Rx Drugs - The Liverpool, England method

Transciption of CBS-TV Program, 60 Minutes. Aired Sunday, December 27, 1992

Titled: Rx Drugs

By: Ed Bradley

Ed:       Can Britain teach us anything about dealing with drugs?  That  remains to be seen.  But one thing seems certain, there is little or nothing we can teach them.  They tried our hard line methods back in the 70's and 80's and all they got for their         trouble was more drugs, more crime, and more addicts.  So they  went back to their old way of letting doctors prescribe whatever drug a particular addict was hooked on.  Does it  work?  If they're ever going to know, Liverpool, where drugs  are out of control is the place to find out.

Ed:       This is a gram of 100% pure heroin, it is pharmaceutically  prepared.  On the streets it would be cut 10 to 15 times and sell for about $2,000.  But take it away from the black  market, make it legal, and heroin is a pretty cheap drug.  The          British National Health Service (NHS) pays about $10.00 for this gram of heroin.  And for an addict with a prescription,          it is free.

Ed:       In Britain, doctors who hold a special license from the  government are allowed to prescribe hard drugs to addicts.      Dr. John Marks is psychiatrist who runs an addiction clinic just outside of Liverpool and has been prescribing heroin for          years 

Dr. Marks:   If a drug taker is determined to continue their drug use,  treating them is an expensive waste of time... and, really,  the choices that I am being offered and society is being offered, is drugs from the clinic or drugs from the Mafia. 

Ed:       To get drugs from the clinic rather than the Mafia, addicts  have to take a urine test to prove they are taking the drug    
they say they are.  And unlike most other addiction clinics  where you have to say you want to kick the habit before they'll take you in, addicts here have to convince Dr. Marks, a nurse and a social worker they intend to stay on drugs come what may.   But does Dr. Marks try to cure people?  

Dr.  Marks:     Cure people?  Nobody can.  Regardless of whether you stick them in prison, put them in mental hospitals and give them  shock treatment, we have done all these things, put them in a nice rehab center away in the country, give them a nice social  worker and pat them on the head, give them drugs, give them no  drugs, does not matter what you do.   5% per annum, 1 in 20 per  year, get off spontaneously.   Compound interested up that reaches about 50% (50/50) after ten years are off drugs.  They seem to mature out of addiction regardless of any intervention in the interim but you can keep them alive and healthy and legal during that 10 years, if you so wish to.

Ed:       By giving them drugs?

Dr. Marks: It doesn't get them off drugs, it doesn't prolong their addiction, either.  But it stops them offending, it keeps them healthy and it keeps them alive.

Ed:       That's exactly what happened to Julia Scott.   Although she doesn't look it, Julia is a heroin addict.  For the last three   years the heroin she injects every day comes from a prescription.  Before, she had to feed her habit by working as a prostitute, a vicious circle that led her to use more heroin  to cope with that life.

Julia:    Once you get in that circle you can't get out.  I didn't think  I was ever going to get out.

Ed:       But once you got the prescription?

Julia:    I stopped straight away.

Ed:       Never went back?

Julia:    No, never.  I went back once just to see and I was almost physically sick just to see those girls doing what I used to do.

Ed:       Julia says she's now able to have normal relation, to hold  down a job as a waitress and to care for her 3 year old daughter.  Without the prescription, where do you think you would be?

Julia:    I would probably be dead now.

Ed:       Once, they have gotten their prescriptions, addicts must show up for regular meetings to show that they are staying healthy and free from crime.  But how can anyone be healthy if they are taking a drug like heroin?

Alan Perry:  Pure heroin is not dangerous.  We have people on massive doses of heroin.

Ed:       Alan Perry is a former Drug Information Officer for the local  Health Authority and now a counselor at the clinic.  So how come we see so much damage caused by heroin?

Alan:     The heroin that is causing that damage, is not causing damage because of the heroin in it, it is causing damage because of  the bread dust, coffee, crushed bleach crystals, anything that causes the harm and if heroin is 90% adulterated that means only 10% is heroin, the rest is rubbish, and if you inject cement into your veins, you don't have to be a medical expert to work it out, that's going to cause harm.

Ed:       Many at the clinic like George still suffer from the damage caused by street drugs.  Alan Perry believes you can't prescribe clean drugs and needles to addicts without teaching them how to use them.

Alan:     You know the major causes of ill health to drug injectors is not even the dirty drugs they take, it is their bad technique.  Not knowing how to do it.   In America I have seen addicts missing legs and arms and that is through bad technique.  So we show people how to, not how to inject safely, but how to inject less dangerously.  We have to be clear about that, you have stoned people sticking needles in themselves in a dangerous activity.  The strategy is called "harm  minimalization."  

Ed:       George's legs have ulcerate and the veins have collapsed.  To inject he must use a vein in his groin that is dangerously  close to an artery.

Alan:     When you get in there, do you get any sharp pains?

George:   No.

Alan:     If you hit an artery how would you recognize it?

George:   By me head hitting the ceiling.

Ed:       In the 70's the British were not content with minimizing the harm of drug abuse.  They adopted the American policy of trying to stamp it out all together.  Prescription drugs were no longer widely available.   Addicts who couldn't kick the habit had to find illegal sources. The results:  By the end of the 80's drug addiction in Britain had tripled.  In Liverpool there was so much heroin around, it was known as "smack city".  And then came an even greater threat.  

More than anything else, it has been the threat of AIDS that has persuaded the British to return to their old policy of maintaining addicts on the drug of their choice. In New York, it is estimated that more than half those who  inject drugs have contracted the AIDS virus through swapping contaminated needles.  Here in Liverpool, the comparable  number, the number of known addicts infected, is less than one percent.

In an effort to get addicts away from injecting, Liverpool pharmacist Jeremy Clitherow has developed what he called Heroin Reefers.  They are regular cigarettes with heroin in them.  "Whatever you feel about smoking," he says, "these cigarettes hold fewer risks than needles for both the addicts and the community.

Jeremy:   See, we then use this (hypodermic syringe) to put in a known volume of pharmaceutical heroin into the patient's cigarette.  And, there we are, one heroin reefer containing exactly 60 mgs of pharmaceutical heroin.

Ed:       So, that, the National Health Service will pay for the heroin but not the cigarettes?

Jeremy:   Oh, Yes, of course, its the patients own cigarettes but with  the National Health Service Prescription in it.                 

Ed:       Addicts pick up their prescriptions twice a week from his neighborhood pharmacy.  And how does this affect his other customers?  

Jeremy:   The patient who comes in to pick up his prescription of heroin in the form of reefers would be indistinguishable from a patient who picks any other medication.  The prescription is ready and waiting and they pick it up just as they would pick up their aspirin or bandages.

Ed:       But with all these drugs available to most people plus the hard drugs that you have here, what's your security like?

Jeremy:   Like Fort Knox.  But we keep minimal stocks.  We bring the stuff  in regularly, frequently.   What comes in, goes out.

Ed:       And heroin isn't the only stuff to come in and out of here. Clitherow also sells prescriptions for cocaine and that is 100% per free base cocaine.   In other words, crack.

Ed:       So, in fact, when you are putting cocaine in here you are actually making crack cigarettes?

Jeremy:   Yes.

Ed:       In America that has a very negative connotation, but not for you?

Jeremy:   Depends on which way you look at it.  If they continue to buy on the street, whether it is heroin, methadone, crack, or whatever, sooner or later they will suffer from the merchandise they are buying.   I want to bring them into contact with the system and let them get their drug of choice, if the physician agrees and prescribes it in a form which won't cause their health such awful deterioration.

Ed:       (to Dr. Marks)  And you don't have any problem giving people injectable cocaine or cocaine cigarettes?  

Dr. Marks:  No, not in principle.  There are patients for whome I have prescribed cocaine, and to whom I have then stopped   prescribing cocaine because their lives did not stabilize. They continue to be thieves or whatever.  But, there are equally many more to whom we have prescribed cocaine, who have then settled into regular sensible lives.

Ed:       Michael Lythgoe is one who has settled into a regular sensible life on cocaine.  He has a prescription from Dr. Marks for both cocaine spray and the cocaine cigarettes. Before he got that prescription, the cocaine he bought on the street cost him nearly $1,000 a week, which at first he managed to take from his own business, but it wasn't long before it cost him much more than that.        .... so you lost your business, you lost your wife, you lost your kids and the house but you kept going after the cocaine?

Michael:  Yes, that is what addiction is, that is the very nature of addiction, if the fact that one is virtually chemically and physically forced to continue that way.

Ed:       Now, after two years of controlled use on prescription drugs, Mike has voluntarily reduced his does, he has got himself a regular job with a trucking company and is slowing putting his life back together.

Ed:       Where do you think you would be now if Dr. Marks had not given you a prescription for cocaine?

Michael:  I wouldn't be here talking to you.  And you probably wouldn't be interested in talking to me either.  I'd be on the street.

Ed:       Dr. Marks, how would you reply to critics who say that you are nothing more than a legalized dealer, a pusher?

Dr. Marks:   I'd agree.  That is what the State of England arranges.  That  there is a legal controlled supply of drugs.  The whole concept behind that is control.

Ed:       And there are signs that control is working.   Within the area of the clinic, Alan Perry says, the police have reported a significant drop in drug related crime and since addicts don't have to deal anymore to support their habit, they're not recruiting new customers.  So, far fewer new people are being turned on to drugs.

Ed:       What about dealers around the area of the clinic?

Alan:     There are not any around the clinic.

Ed:       You have taken away their business?

Alan:     Exactly, there is no business there, the scene is disappearing.  So, if you want to get really into a problem which presumably all societies do, there are ways of doing it. But you have to counter your own moral and political prejudices.  

Ed:       (to Julia)  What can you say to people who would ask why give addicts what they want?  Why give them drugs?

Julia:    So they can live, to have a chance to live like everyone else does.  No one would hesitate to give other sort of maintaining drugs to diabetics.  Diabetics have insulin, in my mind it is no different, it is the same.   I need heroin to live.