Maintenance isn't cure, but it's limiting HIV, crime in Britain's drug picture

September 19, 1993|By Richard O'Mara | Richard O'Mara,Staff Writer

WIDNES, England -- Siobhan Monaghan smokes 15 heroin reefers a day. She gets them free, here at the Widnes Drug Dependency Clinic.

The clinic takes up a few rooms above an insurance office in an old house on Victoria Road. Lives are being reclaimed there. It is the largest of about a dozen similar establishments throughout Britain that prescribe heroin, cocaine and amphetamines to addicts.

Ms. Monaghan is 36 and a functioning heroin addict; she gets paid for her work as an outreach worker at the clinic. An addict for 21 years, she's not certain she will ever stop using the stuff: "It's quite pleasant and enjoyable you know, if you use it in the right way."

The idea of maintaining an addict on heroin or cocaine, rather than trying to break the addiction, is controversial and is not widely practiced, not in Britain, not anywhere.

A task force on drug reform appointed by Baltimore Mayor Kurt L. Schmoke looked at a variety of maintenance programs in Britain and other European countries, though none was seriously considered for Baltimore. Instead, two weeks ago, the panel recommended starting a needle exchange program, focusing on arrests of drug traffickers over users, and retraining doctors to offer more treatment to addicts.

At the Widnes clinic, 61 addicts are under treatment. Of them, 18 are injecting maintenance doses of heroin, and two are injecting cocaine. Nine are smoking heroin reefers. Others are taking methadone -- a more benign alternative to heroin -- or amphetamines orally, while one is taking cocaine through a nasal spray.

Dr. John Angus Marks, the resident psychiatrist, said each year about 5 percent of the clinic's 150 addicts go off drugs entirely. A study of the lives of 89 of them between 1982, when the clinic opened, and 1989 revealed 20 had given up drugs completely.

"This is not a great cure rate," he said. "But they all live more or less normal lives, aren't always in trouble with the police. And they don't die."

The nine staff people inside these stark white rooms who do the work of counseling, assessing addicts' needs, or prescribing drugs believe they have ameliorated the scourge of drug abuse within their part of the economically blighted Merseyside region.

They have saved lives, not only those of addicts but of people with no connection to the addicts' world: the citizens who would be victimized by the crime that accompanies drug addiction.

The experiences of Britain and the United States in the matter of drug abuse and how to deal with it couldn't be more different, their policies more divergent. Both were set after World War I.

The United States opted for total prohibition of opiates (and alcohol), and Britain chose to ration them. Neither country has abandoned its original policy, though Britain has modified its practices.

Originally, some 20,000 British general practitioners were authorized to prescribe opiates, cocaine and other drugs to addicts, as patients. That was many more physicians than needed. According to Dr. Marks, the number of addicts was always low in Britain and reached only "about 540 in 1960."

Late in that decade, as the incidence of drug abuse grew dramatically in the United States, dealers made their way to England, found physicians to prescribe narcotics for large profits, then returned and marketed them at home. More dealers came; more British drugs found their way to the United States.

"The Americans hated this," said Dr. Marks, "so the British government, deciding its relationship with America was more important than a few addicts, passed the Misuse of Drugs Act of 1971."

This reduced to about a thousand the number of physicians who could legally prescribe opiates. It wasn't a total abandonment of the rationing policy, but many of the authorized physicians -- psychiatrists for the most part -- weren't interested in treating addicts.

Thus, the old maintenance system was diminished, and, as a consequence, the number of addicts grew, though at nothing similar to the rate in the United States. Today, according to Dr. PTC Marks, there are about 50,000 addicts among Britain's 55 million people. Baltimore alone may have as many addicts as that.

Dr. Marks and those who favor giving hard drugs to addicts believe it reduces their number within the population, and also lowers the mortality rate among them. How? Free, legally obtained drugs remove the addict's need to deal to support the habit, so there is less pressure to seduce others into that life.

Also, legal clinics prescribe drugs free of dry milk or some of the more lethal substances that are mixed with street drugs.

Supporters of maintenance see another benign effect: The antiseptic practices used in clinics reduce the incidence of AIDS in the population. Sharing of dirty needles by addicts is a major factor in the spread of HIV (human immunodeficiency virus), which causes AIDS.

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