by Mithran Samuel
How to combat hardcore heroin addiction is one of the great domestic public policy questions. Official figures suggest 10% of addicts commit 75% of acquisitive crimes in Britain, and this group appear to be the hardest to treat with conventional methods, such as methadone. So it was encouraging to learn, on Monday’s Today programme, of a scheme that appears to have cut crime rates and contact with dealers significantly. Wasn’t it? No it wasn’t, if the country’s second most popular daily was to be believed. The Daily Mail ran a story headlined: “£2.5m to treat drug addicts – with heroin.”
Yes, that’s right, the project, which is operating in London, Brighton and Darlington, involves allowing addicts to inject themselves, under supervision, with diamorphine (i.e. pure heroin).
However, two-thirds of those being treated are receiving methadone – either orally or under injection – and the project also involves round-the-clock access to nursing care, as well as counselling.
One cannot fault the Mail on laying out the positive findings. It faithfully reports the comments of King’s College London’s Professor John Strang, who is leading the trials, in an interview with John Humphreys, on crime rates (down from 40 per month per user to four) and significantly reduced contact with dealers (In fact, the 150 volunteers are now only buying street heroin four or five times a month on average – down from once a day). However, you have to get to paragraph six to find this.
The substance of the Mail piece is about the cost. It would be churlish to say this is not an issue. At £9,000 to £15,000 per patient per year, it is three times the cost of conventional methadone treatment.
But as Dr Nicola Metrebian, from the KCL team, says: “It is more expensive than standard treatment. But standard treatment, though cheaper, is not effective for this group of people, so it is not cost-effective.”
Jamie, a user of 25 years, told Today: “For the first time in my life I’m actually happy. I’ve got a life, I’m stable and I’ve got a great relationship with my family and I don’t want to lose that.”
You won’t find her story in the Mail piece while Metrebian’s comment on value for money comes in the very last paragraph. It is preceded by a series of comparisons with the restriction, on cost-effectiveness grounds, of NHS treatments by the National Institute for Health and Clinical Excellence for Alzheimer’s and cancer patients. The line of the undeserving addict receiving treatment at the expense of the deserving patient is spruced up with some comments by a trio of sources whose credentials on drug treatment are, to put it politely, minimal.
Shadow home secretary David Davis banged the drum for his party’s backing of “abstinence-based rehabilitation programmes”, an idea given short shrift by drugs charities when articulated in Iain Duncan Smith’s Breakthrough Britain report. The Victims of Crime Trust and the Taxpayers’ Alliance are also thrown in, articulating the zero tolerance law and order and anti-welfare/anti-public sector philosophies beloved of the Mail.
My favourite comment came from Alliance chief executive Matthew Elliott: “Free healthcare shouldn’t be about getting high at taxpayers’ expense.”
The scheme is yet to be properly evaluated and should only be pursued more widely if it proves good value for money in terms of reducing crime and enabling addicts to wean themselves off the drug and lead more constructive lives over the long-term. It may yet be rejected on that basis, illustrating the spurious comparison with the Nice ruling on dementia drugs, which followed substantial evaluation.
As a conservative paper, the Mail should stand up for value for money, not ideology, as the criterion of decision-making in public policy and finance.