The 'anti war on drugs' resource thread
War on drugs is one of those topics that comes and goes with interesting, alarming and occasionally depressing regularity. There is always a call for sources and other bits of information and I find myself googling it everytime. "Why I thought, why, haven't I just collated all the sources I, and other people have brought up on the subject together. That way I can leave a subscription to the thread open and have them to hand next time the argument springs up.
To my mind it is an argument that is done and won by the anti war on drugs side, with zero good supporting arguments to oppose it but since people come along that are new to the site they will want to discuss it again. So for the people who have argued this topic frequently, can you help me out by making contributions and I will update the OP?
I'll break it up into topics.
Has the War on Drugs been successful?
Wikipedia on the arguments against drug prohibition:
Stephen Rolles, writing in the British Medical Journal, argues....
Spoiler Alert, click show to read:
Consensus is growing within the drugs field and beyond that the prohibition on production, supply, and use of certain drugs has not only failed to deliver its intended goals but has been counterproductive. Evidence is mounting that this policy has not only exacerbated many public health problems, such as adulterated drugs and the spread of HIV and hepatitis B and C infection among injecting drug users, but has created a much larger set of secondary harms associated with the criminal market. These now include vast networks of organised crime, endemic violence related to the drug market, corruption of law enforcement and governments.
These conclusions have been reached by a succession of committees and reports including, in the United Kingdom alone, the Police Foundation, the Home Affairs Select Committee, The prime minister’s Strategy Unit, the Royal Society of Arts, and the UK Drug Policy Consortium. The United Nations Office of Drugs and Crime has also acknowledged the many "unintended negative consequences" of drug enforcement.[15]
The editor of the British Medical Journal, Dr Fiona Godlee, gave her personal support to Rolles' call for decriminalisation, and the arguments drew particular support from Sir Ian Gilmore, former president of the Royal College of Physicians, who said we should be treating drugs "as a health issue rather than criminalising people" and "this could drastically reduce crime and improve health".
Danny Kushlik, head of external affairs at Transform, said the intervention of senior medical professionals was significant. "Sir Ian's statement is yet another nail in prohibition's coffin," he said. "The Hippocratic oath says: 'First, do no harm'. Physicians are duty bound to speak out if the outcomes show that prohibition causes more harm than it reduces."
Nicholas Green, chairman of the Bar Council, made comments in a report in the profession's magazine, in which he said that drug-related crime costs the UK economy about £13bn a year and that there was growing evidence that decriminalisation could free up police resources, reduce crime and recidivism and improve public health.[16]
A report sponsored by the New York County Lawyers' Association, one of the largest local bar associations in the United States, argues on the subject of US drug policy:
Notwithstanding the vast public resources expended on the enforcement of penal statutes against users and distributors of controlled substances, contemporary drug policy appears to have failed, even on its own terms, in a number of notable respects. These include: minimal reduction in the consumption of controlled substances; failure to reduce violent crime; failure to markedly reduce drug importation, distribution and street-level drug sales; failure to reduce the widespread availability of drugs to potential users; failure to deter individuals from becoming involved in the drug trade; failure to impact upon the huge profits and financial opportunity available to individual "entrepreneurs" and organized underworld organizations through engaging in the illicit drug trade; the expenditure of great amounts of increasingly limited public resources in pursuit of a cost-intensive "penal" or "law-enforcement" based policy; failure to provide meaningful treatment and other assistance to substance abusers and their families; and failure to provide meaningful alternative economic opportunities to those attracted to the drug trade for lack of other available avenues for financial advancement.[17]
Moreover, a growing body of evidence and opinion suggests that contemporary drug policy, as pursued in recent decades, may be counterproductive and even harmful to the society whose public safety it seeks to protect. This conclusion becomes more readily apparent when one distinguishes the harms suffered by society and its members directly attributable to the pharmacological effects of drug use upon human behavior, from those harms resulting from policies attempting to eradicate drug use.[18]
With aid of these distinctions, we see that present drug policy appears to contribute to the increase of violence in our communities. It does so by permitting and indeed, causing the drug trade to remain a lucrative source of economic opportunity for street dealers, drug kingpins and all those willing to engage in the often violent, illicit, black market trade.
Meanwhile, the effect of present policy serves to stigmatize and marginalize drug users, thereby inhibiting and undermining the efforts of many such individuals to remain or become productive, gainfully employed members of society. Furthermore, current policy has not only failed to provide adequate access to treatment for substance abuse, it has, in many ways, rendered the obtaining of such treatment, and of other medical services, more difficult and even dangerous to pursue.[19]
In response to claims that prohibition can work, as claimed by Antonio Maria Costa, executive director of the United Nations Office on Drugs and Crime, drawing attention to the drug policy of Sweden Henrik Tham has written that sometimes it's domestically important to stress drug policy as successful, as the case of Sweden where this notion is important, serving "the function of strengthening a threatened national identity in a situation where the traditional ‘Swedish model’ has come under increasingly hard attack from both inside and outside the country." Tham questions the success of the Swedish model - "The shift in Swedish drug policy since around 1980 [nb 1] towards a more strict model has according to the official point of view been successful by comparison with the earlier, more lenient drug policy. However, available systematic indicators show that the prevalence of drug use has increased since around 1980, that the decrease in drug incidence was particularly marked during the 1970s and that some indicators point towards an increase during the 1990s."[20]
Leif Lenke and Börje Olsson from Stockholm University have conducted research that showed how drug use have followed the youth unemployment in close correlation. They noted that unlike most of Europe, Sweden did not have widespread and lingering youth unemployment until the early 1990s financial crisis, suggesting that unattractive future prospects may contribute to the increase in drug use among the young.[21] CAN, the Swedish Council for Information on Alcohol and Other Drugs, 2009 report stated that the increase in drug use have continued since the 1990s with a slight dip in the mid-2000.[22]
The professor emeritus in criminology at the University of Oslo, Nils Christie, pointed out Sweden as the hawk of international drug policy, being a welfare alibi and giving legitimacy to the US drug war. Adding that the two countries have an extraordinary influence on UNODC as the biggest donor countries.[23]
An editorial in The Economist argued:
fear [of legalisation] is based in large part on the presumption that more people would take drugs under a legal regime. That presumption may be wrong. There is no correlation between the harshness of drug laws and the incidence of drug-taking: citizens living under tough regimes (notably America but also Britain) take more drugs, not fewer. Embarrassed drug warriors blame this on alleged cultural differences, but even in fairly similar countries tough rules make little difference to the number of addicts: harsh Sweden and more liberal Norway have precisely the same addiction rates.[24]
Antonio Maria Costa's conviction that "countries have the drug problem they deserve" if they fail to follow the 'Swedish Model' in drug control has also been criticised in Peter Cohen's work - Looking at the UN, smelling a rat.[25]
This one was by Garb.
Spoiler Alert, click show to read:
Actually, it is very unsafe to say that. To be precise it is a non-falsifiable statement belonging mostly to an alternate history forum than a politics one.Originally Posted by Copperknickers II
Its safe to say that without the massive offensive against drugs going on in most parts of the world, the problems caused by drugs would be worse than they are now.
However we can reach a measure of understanding of what can be construed as "success" by simply comparing the stated purposes of this "War on drugs" with the outcomes. (By the way, why do they even call it a "war"? Wars, usually, end.)
First we need to have a baseline. We could go to 1973 when Nixon declared "a war on drugs" but there were no stated policy goals. That happened eventually in 1998 during the Clinton presidency and amended later by GWBush:
So the crucial questions are the following:
- Is drug use DOWN?
- Is crime DOWN?
- Are health and social costs DOWN?
- Are drug users HEALTHY?
- Is treatment AVAILABLE?
- Are drugs LESS AVAILABLE?
Let us now examine the answers:
1. Is drug use DOWN?
Spoiler Alert, click show to read:
http://oas.samhsa.gov/NSDUH/2k9NSDUH/2k9ResultsP.pdf
Answer:NO
2. Is crime DOWN?
Spoiler Alert, click show to read:
Actually drug-related arrests are increasing as a percentage of total crime rate.
Answer: NO
3. Are health and social costs DOWN?
Spoiler Alert, click show to read:
And the DoD budget for the war abroad....
Spoiler Alert, click show to read:
Answer: NO
4. Are drug users HEALTHY?
Spoiler Alert, click show to read:
Rates of Drug-Induced Deaths,* by Race/Ethnicity† --- United States, 1999--2007
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5942a7.htm
Answer: NO
5. Is treatment AVAILABLE?
Spoiler Alert, click show to read:
Answer: NO
6. Are drugs LESS AVAILABLE?
Spoiler Alert, click show to read:
The above is the percentage of people answering yes to the question: "How easy it is to find these drugs?"
http://whitehousedrugpolicy.gov/publ...supplement.pdf
Answer: NO
So, based on the available data the "War on Drugs" is an abject failure at any level. Thank you.
Now as to the question of the OP, let's hear what a conservative Economist and Nobel Prize winner has to say:
The attempt to enforce the prohibition of the use of drugs is destroying our poorer neighborhoods in city after city, creating a climate that is destructive to the people who live there. This phenomenon is perhaps the greatest disgrace in the United States at the moment. I say "perhaps" because an alternative is what we are doing to other countries. Can anybody tell me that the United States of America is justified in destroying Colombia because the United States cannot enforce its own laws? If we enforced our laws, there would be no, problem.
People sell drugs because it is A. Profitable (gangs) and B. The only way for many to obtain the drugs they need (addicts).
And since you read all this, well, you deserve a bonus quote:
[/quote]Spoiler Alert, click show to read:"You know, it's a funny thing, every one of the bastards that are out for legalizing marijuana is Jewish. What the Christ is the matter with the Jews, Bob? What is the matter with them? I suppose it is because most of them are psychiatrists." Richard Nixon
But we've got to keep heroin illegal, it is dangerous 1111!!!!111
Governments treating heroin addicts by giving them heroin has positive effects.
In the UK a comparison of giving patients psychological support and injectable heroin vs oral methadone and injectable methadone
Spoiler Alert, click show to read:
Untreatable or just hard to treat?
Results of the Randomised Injectable Opioid Treatment Trial (RIOTT)
Press Briefing 15 September 2009
Introduction
The headline results from RIOTT are made public today 15 September 2009 at the Royal College of
Physicians. Details of the findings are set out below. RIOTT is the first randomised controlled trial in
the UK to compare injectable opiate treatment (injectable methadone and injectable heroin)
delivered in new medically supervised injecting clinics to optimised (high quality) oral methadone for
severely entrenched and ‘hard to treat’ heroin addicts.
The RIOTT trial has been coordinated by the National Addiction Centre which was developed by the
Institute of Psychiatry, Kings College London, and South London and Maudsley NHS Foundation
Trust (SLaM). Both organisations are part of King’s Health Partners, one of the UK’s five Academic
Health Sciences Centres. The research was funded by the Big Lottery through the charity Action on
Addiction in partnership with the National Treatment Agency who have funded the supervised
injecting clinics on behalf of the Government.
The RIOTT trial took chronic heroin addicts who, despite active treatment, were still continuing to
inject heroin most virtually daily. These entrenched heroin addicts were then randomised to
treatment with either supervised injectable heroin, supervised injectable methadone or optimised
oral methadone.
Three supervised injecting clinics have been established in England in recent years and these are
the sites for the trial , - in London (SLaM – established October 2005), Darlington (began
September 2006) and Brighton (began September 07).
The three Trusts where the three sites/clinics are located are: South London and Maudsley NHS
Foundation Trust, Tees, Esk and Wear Valleys NHS Foundation Trust and Sussex Partnership NHS
Trust.
The RIOTT clinical trial is led by Professor John Strang and his team based at the National
Addiction Centre, King’s Health Partners (which should be referenced in any description of his role,
and in picture captions). 2
Key points
About the trial
• This treatment was for a select group of heroin addicts –
o entrenched heroin addicts who have repeatedly been found to fail to benefit from
existing treatments
o existing clients who despite receiving oral methadone maintenance treatment
were continuing to inject street heroin almost every day.
• These supervised injecting clinics provide intensive treatment
o providing a prescription of injectable heroin and injectable methadone injected
under strict medical supervision
o with a high level of psychological and social support to address health and life
issues
• The trial compares injectable heroin and injectable methadone delivered in supervised
injecting clinics with high quality conventional treatment (oral methadone).
The key findings from RIOTT based on raw data are
• This trial shows that it is possible to engage and retain in treatment some of the most
entrenched hard-to-treat heroin addicts for whom previous treatment, rehabilitation and
prison appear to have had little beneficial impact. These are existing clients who despite
receiving oral methadone maintenance treatment were continuing to inject street heroin
almost every day
o All groups achieved good retention
o Better retention in the injectable heroin group (88%) compared to 81% in the
injectable methadone group and 69% in the oral methadone group.
• The trial has achieved very positive results in terms of the primary outcome measure –
reduced use or abstinence from ‘street’ heroin. There was a reduction in street heroin use
amongst all 3 treatment groups at six months.
• The most pronounced reduction was seen in the injectable heroin group
o Three quarters responded well by substantial reduction in the use of ‘street’ heroin.
o Of these, three quarters (or around 60% of the total group) remained largely
abstinent allowing for no more than two lapses in drug testing during a three month
period.
o A quarter of those who reduced (almost 20% of the total group) were totally abstinent
from street heroin. This is remarkable in a group for whom daily illicit use while in
treatment was the norm.
• For the injectable methadone and oral methadone groups, the achievements were much
more modest. About a third were no longer using street heroin regularly, although very few
of these were totally abstinent from street heroin.
• There was an almost immediate benefit just 6 weeks into treatment and this benefit was
maintained throughout the six-month period of study for each patient
• The degree of effect of the treatment was greatest in the injectable heroin group, followed by
injectable methadone and optimised oral methadone. 3
• Optimised oral methadone showed greater success than predicted, perhaps due to the high
intensity of engagement provided by regular attendance and psychosocial support. At the
same time the injectable methadone group performed less well than predicted, though still
with a positive effect.
• The amount of money spent on street drugs reduced in all treatment groups.
• The biggest reduction was seen in the heroin group.
o Clients were spending an average of just over £300 a week on drugs before entering
RIOTT treatment (despite already being in active treatment) and this reduced to an
average of just under £50 a week at 6 months.
o This was as a result of (a) substantial numbers who became ‘crime-abstinent’, and
also (b) substantial reduction in the extent of criminal activity of those who were still
criminally involved.
o The total spending for the whole heroin group (approximately 40 people) translates
as reducing from nearly £14,000 spent a week prior to entering RIOTT which then
reduced to under £2,000 at 6 months.
• Across the board there was a dramatic reduction in self-reported crime.
o Prior to entering RIOTT treatment over half of the clients in each treatment group
were committing crime and were commiting a mean number of between 20-40 crimes
in the past 30 days.
o At six months, the proportion committing crimes in each group more than halved and
the mean number of crimes committed in the past 30 days reduced to between 4 -13
– less than a third of previous levels.
o The actual number of crimes committed drastically reduced by two thirds in each
group. For example, those in the heroin group were committing a total of 1731 crimes
in the 30 days prior to entering RIOTT treatment and after 6 months, this fell to 547
crimes (a reduction of 1,184 crimes per month).
• Prior to entering RIOTT treatment, around three quarters of each group were using crack. It
has been thought that crack use might increase amongst clients receiving injectable opiate
treatment (perhaps as compensatory other drug use; or perhaps due to more available
cash). However, this was not the case and at 6 months the proportion using crack had
reduced across all treatment groups as had the amount used.
• It is important to remember that these clients were existing service users and already
receiving oral methadone treatment prior to entering RIOTT. Their levels of street heroin and
crack use, money spent on drugs and criminal activity were occurring whilst receiving
conventional treatment. It is all the more remarkable that such benefits have been made with
the RIOTT treatment but in particular with injectable heroin.
• There were improvements in physical, mental health and social functioning across all
treatment groups over the 6 month period.
• The cost of producing positive results in this ‘difficult to treat’ group is around £15k per
patient per year. These are the most severe 5% of the heroin using population, many of
whom are typically committing a high level of crime to fund their addiction. By comparison
the typical cost of prison is £44k a year per person, not to mention many other costs to
society, so ‘do nothing’ is not a cost effective option. 4
• This is a scientific study. It is for policy makers to decide how the findings will be applied.
The 2008 Government Drug Strategy recognises the potential of supervised injection under
strict clinical supervision. It cites - “... rolling out the prescription of injectable heroin and
methadone to clients who do not respond to other forms of treatment, subject to the findings,
due in 2009, of pilots exploring the use of this type of treatment” (H.M.Government Drug
Strategy, 2008).
Additional points
• This has been a national randomised controlled trial in a supervised clinical setting which
looked at – for the first time in the UK – the relative effectiveness of injectable methadone
and injectable diamorphine compared to oral methadone.
• The trial focussed on treating a very small but significant number of existing service users
who are entrenched users and ‘hard to treat’, and have not responded well to standard
treatment options, often relapsing many times.
• Patients on the trial take medication under the supervision of trained medical practitioners.
They cannot bring illicit supplies into the clinic or take prescribed doses out.
• This scientific study has tested whether this treatment is effective in reducing illicit heroin
use, improving health and reducing criminal activity among a particular group of hard to treat
heroin users. Research in Holland, Switzerland, Germany and Canada shows promising
results in these areas.
• The social costs of heroin addiction to society and to individuals are many times greater than
the cost of treatment, particularly in this hard to treat group. There is a range of research
focusing on the social costs of drug-related crime, but there are other factors to take into
account including the effects on individuals and their families, the loss of economic
productivity and the costs to the benefits and criminal justice systems.
• The location of the clinic is confidential for reasons of security and patient confidentiality, as
well as to avoid compromising the research ethics of the study
• The identity of patients engaged in the trial is also confidential
• The diamorphine used does not draw on existing NHS supplies. At the start of the trial, it
was imported and licensed especially for research purposes; it cannot be used for any other
purpose (such as palliative care). The multi-dose ampoules are more cost effective and
suitable only for use in a clinical setting. More recently, the trial moved to using a British
supplier when this became available at a affordable price.
• The relative costs of treatment including staffing – oral methadone about £5k p/a,
diamorphine about £15k (may be reducible post pilot). Social costs of drug related crime,
imprisonment etc many times higher to society, not to mention the benefits of treatment for
users, their families and friends. Estimates vary but … for this group, (estimated at between
5 and 10% of the opiate using population) cheaper forms of treatment are not cost effective,
because they simply haven’t worked.
• The RIOTT trial has recruited 127 subjects into the trial, of whom 51 are from the SLaM
clinic, 45 from the Darlington clinic and 31 from the Brighton clinic.
• Clients at each site are distributed across three treatment groups – with a total of 42 in the
optimised oral methadone, 42 in the injectable methadone group and 43 in the injectable
diamorphine group.
• All doses of injectables are supervised. There are absolutely no take-home injectable doses.
Clients receiving injectable heroin attend typically twice daily, and those receiving injectable
methadone typically once a day, every day. Initial engagement is for six months.
• An additional benefit of daily attendance and supervised medication is the development of
closer relationships with staff, allowing more key worker sessions, including advice on
general health and social support. Initial clinical impressions are positive.5
• After six months, each client was fully assessed by their doctor and a clinical decision was
made as to what treatment they go on to. Many of the clients in the trial are still receiving
injectable heroin and to a lesser degree injectable methadone.
Notes to Editors
The National Addictions Centre, King’s Health Partners (NAC) seeks to improve understanding
of addiction to drugs, alcohol and tobacco, and to develop effective preventative and treatment
interventions. It is collaboration between researchers at the Institute of Psychiatry (IoP), King’s
College London and clinicians at South London and Maudsley NHS Foundation Trust (SLaM). Both
SLaM and King’s College London are partners in King’s Health Partners. Professor John Strang is
director of the National Addictions Centre, King’s Health Partners. For more information or to
arrange interviews please contact:
Lorcan O’Neill lorcan.oneill@slam.nhs.uk, tel: 020 3228 2830, mobile 07966 548147.
King’s Health Partners is one of five UK Academic Sciences Centres bringing together research,
clinical practice, education and training across physical and mental health. King’s Health Partners is
a pioneering collaboration between King’s College London, and Guy’s and St Thomas’, King’s
College Hospital and South London and Maudsley NHS Foundation Trusts. For more information,
visit www.kingshealthpartners.org
Action on Addiction is the only UK charity working across the addiction field in research,
prevention, treatment, professional education and family support. Contact Rachel Silver, Head of
Communications, tel 020 7793 1011, mobile 07974 983859 07825 620 130.
rachel.silver@actiononaddiction.org.uk
See www.actiononaddiction.org.uk
http://idpc.net/sites/default/files/...to%20treat.pdf
In Germany the best way to get heroin addicts off heroin is to give them heroin, taking it out of the criminals hands and taking the profits out of crime.
Less crime and less heroin use.
Spoiler Alert, click show to read:
http://news.bbc.co.uk/1/hi/scotland/5043766.stm
Experts hail heroin clinic trial
By Bob Wylie
Investigations correspondent, BBC Scotland
Germany is nearing completion of a three-year trial under which its worst heroin addicts are given the drug on the state.
The heroin was given out in seven clinics in seven cities across the country. Bob Wylie has been to Hamburg to investigate the results.
The scheme has been trialled in seven German cities
See one addict's view
If you go to Hamburg these days you can't miss the Blue Goals. They are a modern art masterpiece for the World Cup - 120 fluorescent blue goals on buildings all over the city.
When the battle for the Jules Rimet Cup is in town Hamburg will host three matches including a quarter final.
Big Frank Jerke says he can't wait. He'll be glued to the television and may even try to get a ticket for one of the games.
Time was when that would have been unthinkable. Less than three years ago Frank was down and out, homeless and hopelessly hooked on heroin.
It was around seven in the morning when I first saw him on Hoegerdamm Street on the outskirts of Hamburg's city centre.
He's a big man. He stumbled off the bus and muttered "Morgen", as he passed me at the top of the steps.
Medical supervision
Downstairs he rang the bell at the Hamburg heroin clinic. Inside he took a breath test to prove he had not had any alcohol and then he went next door into what they call the application room.
There, under medical supervision, he was given a syringe with chemically pure heroin - diamorphine - diluted in water.
He got up on one of the beds, dropped his trousers and injected it into his thigh.
Dr Christian Haasen says the results are "significant"
See a full interview
He put his head back and closed his eyes for a few minutes then got up, left the clinic and went to work in one of Hamburg's ship repair yards - the same as he used to do all those years ago before the smack got him.
"Everything is good now. I've got a nice flat of my own and a good job. Better," he says.
He laughed as he left. These days his teeth are a credit to any toothpaste manufacturer.
Frank is one of 500 drug addicts in Germany who are on the heroin pilot programme.
It is being conducted in seven major cities across Germany. Hamburg is the biggest trial.
Results published
German doctors looked at the success of heroin on prescription in Switzerland and then the Netherlands and after years of debate the Bundestag accepted that a pilot should be set up.
The project started three years ago and was based on comparing heroin maintenance with methadone maintenance.
Five hundred or so users were given heroin - they had to have failed on methadone beforehand - and 500 were given methadone.
The results were published recently. On almost all counts the heroin group did better than the methadone group.
Frank Jerke is among those on the programme in Hamburg
Dr Christian Haasen is the research director of the German trial.
In his office at the University of Hamburg he tells me in a matter of fact manner: "The differences between the heroin group and the methadone group are statistically significant.
"Those on heroin stayed in treatment longer and the drop out is less than the methadone group. They had much less illicit drug use, using street heroin and cocaine, and so have better health records."
He says he knew from other heroin trials in Switzerland and the Netherlands that there would be differences but that even he was surprised at the improvements sustained by those on heroin.
These positives also affect employment prospects. At the Hamburg clinic 40 of the clients are working out of the 90 going there to get heroin.
Stuck on heroin
Ludovic Leblanc, 32, is a waiter in one of the best Italian restaurants in Hamburg.
His take home pay, with tips, is 2,400 euros, or £1,800. He's got a good flat in the city centre and looks every inch an aspiring head waiter when he's kitted out for work. Not bad for 15 years on heroin.
Ludovic goes to the clinic twice a day - once in the morning before work and during his afternoon break.
His employer knows about it. But in his kitchen 13 storeys up above the river Elbe, I put it to him that, remarkable as his progress has been, he's still stuck on heroin.
For us to give patients a daily kick on heroin cannot be seen as a permanent solution
Dietrich Wersich
State health minister
Heroin prescription 'cuts costs'
'Let GPs prescribe heroin'
"No, I hope to be drug free by this time next year," he asserts.
He's now on a quarter of the daily dose of heroin he was getting when he started at the clinic two years ago.
"I couldn't have dreamed of that on methadone. After a year and a half on methadone the dose stayed the same and I would go to get street heroin almost every night," he said.
Doctors at the Hoegerdamm clinic say one in 10 are on sufficiently decreasing doses to be described as "moving towards abstinence".
But the preliminary figures for the study do not show any remarkable difference between heroin and methadone in the numbers that finish drug free.
Youth protection
Drug deaths are different. Since 2001 German drug deaths are down by 40%, according to Christian Haasen.
A policeman made the same point about Hamburg.
Ch Supt Norbert Ziebarth is the head of youth protection for Hamburg police. At the rather imposing Polizeiprasidium HQ in the north of Hamburg he tells me that in the time of the heroin clinic drug deaths in Hamburg have dropped from 101 in 2001 to 61 last year.
Police in Hamburg are supportive of the scheme
The existence of the clinic, in a way, also allowed a police crackdown on what used to be Hamburg's open drug scene.
There are no shooting galleries in parks or congregations of drug users at the central railway station, on the scale there used to be. The police support the trial and its extension.
"It works for the worst heroin users. We support it," says Det Supt Ziebarth.
Not that everyone is of the same view.
The heroin clinic experiment was introduced by the Social Democrat government of Gerhardt Schroeder.
Now the conservative CDU, led by Angela Merkel, are in power. They are altogether less enthusiastic about heroin on the state.
Better support
I found that out when I met the Hamburg state minister of health, Dietrich Wersich. He disputes some of the findings of the German study and questions the costs of heroin on prescription - thus far three times greater than methadone.
"The results for the heroin group were only slightly better than those of the methadone group," he says, "and they may have been due to other factors than solely the prescription of heroin, like better social services support and things like that."
Herr Wersich is also dubious about what he describes as the state becoming in effect a licensed narcotics dealer.
Ludovic Leblanc holds down as job as a restaurant waiter
"For us to give patients a daily kick on heroin cannot be seen as a permanent solution," he said.
"Instead we have to work to get them drug free and how can you say that's being done if the government is giving them a kick on heroin every day... and besides will the taxpayer be prepared to pay for this?"
This weekend the Lancet published a research study of the Swiss heroin clinics, which have been running for 10 years.
The study suggests that the Swiss model is responsible for reduced heroin use in the long term. Swiss drug deaths have plummeted in the last 10 years.
The Lancet editorial points that in the same time the UK has had the highest drug deaths every year of any European country.
The last official figures for drug-related deaths in Scotland was 356 for 2004. That was almost 50% higher than the figure a decade ago.
So here's the question: Is it now time for Scotland to follow Germany and other European countries and introduce heroin clinics to give our worst addicts heroin on prescription?
Bob Wylie's report from Hamburg will be broadcast on Radio Scotland's Investigation programme at 0900 BST on Monday. There will also be a special report on Newsnight Scotland at 2300 BST.
Arguments about Gateway Theories
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Originally Posted by Simon Cashmere
