensic Science Service, the average purity of street heroin is the lowest since 1984. From an average purity of between 30 and 40 per cent over the last 26 years, heroin seized by police on Britain’s streets plummeted to 13.6 per cent in December and 13.1 per cent in January. By February it rose slightly to 14.5 per cent. In most places the drought began in October last year, accelerated in December and is still present. In some areas, batches of good quality heroin have appeared and may have beenresponsible – because of users’ reduced tolerance levels – for drug-related deaths.
Police believe that three heroin users who died in the space of one hour in eastLancashire may have overdosed on the same batch of high purity heroin. Therehave also been six reported heroin related deaths in the last two weeks of February in Ireland, where a drought has also hit.Across the board, those working with heroin users have expressed concern over the vulnerability of drug users when, and if, the current drought lifts. Many services have put up posters warning of the risks of overdose. Most users have continued to useheavily cut heroin while compensating for this by ‘topping up’ with illicit tranquillisers, pharmaceutical opiates, alcohol and stimulant drugs such as speed and crack cocaine. In London crack has been offered by dealers at bargain rates alongside poor heroin to attract customers.Figures released in February by drug testing firm Concateno, revealing thatpositive tests for heroin had dropped among users in treatment by morethan 50 per cent in the last year, were matched by test on arrest figures inLancashire and Cleveland, which showed similar dramatic falls. The use of illicit diazepam has, increasingly since the start of the heroin drought, become a major problem in some areas. In Stoke on Trent there have been two reports of heroin usersinjecting nail varnish remover. A detailed intelligence report into the drought’s impact, compiled by Cleveland Police over three months, found that during the drought, which began with an almost total disappearance of heroin in October last year, positive test on arrest figures for heroin nearly halved, while the numbers doubled for cocaine andcrack cocaine. Drug-related deaths averaged between zero and three a month inCleveland up to November last year, when the figures jumped to eight deaths and six deaths in December. The report, seen exclusively by Druglink, said the average heroin purity was 21 per cent and there has been no increase in people going onto methadone programmes. Although Cleveland police, believed to be the only force to carry out such an investigation, were expecting a rise in crime in the area as users needed to find more money to get the drug and dealers battled over good batches of heroin, burglary, violence and theft have fallen. There have been none of the expected raids on pharmacies. The report said some users travelled outside Cleveland, to other areas such as Northumbria, to seek out better quality heroin. Cleveland Police said that high end dealers in the area were cutting their product as a result of having to pay higher than usual wholesale prices. Dealers have chosen to ride the drought out rather than offer their customers alternative drugs because, the report says, they did not have time to source new product lines. But Det Insp Paul Tait, who compiled the report, said he believed that Cleveland was moving out of a drought situation because heroin purity was on the up and the latest test on arrest figures had shown a rise in heroin positives. He added that dealers were likely to keep purity as low as possible because they now realise most users will continue buying it at the same price as higher purity heroin. The Druglink survery found that many areas described the heavily cut heroin as reddish in colour, and when it is smoked, smells of TCP . It doesn’t ‘run’ as normal street heroin does. When prepared for injection, the heroin crystallises and coagulates when it cools, blocking the needle. A press release in February issued by the drug testing firm Concateno revealed that positive tests for heroin by users attending treatment services across the UK had dropped by more than 50 per cent in the last year. Druglinkresearch has revealed that it is likely a significant number of those negatives did not mean that people are no longer using heroin – they may have usedsome of such low purity that it did not register within the test’s parameters. Kath Tallboys from Blackpool’s Drugline charity, who had reports of poor quality heroin from November, stated that this was corroborated by test on arrest statistics from the local DIP which showed a lower level than normal of heroin positive samples. A number of areas in our survey reported clients who were turning up for services after having used heroin and testing negative. Michael Linnell at Lifeline in Manchester had heard of users presenting to services wanting to get onto some form of prescribed treatment and being refused as they’d tested negative for heroin use despite claiming to have used the day before. In Tower Hamlets, a current service user claimed to have used £60 worth of heroin the previous day and still tested negative.The investigation found little evidence of the expected increase in users accessing treatment services, whether they are offering methadone and Subutex or rehab and detox. A senior drugs worker from an agency covering the south coast of Englandstated: “Contrary to expectations, we haven’t seen a deluge of people seekingtreatment because they can’t get gear.” David Prescott, the senior practitioner atLifeline in Manchester, said that “despite the ongoing promotion of detox and treatment, there has been no noticeableincrease in referrals”. This was a situation also seen in Merseyside and Staffordshire. Peter Sheath, of CRI , who manages two largeprescribing services in Sefton and Stoke on Trent, said there had been no increase in users coming onto scripts. The absence of an increase was also notedin Southwark and Camden in London, Torbay, Blackpool, Edinburgh and Cardiff.In Leeds and Bristol drug services experienced falls of around 50 per cent in the number of syringe packs and foil handed to drug users. There were exceptions. Cliff Askey,service manager at Lifeline in Tower Hamlets said the service saw an increasein people attending prescribing services of 40 per cent from October and stated thatthe neighbouring borough of Hackney had seen big increase in new clients wantingto access prescribing services.But the usual networks of information among users about ‘good’ heroin dealershas in some areas broken down, as some buyers are keeping this informationclose to their chest. This makes it harder for drug services to access important knowledge about the arrival of higher purity batches of heroin. Services are bracing themselves for a spike in heroin overdoses and deaths when, or if, purer heroin makes its way back to UK streets after users have become less tolerant tothe drug,Jill Cole of Cardiff Community Drug Team told of the increased use of black market diazepam pills, branded as ‘MSJs’ and thought to be from south east Asia. “We think these pills may have been responsible for a number of recent local deaths in Cardiff, initially thought to be heroin overdoses, but the use of naloxone by emergency staff had no effect. These pills vary in strength and appear to make people aggressive and black out more often than diazepam. And due to their low price and easy availability, users are taking them by the handful. The service user group in Cardiff is so concerned about the use of MSJs they are producing a warning poster,” said Coles. There has also been increased use of street tranquillisers in the North East, where one brand has been given the street name of ‘charge sheets’ for the propensity of the drug to cause black outs during which users wake up to find they’ve been arrested for some unknown crime. The drought meant that users were swallowing 20-30 10mg tablets after using heroin. Several services said that the drought had been a positive thing for some drug users, who have become so fed up with the poor quality goods on sale that they have ditched street heroin and stabilized on methadone and Subutex.



WHA T SPARKED THE DROUGHT?There are several theories – pinpointing causes from the productionend of the heroin trail in Afghanistan to the distribution side managed by high level dealers in the UK – as to why Britain is experiencing this dearth in heroin.Poppy BlightThe UNODC reported in May 2010 that opium production would be severely affected by a poppy blight affecting most of the major poppy growing areas. The fungus, macrosporium papaverus, causes capsule rot, resulting in little to no opium latex being available for extraction by farmers. However, a shortage of heroin has not been notedin other countries across Europe.EnforcementSO CA have said that recent law enforcement operations against heroin wholesalers in Turkey and the dismantling of UK distribution networks had had a considerable impact on the amount of heroin entering the UK reported. SO CA accepted that other factors, such as the blight, may also be involved.StockpilingThis theory argues that there is not a production problem, but that wholesalers are stockpiling heroin to increase the price within the UK. Price of heroin has dropped lowerthan any other drugs over the last ten years.Russian marketThere is a market of upwards of three million heroin users in Russia who pay more per gram than in Britain. Also, the logistics of getting the drugs to Russia are easier. Why face the trouble of getting heroin to the UK for so little return when you can export direct to Russia over a porous border?


Used with the permission of Druglink the magazine of DrugScope, who first published the article: www.drugscope.org.uk

Saturday 12 March 2011

Models of Compliance

 by By Alex Boyt
Alex Boyt on how the treatment
system is failing those most at risk, and
the potential dangers of the recovery
agenda in the current climate
MODELS OF
COMPLIANCE?

I SAT IN A MEETING RECENTLY – various
players, not much said, a few providers
reassuring the NTA by talking about ‘the
need for an overarching strategic body’
and the NTA talking about replacing
models of care with something not
called models of care. When I
complained about clinical guidelines
both protecting and strangling effective
intervention, a couple of people made
noises to humour me and someone said
the word ‘recovery’ was very unhelpful –
a few people including me nodded while
the NTA made ‘taking this on board’
movements and wrote something down.

A while back I read something
about the recovery agenda being hijacked by abstentionists and a pal of mine
working in another part of England said there was a battle for recovery credibility
between the local 12-step agency and the major prescriber.

Let me tell you a story. It was 1999 and I was on a script, about 70ml of
methadone a day that I took home from the chemist with daily pick up. I didn’t
 want methadone – nasty habit, harder to kick than gear – so I didn’t take it much, putting it in lemonade bottles under the sink. Twice a week when I couldn’t get the gear Ineeded I took a swig out of the bottle and my partner, who was pregnant,
 had the odd swig too – she didn’t want a script for fear of having our baby taken away.

We sold a bit or gave a bit to mates and we ticked along ok. The service kept drug
testing me, I couldn’t give a clean sample, and they kept putting my script up – 80,
90, 100, 110ml. They thought that if they gave me enough it would somehow have
the effect of crack and smack and I wouldn’t use on top, then they got fed up.
 It wassupervised consumption and I was taking 110ml a day that I didn’t want and didn’tneed while my partner had nothing. I disengaged with services and didn’t
 go back,my behaviour got wilder and more desperate, and I ended up in jail again.
A few years later I wanted help. I’d had enough, so I went to my family. They
had a few quid and got me into a rehab in days. I staggered in, having given my
flat to a dealer, and arrived in the middle of very chaotic using. My detox started
at 80ml – the timing was right and I’ve done ok since. What does all this prove?

Nothing much, I guess.

I read the other day that the number of drug-related deaths has gone up over
the last five years. Some people expressed surprise but I didn’t. The drug
treatment system has grown and it has stabilised and retained hundreds of
thousands, even getting a few abstinent – shouldn’t knock it, really. About 50
per cent in treatment, but which 50 per cent – those most at risk? I doubt it.

In my work I talk to a lot of service users and in other parts of my life I know
users and ex-users. I’m not a researcher but I hear a lot of stories and some
undeniable patterns are glaring at me – the more dangerous your using, then the
less likely services are to engage you.

Take alcohol, methadone and dispensing clinics. You rock up for your daily
dose, you’ve had a can or two to get you out of bed and you get breathalysed –
too dangerous to give you your methadone. Better go buy some gear and have
a hit – that should be safer. Another scenario is you’ve been in services for a
while and managed to convince them you’re stable – they test you, catch you out
and you’re back on daily supervised consumption for your own safety. With the
ritual daily humiliation, you drop out of treatment.

Or maybe something happens – you nearly die or your partner dies or you get
nicked again, and you decide you’ve had enough. Window of opportunity – you
go to a service for the first time in ages and say you want to go in somewhere
to become drug free. They tell you they need to stabilise you for a few months
 first, but if you could stabilise you wouldn’t need rehab. You walk away confused.

Or you know you want to stop one day. You’re working towards it in your mind,
you know that the methadone is going to be harder to kick than the gear and you
want to reduce the methadone the service is giving you. You’re using on top – of
course you are, you always have – but the service says you have to stop before
they reduce you.
You make an appointment to get assessed for treatment. It’s taken you two
years to get there and you arrive an hour late. Sorry, you’ll have to make another
appointment for next week. Or you’re in a tier 4 residential something – detox or
rehab – with a 20-year crack and smack habit. You’ve been in three weeks, the
detox is pretty much over, you’ve been abstinent for a week. You have a puff on a
spliff – suddenly your care plan becomes ‘you have half an hour to pack your bags’.

All of these stories I’ve heard many times, in different areas of the country.

Of course there are clinical guidelines and service rules to keep clients safe, but
the reality is that those not in treatment are ten times more likely to die a drug related death and more likely to pick up a BBV or go to prison. The treatment
protocols designed to keep clients safe can have the reverse effect.

So back to the recovery agenda – an increased focus on stability, an
increased focus on abstinence for some, an increased focus on getting better
faster. Of course there are aspects of the recovery agenda that are positive –
moving those that are ready back towards the employment market, helping to
move forward those that have undeniably been parked on methadone. The
retention targets that generated treatment funding made substitute prescribing
too easy an option, and the notion of a greater emphasis on moving through the
treatment system is good in theory.

But there are many users for whom losing limbs, liberty or loved ones does not
trigger stability. The reality is that there is a large section of the drug-using
population that is damaged and traumatised and not able or willing to embrace
stability, abstinence or recovery, whatever shape that takes.

The Conservatives are using rhetoric about introducing abstinence-based
drug rehabilitation orders to break the cycle of addiction and offending, and
saying a focus on abstinence is a fundamental distinction between Labour’s
failed approach of maintenance and management and theirs. So not only are we
failing to engage those whose using is the most risky, the recovery agenda is in
danger of mutating into a beast that requires such strict treatment compliance
that many who are engaging under the current system will also be lost.

The word recovery was considered unhelpful by some because of its ability to
mean such different things to different people – I worry that it will move from being
unhelpful to being outright dangerous. The NTA was until recently a champion of
fighting for the cause and proclaiming the effectiveness of substitute prescribing. In
the changing political climate, if they survive, I hope they don’t hijack their own
recovery agenda to appease the political masters on whom their future depends.

Let’s hope models of care are not replaced with models of compliance.

Alex Boyt represents the National User Network (NUN) on the Cross Party Group

on Drugs and Alcohol