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.       If a drug taker is determined to continue their drug use,
Marks:    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.       Cure people? Nobody can. Regardless of whether you stick
Marks:    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.       It doesn't get them off drugs, it doesn't prolong their
Marks:    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      Pure heroin is not dangerous. We have people on massive doses
Perry:    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:   S, 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 buy 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.       No, not in principle. There are patients for whome I have
Marks:    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.       I'd agree. That is what the State of England arranges. That
Marks:    there is a legal controlled supply of drugs. The whole
          concept behind that is control.

Ed:       And there are signst 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
          whih 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.

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