The British government is bribing doctors to kill their patients and others. It wants (and will pay them) to prescribe methadone to heroin addicts, in the full knowledge that this will be done in so sloppy and irresponsible a fashion that many people will die as a result. He who wills the means, wills the ends.
The arguments for the prescription of methadone to heroin addicts are well known. Methadone is a synthetic opiate first developed in Nazi Germany during the war because of a shortage of opium supplies from the Far East. It was named dolophine in honour of a leader of the time (it is still sold under a similar brand name in the United States), and one of its first recipients was Hermann Goering, an addict whose criminality was not much reduced by its prescription.
Methadone is given mainly in liquid form, though it also exists as a pill and an injection, as a substitute for heroin. Its effects are long-lasting by comparison with those of heroin, so that it is taken only once a day. The rationale behind methadone treatment of drug addicts is that its prescription free of charge reduces the criminal activities of addicts, reduces their consumption of heroin and hence their risk-taking behaviour, and stabilises their day-to-day existence so that they are able to rejoin society, while eventually allowing them painlessly to reduce the dose little by little until they achieve total abstinence. Controlled trials have demonstrated the beneficial effects of methadone for groups of addicts.
Unfortunately, methadone is a very dangerous drug. Five millilitres – a teaspoonful – is enough to kill a baby, and 40ml is enough to kill an adult who is not habituated to opiates. The dangers are not merely theoretical, not even for the doctors who prescribe the stuff: from time to time one reads in the medical press of doctors who have been struck off the medical register for negligently believing the lies their patients tell them about the amount of methadone they take, amounts that promptly kill their patients.
Deaths from methadone are by no means negligible in number. In Florida in 2001, deaths from methadone poisoning surpassed those from heroin poisoning for the first time, by 133 to 121. Meanwhile, back in Blighty, to demonstrate that we are also in the vanguard of modernity, deaths from methadone have been rising steadily. Between 1993 and 2000, there were 4,058 deaths from the direct effects of heroin; in the same period, there were 2,500 deaths from methadone. Since far fewer than a third of addicts receive methadone, it is at least as likely, to put it no stronger, that methadone kills rather than saves.
A large percentage of those who die of methadone poisoning are not those who are prescribed it, but purchasers of methadone from those who receive it free and use the proceeds to buy heroin (and sometimes children of addicts who are attracted to the bright green sweet liquid). Diversion of methadone on to the black market is so widespread that the price is low: currently about £1 for 10ml. Addicts are able to sell their methadone because they are prescribed bottles of it at a time.
The diversion of this dangerous substance on to the black market – where it kills – hardly gives our distinguished government pause, or slows the self-propelled juggernaut of the drug-addiction treatment industry. And there could be no clearer illustration of how those who work in the field of drug addiction have become a self-serving bureaucracy than the response of an Australian in the field to the fact that in New South Wales 46 per cent of those who die of methadone poisoning have never been prescribed it: “The large proportion of deaths involving diverted methadone may suggest a high unmet demand for methadone and/or a need to make methadone maintenance treatment attractive to a greater diversity of dependent heroin users.”As a physician friend of mine at the hospital in which I work remarked (where, incidentally, we have treated 51 methadone overdoses in the past 18 months, many requiring intensive care), this is a little like concluding from the existence of rape that there is an unmet demand for sex.
As it happens, it is not inevitable that the prescription of methadone must be accompanied by so many deaths. In Glas-gow, for instance, the number of people prescribed methadone increased from 140 in 1992 to 2,800 in 1998. But the number of deaths from methadone in the city increased from three to seven, that is to say they declined proportionately by 86 per cent.
The reason for this was obvious: Glasgow instituted a policy according to which those prescribed methadone had to take it in front of the dispensing pharmacist each day, and were not given a supply that they could turn into cash. Ninety per cent of methadone prescriptions were dispensed in this fashion: if it had been 100 per cent, the deaths would have been even fewer. Clearly, this method of prescription must have been acceptable to addicts, since so many of them agreed to it.
These figures suggest, indeed, that it is the only ethically acceptable method of prescription: all other methods are tantamount to murder, or at least culpable homicide. Yet the latter methods will remain predominant for the foreseeable future, as most places have not instituted the Glaswegian approach. The death of a drug addict or one of those people inclined to buy methadone on the black market probably saves the British taxpayer a considerable sum of money in the long run, or even the short run, but this is surely taking the desirable principle of economising where possible a little far. Incidentally, the rise in deaths from methadone in America is probably attributable to the adoption of British methods. For once, the Americans are copying us, with predictably disastrous results.
There is another, wider objection to methadone maintenance treatment, however – or indeed any form of treatment of drug addicts. It is astonishing to me that the authors of trials which demonstrate a reduction of criminality among addicts when prescribed methadone conclude that the prescription of methadone will reduce the total amount of allegedly drug-fuelled crime in society.
Not only is the relation- ship between criminality and drug-taking much more complex than the “feed-my-habit” conception usually peddled (the decision to take heroin is also a conscious way of opting for the criminal life, because no one any longer is ignorant of the consequences of taking the drug), but it does not follow that, if criminality is reduced among treated addicts, criminality as a whole decreases.
If you were a drug dealer with a customer who told you that, thanks to methadone (or any other treatment), you no longer required his wares, would you simply accept the contraction of your market, or would you act as any salesman would act when one customer fails to buy? Thus, it is possible that, with treatment, we end up with a methadone addict and a heroin addict, whereas before we had only a heroin addict.
Does this fit what has actually happened in Britain better than, say, the tuberculosis model of methadone treatment? When a patient has infectious TB, treating him is not only therapeutic for him but preventive for the public: it interrupts the transmission of the disease. But the apparatus of treatment for drug addiction is more likely to spread the problem – I won’t call it a disease – than to cure or prevent it. The number of people receiving methadone in this country has reached 30,000, but heroin continues to cut a swathe through the lower reaches of society. Opium (loosely construed) has become the opium of the masses.
Neither methadone nor any other medicalised “treatment” will solve the social problem of heroin addiction. On the contrary, it will increase it.
True, a doctor has to do his best for the individual patient who consults him: he treats an individual’s problems, not those of society, and therefore can quite ethically, on the basis of published research, come to the conclusion that methadone is the best available solution to his patient’s current problem – provided that the methadone is swallowed in front of a pharmacist. It is not his concern if, by prescribing the wretched stuff, he is encouraging the spread of heroin yet further.
Speaking to hundreds of addicts, as I do, it is evident that, considered as a whole, the problem is a deep social, psychological, cultural, moral, educational and spiritual one. There is no technical fix for it, not now and not in the future. Biomedical research, however fascinating it may be from the point of view of disinterested intellectual curiosity, will not provide a solution.
The poor abandoned addicts whom I see every day of my life have never had a father, have never eaten a meal at a table with other people, have nothing in their minds but pop music and football. They are the new wretched of the earth, and there is no medicine for their wretchedness.
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