In late 2006, the whole of Britain watched in horror as five vulnerable female prostitutes were, one by one, over the course of one and half months, picked up off the streets of Ipswich and taken to their deaths. The last victim, Paula Clennell, was even seen on television stating that, despite news of the murders and despite being alerted to the fact a killer was on the loose, she would continue working the streets as she ‘‘needed the money’’ to fund her drug habit. The killer was eventually identified as a Mr Steve Wright, who, in February 2008, was found guilty of all five counts of murder, and sentenced to life imprisonment. But the truth is that all five deaths were preventable. Preventable, that is, for want of some political courage on the part of our leaders.
In response to the murders, there was, of course, a wide and varied national debate about policy on prostitution, and how to make these vulnerable women safer. Criminalization of demand, legalization, brothels, tolerance zones – all were considered and discussed. But one simple way to keep vulnerable women away from ‘‘the oldest oppression’’ as some feminists prefer to call it, was ignored: heroin prescription.
But before explaining the rationale for this, it’s worth describing in more detail the risk that women put themselves in when they enter into prostitution. Here are a few shocking, striking facts: as many as 60 women involved in prostitution have been murdered in the UK in the last 10 years; more than a quarter report attempted rape; and over 50% of women working as prostitutes start in prostitution before the age of 18. And let’s not forget: prostitution, by its very nature, involves having sex with someone you do not want to have sex with – a fact too often overlooked.
And here’s yet another astonishing statistic: according to the Fawcett Society, 63% of women in prostitution report that they are doing so in order to fund a drug habit – the drug, in most cases, being heroin. The immediate response is, of course, to call for rehabilitation services to be enhanced, broadened, and improved. Now, rehabilitation programmes have their place, and it is imperative that the health service try to wean people off drugs entirely, but to think this is the only way of dealing with the problem misses one hard, crucial fact: rehabilitation of hard drug users has a very low success rate. Even the swishest, swankiest form of residential rehab only has a success rate of 50% at best, according to research by Dr David Best, chair of the Scottish Drug Recovery Consortium. For a significant number of addicts rehab, sadly, doesn’t work. It is, as the medical research refers to it, a ‘chronic relapsing condition’.
The solution for this group of remaining addicts is to provide a safe, clean supply of heroin (otherwise known as diamorphine), prescribed by a medical professional, allowing them to hold down a stable, unchaotic life, where they no longer have to burgle or prostitute themselves to fund their ineradicable habit.
Many of you may be reading this and thinking: what ‘safe, clean supply of heroin’? But the truth is that unadulterated heroin is, in reality, a relatively safe drug: the only consequences being addiction itself and a bit of constipation. It may seem shocking at first, riddled as the British press is with misinformation about drugs, but the distinguished investigative journalist Nick Davies has conducted a detailed study into this, highlighting large scientific studies of unadulterated heroin users. He states: ‘The Oxford Handbook of Clinical Medicine records that a large proportion of the illness experienced by blackmarket heroin addicts is caused by wound infection, septicaemia, and infective endocarditis, all due to unhygienic injection technique’. (But, given that street heroin has a purity of between 20-90%, it’s probably wise not to go near it).
Interestingly, he gives a few historical examples of well-functioning heroin addicts, including the children’s novelist Enid Bagnold, who died quietly in her bed at the of 91, having spent twelve years her life after a hip operation consuming up to 350 mg per day. Two others of note include Dr William Stewart Halstead – widely regarded as the most pioneering surgeon in US history – and Dr Clive Froggatt, Margaret Thatcher’s health advisor (now an avowed champion of heroin prescription on the NHS).
Of course, many people reading this will be familiar with the heroin substitute methadone – a bright green gloop consumed orally – which has been the principal drug used in harm reduction strategies for problematic heroin addicts for well over a decade. The problem is that, while it works to some degree, methadone is in many ways more dangerous than heroin, and unpopular among recovering addicts, meaning they are not successfully driven away from the illicit heroin trade. As the epidemiologist Dr Ben Goldacre demonstrates in his detailed analysis of the scientific literature, it is a profoundly unpleasant drug to take, causing tooth decay, nausea, vomiting and so on. But more alarmingly: it has a higher mortality rate than heroin; this, despite the fact that there are a higher number of heroin users to methadone users in the UK (some scientists have put this down to its longer half-life – a fact used to justify its use in preference to heroin). The real reason for the choice of methadone over heroin is, I suspect, one of price: pure heroin is almost 8 times more expensive than methadone. This can, however, be easily dealt with by dismantling the monopoly the company ‘Evans Medical’ has on the drug.
A comprehensive 2006 study conducted by the Joseph Rowntree Foundation found that Drug Control Rooms – supervised clinics where heroin addicts could turn up at any point, day or night, to shoot up – had been a stunning success: places where drug deaths fell to literally one – one! – and levels of HIV infection collapsed from 50% to 2%. Once addicts have a safer, cleaner supply of their drug – where they can, of course, be slowly weaned off it, inch by cautious inch – the need to deal to fund vanishes: the Global Commission on Drug Policy highlighted that under a heroin-prescription policy the number of new users fell by a spectacular 80%, thereby ending the most vicious of vicious cycles. Don’t be deceived by the seemingly low levels of success by the National Treatment Agency (the body responsible for delivering harm-reduction treatments) in ending dependency entirely; this is, in the words of the NTA’s Director of Communications ‘like measuring a school’s GCSE success by counting the number of A grades as proportion of the total school population’. Remember: heroin addiction is a chronic relapsing condition.
Up until the 1960s, this was common practice in the UK, and so successful it was replicated throughout the world as the famous ‘British method’, only ending in the wake of Richard Nixon’s global ‘war on drugs’. Returning to this model would mean fewer families unnecessarily torn apart, and, crucially, far fewer women having to enter to prostitution, keeping them safe from disease, destitution, and death.
So what is the current government’s policy? Initially, it looked like David Cameron was going to cave-in to the utopian, senseless, cold-turkey approach of his colleagues, but the government has since back-tracked: the money for the National Treatment Agency has been ring-fenced, with Ken Clarke providing a sober voice of reason, pointing out that outright withdrawal of heroin was clinically dangerous. They have not, however, signalled a change from methadone to heroin, so for Cameron to continue with a policy he knows full well increases disease, destitution, prostitution, and death, is nothing short of a disgrace. Only public pressure – by the medical establishment in particular but with the backing of the public – will make him change course.
A virtually identical policy is pursued in Scotland, where methadone is prescribed around the country, although Audit Scotland complain that treatment services for cocaine users are chronically underfunded, and one addict complained of a lack of choice over treatment options: “one size fits all – you have to fit with the service, not it with you.” Both governments, of course, like to brag about big, headline-grabbing drug seizures, but don’t be deceived: Lothian and Borders Police once admitted that they only seize 1% – 1% – of all the heroin available on their patch. At any rate, if the seizures were successful, because demand is inelastic price would increase – meaning more burglary, robbery, and prostitution.
We are at a point in the debate now where it is no longer heretical to critique conventional wisdom on drugs policy; that is, to critique a policy which bears virtually zero relation to medical and sociological evidence. We need to seize this moment. Make a noise. Get it on the agenda. Pile on the pressure on the politicians. Educate and inform: too many people are still misled by newspaper misinformation and irrational tabloid hysteria. After all, it’s an urgent cause, as the experience of Tania, Gemma, Anneli, Annette, and Paula – the five women murdered in Ipswich in 2006 –and countless other faceless, nameless victims show. How many more women have to beaten, raped, or murdered before we finally see sense?
* Paying the Price, Home Office 2004. http://webarchive.nationalarchives.gov.uk/20100418065544/http://www.homeoffice.gov.uk/documents/cons-paying-the-price/paying_the_price2835.pdf?view=Binary
* Briefing on Prostitution, Fawcett Society http://www.fawcettsociety.org.uk/documents/Prostitution%20Factsheet%201.9.07.pdf
* Happy Endings, Addiction Today http://www.addictiontoday.org/addictiontoday/2011/03/happy-endings-research-addiction-stories-of-success.html
* Ben Goldacre, Heroin on Prescription http://www.badscience.net/2006/11/methadone-and-heroin/