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Alcohol More Harmful Than Heroin or Crack, British Study Finds

A study published Monday in the Lancet assessed the harms of various substances and found that alcohol caused more harm in the United Kingdom than heroin or crack cocaine. The study was done by the Independent Scientific Committee on Drugs, which is headed by Professor David Nutt.

drug harm comparison chart, from the Lancet study
Until this time last year, Nutt was head of the governmental Advisory Council on the Misuse of Drugs, but he was fired for criticizing the then Labor government as basing its decision to reclassify marijuana on politics rather than science. He also offended government sensibilities by saying that riding horses was more dangerous than taking ecstasy. After his firing, he and other scientists formed the Independent Scientific Committee on Drugs.

The study, Drug Harms in the UK: A Multicriteria Decision Analysis, assessed the relative harms of different legal and illegal drugs to drug users and to society and concluded that "alcohol was the most harmful drug (overall harm score 72), with heroin (55) and crack (54) in second and third places."

It also demonstrated that Britain's drug classification scheme bears little relation to the harms caused by the various substances it regulates or fails to regulate. Alcohol, ranked most harmful in the study, is not a controlled substance, but cannabis (20 points) is Class B, the second most serious drug schedule. LSD (7 points) is a Class A drug, the most serious drug schedule, while tobacco (26 points) is not a controlled substance.

"Our findings lend support to previous work in the UK and the Netherlands, confirming that the present drug classification systems have little relation to the evidence of harm," the authors said.

A group of experts looked at drug-specific mortality, drug-related mortality, drug-specific damage, drug-related damage, drug-specific impairment of mental functioning, drug-related impairment of mental functioning, loss of tangibles, loss of relationships, injury, crime, environmental damage, family adversities, international damage, economic cost, and harm to the community and assessed weighted values for each to arrive at a final figure.

"The weighting process is necessarily based on judgement, so it is best done by a group of experts working to consensus," Nutt and his coauthors said. "Extensive sensitivity analyses on the weights showed that this model is very stable; large changes, or combinations of modest changes, are needed to drive substantial shifts in the overall rankings of the drugs."

Science-based drug policy, anybody?

United Kingdom

FDA Appoves Drug to Treat Heroin, Morphine Addiction

The Food and Drug Administration has approved an injectable drug designed to treat people addicted to opiates who have undergone detoxification treatment. Vivitrol, made by Massachusetts drug maker Alkermes, is a so-called extended-release formulation of the drug naltrexone that is injected once a month into the muscle, according to an FDA statement. The drug works to block opioid receptors in the brain.
Publication/Source: 
All Headline News (FL)
URL: 
http://www.allheadlinenews.com/articles/7020200536?FDA%20Appoves%20Drug%20To%20Treat%20Heroin,%20Morphine%20Addiction

Cambodia Opens First Methadone Clinic

The Cambodian Ministry of Health has opened a clinic where people addicted to opiates, primarily heroin, can be administered methadone. The move is a significant departure in a country in which "drug treatment" has typically meant imprisonment, forced labor, and unproven herbal treatments.

Royal Palace, Cambodia (wikimedia.org)
The opening of the clinic is the culmination of years of quiet effort by harm reduction organizations, the BBC reported. Two of those groups, which run outreach programs for drug users, will identify candidates for treatment.

The program is strictly voluntary. Participants will be taken to the clinic for a needs assessment in line with international standards. The clinic is inside a public hospital and run by the Ministry of Health with support from the UN's World Health Organization.

While harm reductionists and public health workers are pleased with the government's new approach, they said more steps need to be taken to shut down the existing, punitive drug treatment centers. But the government says it has no plans to do so.

Read an expose of existing Cambodian drug treatment centers here.

Cambodia

British, Canadian Troops Smuggling Afghan Heroin: Report

Location: 
Afghanistan
Military police in Afghanistan are investigating whether British and Canadian soldiers may have smuggled heroin out of the war-torn country.
Publication/Source: 
CTV Television Network (Canada)
URL: 
http://www.ctv.ca/CTVNews/World/20100912/afghanistan-heroin-smuggling-allegations-100912/

Commentator: Why Do Pols, Society Ignore Failure Of Drug War? (Opinion)

Location: 
United Kingdom
Last year, Professor Neil McKeganey of the University of Glasgow, one of the most respected academics in Britain, established that the authorities seize just 1% of the heroin that enters Scotland in any one year. But where are the headlines about this utter failure? Documentary filmmaker Angus Macqueen thinks he knows the answer -- our drug policies have been hijacked by the emotive rhetoric of moralists.
Publication/Source: 
The Crime Report (NY)
URL: 
http://thecrimereport.org/2010/08/03/commentator-why-do-pols-society-ignore-failed-drug-war/

HOPHEAD CONFESSIONS!!! A DISEASE OR A CRIME???!!!

"The individual has always had to struggle to keep from being overwhelmed by the tribe. If you try it, you will be lonely often, and sometimes frightened. But no price is too high to pay for the privilege of owning yourself." "All things are subject to interpretation; whichever interpretation prevails at a given time is a function of power and not truth." "The advantage of a bad memory is that one can enjoy the same good things for the first time several times." "A little poison now and then: that makes for agreeable dreams." -F. Nietzsche Recreational narcotic addiction. This subject is as welcome in polite company as recreational pedophilia I suppose. But here I write from the the eye of the hurricane, no longer in the belly of the beast. Perhaps this is a privilege of age and white skin and a little luck. But still I must suffer the financial toll of the gray and black market. And the little HepC bugs gnawing on my liver. I've used narcotics for pleasure since 1971, opium was my preference, or chemical narcotic drugs whenever opium was not available, which is now virtually all the time. The "drug world" has changed over the years that I have used, or "practiced" as the old timers used to call it, and not for the better. The available "street" narcotic, heroin, has declined in quality terribly over the decades. At least the junk that comes from Mexico, which is now the primary heroin source for the U.S. it appears. Despite the government inflicted propaganda that both Cannabis and heroin are both now much "stronger" or of a higher quality than we "baby boomers" had access to when we were young: think Vietnamese black, Cambodian red or the ultimate moonrocket weed, Thai. And Double U-O Globe brand #4 "China white" heroin smuggled from Vietnam and Thailand (90-99% purity). This was 40 years ago. Don't let my generations always narrow minded and often duplicitous career social engineers bullshit you. Street heroin is and has been cut with just about everything under the sink over the last couple decades. When I was young heroin was cut with lactose. Too far down the "junk pyramid" some might be cut with procaine in the west, or quinine in the east. I lived in L.A. during the 80s when crack profits funded the rapid proliferation of criminal gangs. After a period of drug abstinence, in 1994 I went to score near 6th and Union, an old open heroin street market in L.A. Once inhabited by independent dealers, the area had, in my "absence" been claimed, tagged off and monopolized with armed force, as 18th Street gang turf. And the 18th Street gang was cutting their dope with shoe polish. The drugs induced delirium and a near death experience for me. Others were not so lucky, I suppose. I've only dabbled in junk over the last 20 years, the quality and/or cut of the junk has been so bad, even for strong dope of high "purity" that I believe I flushed a good 20% of all the nasty stuff I've purchased over the last 20 years. Todays veinless junkies carry the brown recluse spiderbite like scars of the filthy junk that is contaminated with flesh eating bacteria. And the veins go fast using the shit on the street these days. Thank God and the pharmaceutical companies for all the nasty pills people mix like inept alchemists, or maybe lemmings. But save the pantapon and dilaudid for me. I suppose. You can have the OC. That little hook takes too long to shake off. And the "cures" for narcotic addiction, addiction to the narcotic drugs methadone and buprenorphine. I think I'll pass on that too. Highly educated academic addiction specialists with the insight of virgin sex therapists, armed with reductionist and social pseudoscience, tell me I suffer from a disease of the brain. This disease forces me against even my own will to desire and consume opium. Help I cry. A huge mutliizillion dollar addiction recovery complex is now in place to help the newly painpill addicted avoid, allegedly, the suffering of drug withdrawal. O the Horror! I recently read that some addicts may need to be addicted to buprenorphine or methadone for life in order to medically recover from addiction. Orwellian medspeak? Others say that I am merely a criminal in need of incarceration or worse in order to save society from itself. Personally I think I just have an acquired taste for a forbidden fruit. But truthfully, to ask me to abstain from this passion permanently is no more reasonable than demanding lifelong sexual abstinence. That conformity is part of your moral code, not mine. This acquired taste runs deep. I practice temperance and self restraint in my use of narcotics and it is no more reasonable of you to hold me responsible for the actions of criminal or terminal addicts than it is of me to hold social drinkers responsible for the actions of criminal or terminal alcoholics. I've kicked many times and always on my own. I do not relapse. I freely choose to use narcotics with eyes wide open. Opium is best suited for use by very mature and stoic individuals. Paradise is temporary and fleeting. Agony is the price exacted for lingering in this paradise. And payment is due in full immediately at the exit when the ride is over. I'm personally fine with this price tag, thank you. Those who wish to avoid agony and suffering should steer clear. Don't you suppose? "O mother of pearl, I wouldn't change you for the whole world". -B. Ferry

Feature: Schwarzenegger Trying to Gut California Methadone Funding in Budget Move

With California facing a $19 billion budget deficit, Gov. Arnold Schwarzenegger (R) last month proposed saving the state $53 million by cutting off Medi-Cal funding for methadone maintenance for most heroin addicts. That would cause the loss of more than $60 million in matching federal funds. The move was fiercely resisted by methadone advocates -- including a former drug czar -- and public policy analysts, and the proposal was defeated last week in committee votes in the state Senate and Assembly.

But California gives the governor the power to veto individual budget items, so advocates are not resting yet. Instead they are reaching out to the administration in hopes they can enlighten it and persuade the budget axe-wielding Schwarzenegger to aim elsewhere.

Schwarzenegger isn't the first top-tier elected official to go after methadone maintenance. Back in 1999, then New York City Mayor Rudy Giuliani vowed to wean all of the city's methadone patients off it in three months. While Giuliani acted for ideological rather than budgetary reasons -- he said he wanted "drug freedom," not drug dependence -- the pugnacious mayor later changed his tune, admitting the idea was "maybe somewhat unrealistic."

http://stopthedrugwar.org/files/harm-reduction-superheroes-vancouver.jpg
superheroes for harm reduction: ''Methadone Man'' public awareness campaign during last February's Olympics in Vancouver. You're needed everywhere, Methadone Man.
Currently, nearly 150 methadone clinics provide the heroin substitute to some 35,000 addicts, 55% of whom are on Medi-Cal. Advocates and treatment providers said that clinics would be forced to close if the proposal passed, affecting not only the Medi-Cal patients, but also patients who paid out of their own pockets or through private insurance to be able to get maintenance methadone.

"Methadone isn't a cure," said Roxanne Baker, president of the National Alliance of Methadone Advocates (NAMA), "but much like thyroid medication, as long as you keep taking it, it keeps your disease in check, and opiate addiction is a disease. When you mess with your brain with painkillers, it then doesn't produce the endorphins it should. It's not a matter of will power, it's a disease. You need something to replace those endorphins, whether its methadone, suboxone, or even prescription heroin, although I doubt we'll ever see that here."

Enacting the proposed cuts would be "a disaster," said Baker. "There would be no methadone programs left. More than half the patients statewide are on drug MediCal, and they wouldn't even have a place to go. A lot of these people have their lives in order. This is somebody's brother, somebody's aunt, somebody's mom. Please don't take this from us."

Last week, Clinton-era drug czar Gen. Barry McCaffrey flew into the state to hold a press conference denouncing the cut. "Dumping tens of thousands of opiate addicts back on the street would be an immediate disaster to law enforcement, and to the families of people who have become stable, functioning adults" thanks to methadone, said McCaffrey, who has a consulting firm and serves on the board of directors of an organization that treats chemical dependency.

Legislators were listening, not only to McCaffrey, but to the methadone treatment community. A Senate Budget Committee hearing last week proved tough going for Schwarzenegger's representatives.

"This measure would eliminate the drug MediCal program with the exception of the perinatal and youth funding," said John Wardlaw from the state Department of Finance. "This is not an easy reduction in any way. We are at the point where we are making very difficult reductions."

Committee Chair Denise Moreno Ducheny (D-San Diego) wasn't buying it. "How much federal funding are you giving up?" she asked.

"Sixty-six million dollars," Wardlaw said.

"We save $53 million and lose $66 million?" asked Ducheny.

"That is correct, ma'am."

Ducheny just stared at him for a few uncomfortable moments before moving on to the next witness.

"There would be cost shifts in the area of corrections and child welfare services," Greg Tallivant of the legislative analysts' office told the solons. "The day the clinic closes, those people have to do something. If they can't make it to the next methadone clinic, heroin would be the next choice. You would see people arrested. You would see prison costs and child welfare costs go up."

Assemblyman Mark Leno (D-San Francisco) was visibly irritated by the proposal. "There is a complete lack of interest in any cost-benefit analysis here," he said. "This is reckless and cavalier. It doesn't really make much sense. We have 171,000 people addicted to drugs. This will increase our crime rate; it's a recipe for disaster on our streets. Does the governor have no interest in this or does he not believe that this will impact the safety of our children and communities? We've already zero-funded the base Proposition 36 program. The outcome of this is to have drug offenders with no jail and no treatment."

"This is really a short-sighted proposal that shifts costs from funding treatment to funding law enforcement, jails, and prisons," said Jason Kletter, a member of the Bay Area Addiction Research Team (BAART), which is in turn a member of California Opioid Maintenance Providers (COMP), a nonprofit organization representing opioid maintenance treatment centers. "It is a public safety issue, to say nothing of the humanitarian crisis it would provoke," he said.

"We think if this happened many clinics would close, and the folks who lose access to care would likely relapse and cost the system much, much more in a short time," said Kletter. "We see relapse rates of 80% within a year when clinics close, so it wouldn't even be like we'd be kicking the can three or four years down the road."

"This would have the biggest impact on programs that have a high percentage of Medi-Cal beneficiaries in treatment and would be unable to stay open because more than half their patients, and thus, their revenues, are gone," said Kletter. "You would have a fundamental dismantling of the system."

The cost incurred would be staggering, Kletter said."If 80% relapse in same year, we know that the state will incur $700 million to $1 billion in new costs in the criminal justice system," he said, citing a study from the 1990s that found each dollar invested in treatment produced a seven-dollar return. "The state wants to save $53 million by eliminating drug Medi-Cal and will also turn away more than $60 million in matching funds. That's $115 total program cost. A seven-to-one return on that is close to a billion dollars. "With 80% relapse, we could end up seeing $700 million in new criminal justice and prison costs."

"It's a terrible proposal," said Glenn Backes, a Sacramento-based public policy analyst who works with the Drug Policy Alliance at the Capitol. "California Democrats in both houses have said so. The Senate Republicans didn't do a cost-benefit analysis; they just said we can't afford to give out subsidized health care."

But in reality, the situation is even worse, said Backes. "They've killed Proposition 36 funding, drug courts are being slashed. According to the governor's finance director, that's 171,000 patients. The cost-benefit for this is worse than nil. If only one out of a thousand relapses and goes to prison, you've already lost money because prison is so much more expensive than treatment. If only one out of a thousand gets Hep C, the taxpayer loses. If only one out of a thousand gets HIV, the taxpayer loses."

It's easy to lose the human side in all the numbers, Backes said. "If only one out of a thousand ODs and dies, that's 170 California families who have lost a loved one."

And the battle continues. "While both the Senate and the Assembly budget committees have rejected the governor's proposal, in California, the governor has a line item veto," said Kletter. "We are continuing to try to work with the administration to explain the impact of this kind of proposal and get them to understand it is a public safety and cost-shifting issue. We haven't had any direct meeting with them yet, but that's next on our agenda. We want to educate them about them dire consequences of this sort of action."

Even if advocates many to salvage the drug Medi-Cal program, they would be well-advised to be searching for alternative funding sources, and how better than to take money from the drug war? Tough times call for creative solutions, and Backes has one: Use federal Byrne Justice Assistance Grants to fund treatment instead of drug task forces. Every dollar funding more drug war arrests costs $10 additional in spending for courts and prisons, he said.

"Historically, Byrne grant funds have been given to task forces to increase arrests," Backes noted. "The Drug Policy Alliance position is that Byrne funds would be better spent on almost anything other than doing low-level drug sweeps. We would rather see that money go into treatment for people in the system."

Opiate Maintenance: Prescribing Heroin to Hard-Core Addicts Keeps Them Off Street Smack, British Study Finds

In research findings reported in The Lancet, scientists monitoring the Randomized Injectable Opiate Treatment Trial (RIOTT) reported that allowing addicts who have failed to get off heroin to use injectable "medical grade" heroin resulted in lower levels of street heroin use than in addicts given either oral or injectable methadone. The research was done by Professor John Strang and colleagues from the National Addiction Center's Institute of Psychiatry at King's College in London.

Up to 10% of heroin addicts fail to respond to conventional treatments, for reasons that are unclear. In recent years, scientific evidence suggesting that providing medicinal heroin, known as diamorphine in the United Kingdom, under supervision is an effective treatment for chronic heroin addiction, has only increased. This study adds to the mounting evidence.

The RIOTT study chose as subjects chronic addicts who were receiving oral maintenance doses, typically of methadone, but were continuing to regularly inject street heroin. Subjects were provided with oral methadone, injectable methadone, or injectable heroin over a half-year period. At the end of the study, 80% of the subjects remained in treatment, with the highest figure for those using heroin (88%), followed by injectable methadone (81%) and oral methadone (69%). Among subjects who had 50% or more negative samples for street heroin -- the authors' measure of measurable improvement -- 66% of medicinal heroin users avoided street smack, while only 30% of injectable methadone users did and only 19% of oral methadone users did.

"We have shown that treatment with supervised injectable heroin leads to significantly lower use of street heroin than does supervised injectable methadone or optimised oral methadone," the authors said in a press release announcing the findings. "Furthermore, this difference was evident within the first six weeks of treatment."

Noting that the UK government's 2008 Drug Strategy had called for rolling out prescription heroin and methadone to clients who don't respond to other forms of treatment, contingent on the results of the RIOTT study, the authors said the results were in and it was time to act. "In the past 15 years, six randomized trials have all reported benefits from treatment with injectable heroin compared with oral methadone. Supervised injectable heroin should now be provided, with close monitoring, for carefully selected chronic heroin addicts in the UK," they concluded.

"Our scientific understanding about how to treat people with severe heroin addiction has taken an important step forward," said Professor Strang. "The RIOTT study shows that previously unresponsive patients can achieve major reductions in their use of street heroin and, impressively, these outcomes were seen within six weeks. Our work offers government robust evidence to support the expansion of this treatment, so that more patients can benefit."

You can watch Professor Strang discuss the findings here.

Feature: First Drug User Union Forms in San Francisco

Thanks to the on-the-ground efforts of local harm reductionists and the funding largesse of the Drug Policy Alliance, San Francisco is now the home of only the second drug user union in the United States. The nascent effort is just getting off the ground, but plans to follow in the footsteps of Canada's Vancouver Area Network of Drug Users (VANDU) and the New York City VOCAL drug user union affiliated with the NYC Aids Housing Network.

http://stopthedrugwar.org/files/sfusersunion3.jpg
While self-identified drug user unions are rare in the US, they have a history dating back to the Dutch "junkiebund" of the 1970s. The movement is currently spreading internationally, with affiliates of the International Network of People Who Use Drugs (INPUD) operating in Europe, North America, South America, and Asia. And while medical marijuana patients did not refer to themselves as drug users, they have done similar organizing based on their use of the weed.

"We gave a $35,000 grant to the Harm Reduction Therapy Center to organize drug users in San Francisco, said Laura Thomas, DPA California state deputy director. "It is an annual grant, and future funding depends on HRTC re-applying for the funds. We have funded VOCAL in New York for several years."

DPA sees drug user groups as a key component in efforts to reduce the harms of both drug use and prohibitionist drug policies, said Thomas. "We hope that drug users in San Francisco will have a voice in policy decisions that affect them," she said. "We hope that they will become an active and organized part of efforts to reduce the harm related to both drugs and the war on drugs in San Francisco. The group is still in the process of forming and determining what their priority issues are, so I can't speak for what they are going to be working on."

"While we haven't quite chosen our main campaign, we've been talking about what we would ideally like San Francisco to look like, about having a safe place to inject, and about having a safe place to consume other drugs, too," said Alexandra Goldman, the organizer for the group. "Within a couple of months, we will choose our first official campaign," she vowed.

"We are also interested in working to decrease the stigma, both within and outside the drug using community," Goldman added. "We're trying to work with health care providers to make it a more positive experience. Our people tend to wait until they are very seriously ill because they are not treated very well. In our meetings, I'm hearing about how people don't get the prescribed pain medications they need because the doctors don't like them."

The group has already been active, joining in protests against the city's proposed ordinance barring people from sitting or lying on public sidewalks. Homeless people in neighborhoods like Haight-Asbury have roused the ire of business owners with their presence, but activists say they have no place to go and should not be criminalized.

The SF Drug User Union participation in the sit/lie protests makes sense given that many of its members are homeless and that its meetings are generally being held in homeless drop-in centers in the Tenderloin and the Mission. The group boasts about 25 members, with an emerging core group of 10 or 12, but is looking to expand by working with lower income communities and people involved in local harm reduction networks.

"We plan to be active consumers, giving our opinions and our voice on issues and policies that affect us," said Isaac Jackson, the other paid staffer for the union. "People are already asking us for our expertise."

So who can join the union? Anyone who identifies as a drug user, past or present, organizers said. Defining members in that manner allows people to get active without necessarily outing themselves as current users.

http://stopthedrugwar.org/files/sfusersunion4.jpg
"There is no piss test to get into this group," said Jackson. "We have heroin users, speed users, people who drink, pot smokers. Some people think pot's not a big issue, but anyone who wants to work with us, we say 'right on.' We support the legalization campaign and we support medical marijuana. That's a success story, and so is needle exchange, and we'll be trying to learn from those."

The only rule at meetings is no drug dealing, said Jackson. "We don't want people to deal drugs at the meeting or endanger other people in the group by that kind of activity, but if people are carrying, so what? Some people have showed up tweaking. We don't want to say they can't come because they're too high. We want people to feel welcome whatever their level of sobriety."

Forming a drug user union in San Francisco has been an idea that's been batted around for at least a couple of years, but it took some cold, hard cash to make it happen. "There were some attempts to organize drug users in the past, and I was involved in those, but they didn't stick because people had other jobs," said Goldman. "But once that Drug Policy Alliance grant came in, I got hired in November and we had our first meetings in February."

"I worked at a small health agency working with homeless people with substance use here in the Tenderloin, and was also working with some people with the Youth Homeless Alliance in the Haight," said Jackson. "A lot of people said we ought to do something like VANDU. We had a conference here a couple of years ago to try to jump-start a safe injection site, but that was mostly health care providers, not drug users."

San Francisco has one of the highest rates of drug use per capita in the country, Jackson noted. "Since there is so much civil disobedience going on already -- the laws are wrong, when you have thousands of people doing something for a long period of time, it's like passive civil disobedience -- there was an opportunity there to give drug users a voice in a more organized way. We're consumers of all these services -- treatment, law enforcement, the whole drug industrial complex -- we're consumers and have no voice. The time was right for it to start here."

San Francisco organizers took advantage of last fall's DPA conference to learn from existing drug user groups on the continent. "I met with Ann Livingston from VANDU and I got in touch with some of the folks from VOCAL," Goldman said. "They work on stuff around syringe exchange, trying to pass statewide ordinances to keep police from hassling people with needles, things like that. And, of course, they're subject to the same ridiculous drug laws we are."

"Drug user groups such as VOCAL in New York, VANDU in Vancouver, and hopefully this group in San Francisco play an important role in drug policy change and ending the war on drugs," Thomas said. "Drug users are usually the people most directly affected by bad drug policies, and the least likely to have a voice in debates. Drug users as active participants in the political process also helps reduce the stigma that is attached to drug use and makes people reconsider their prejudices about what they think 'drug users' are like. The drug policy reform conversation can only benefit from the active participation of drug user groups."

Separate drug user union meetings are taking place every three weeks in the Tenderloin and Mission districts. For more information about joining the union, send an email to sf.users.union@gmail.com.

England: Royal College of Nursing Leader Calls for Prescription Heroin by the NHS

The head of Britain's largest nurses' union has called for the routine prescribing of heroin to addicts by the National Health Service (NHS) as a means of weaning them from their addiction. The remarks by Peter Carter, general secretary of the Royal College of Nursing (RCN), came after the RCN debated the idea at its convention in Bournemouth this week. No vote was taken.

http://stopthedrugwar.org/files/petercarter.jpg
Peter Carter
Expressing his personal views after the debate, Carter, the former head of Central and North West London Mental Health NHS Trust, advocated for harm reduction measures as well as heroin prescription. He said he supported also supported needle exchanges and safe injection sites for intravenous drug users.

"The fact is heroin is very addictive," he said. "People who are addicted so often resort to crime, to steal to buy the heroin. It obviates the need for them to steal. It might take a few years but I think people will understand that if you are going to get people off heroin then in the initial stages we have to have proper heroin prescribing services. Critics say you are encouraging drug addiction but the reality is that these people are addicts and they are going to do it anyway," he added.

The most recent incarnation of heroin prescription calls began in 2002, when then Home Secretary David Blunkett first advocated for them. That call gave rise to pilot programs in London, Brighton, and Darlington in which users were provided with pharmaceutical heroin and allowed to inject under medical supervision. Those programs cut local crime rates by two-thirds over a six month period.

They also led to drug use and spending reductions. Of the 127 users involved in the pilot projects, three-quarters "substantially reduced" their use of street drugs, while their drug spending declined six-fold.

Carter's comments and the nurses' debate comes amid controversy and contention over how to deal with Britain's estimated 200,000 heroin addicts and just 10 days before British national elections. While all three parties have stressed alternative treatments for hard-core addicts, Conservatives have been attacking opiate maintenance programs, especially methadone maintenance, as morally bankrupt and are instead advocating for more abstinence-based programs.

At the RCN convention, Claire Topham-Brown, a nurse from Cambridgeshire, proposed the motion to support prescription heroin. It could be a means of harm reduction, she said, which despite some resistance from health professionals "has now become an accepted model of practice."

But not all delegates agreed. "Where would this stop, cannabis, cocaine, crack cocaine and other illicit substances? If we do this for heroin, do we have to do this for other substances, and can the NHS afford this?" asked Gayle Brooks, a member of the RCN's safety representatives committee.

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