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.

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.