'I get my heroin on the NHS'

Get caught with heroin and you face seven years in prison. But not Erin O'Mara, one of 440 addicts in the UK to get a regular fix from an NHS prescription - an arrangement she says has turned her life around.

Erin O'Mara is a bright, bubbly magazine editor - hardly the stereotype of someone who injects heroin four times a day.

But her habit, now in its 20th year, does not line the pockets of a drug dealer. The 34-year-old gets her fix from her local chemist in west London. This "perfect prescription", as she calls it, began two years ago and rescued her from a life of prostitution, drug dealing and serious illness.

The downward spiral began with Erin's first taste of heroin aged 15 while in her native Australia, and has included 10 unsuccessful methadone programmes along the way.

To finance her habit, she began working as a masseuse, which led to escort work and then street prostitution. That stopped when she discovered she was HIV positive.

But the prescription has transformed her life. As founder of Black Poppy, a magazine by and for drug users, she addresses drug conferences and is being consulted about pilot projects.

Sitting in her office, she says: "My prescription has meant I have money now, and choices I can make in my life - simple things like what I want for dinner. I can do things I haven't done for years and can think five years ahead. Before I was just thinking about my next 'hit'."

Each shot supplied by her chemist is just enough to enable Erin to function properly and prevent the onset of withdrawal. She only feels the buzz if she relaxes.

The NHS allows only licensed doctors to prescribe diamorphine, the medical name for heroin, to addicts if they have failed to respond to methadone treatment. At present just 0.5% of those in treatment are prescribed heroin, but new pilot projects are expected to increase that number.

Supporters of this policy, such as the independent research group DrugScope, say controlled distribution by the state can drastically reduce crime.

They also argue that clean heroin like diamorphine is not in itself dangerous, just incredibly addictive. And a pharmaceutical prescription excludes all the risks associated with unsafe injecting and enables the user to gradually be weaned off the drug.

Topped up doses

Erin believes this approach can save lives. But prescribing heroin is not always the answer, as she herself knows from the first programme she took part in in 1998.

"The whole set-up was really oppressive and heavy-handed, but the doses were too low so people were using other drugs and too scared to admit it. No-one was happy and no-one was doing well on it. The carrot and stick approach doesn't work because you can't punish users enough to make them stop".

One patient, a 45-year-old woman, threw herself off a tower block two days after being penalised by having her prescription withdrawn, Erin says.

And with strict attendance requirements and supervised injections, it prevented users from getting full-time employment.

Erin claims she was forced off the course after 18 months when she tried to start a support group. She then founded Black Poppy to give a voice to drug users, and address issues missed by treatment programmes.

After leaving the prescription programme, Erin was put on methadone injections, which she topped up with crack. This period was one of her lowest and her veins began to collapse.

When she heard about a vacancy on a pioneering prescription course at the Maudsley Hospital in south London, she cornered the doctor in charge at a drugs conference.

"I remember my sense of complete and total desperation. I felt I could not go on any longer, that if they didn't help me, I didn't know where I would be. I felt that this was my last hope, that I'd tried everything. And I begged."

Her powers of persuasion paid off and she joined what turned out to be a more flexible programme. She was able, for instance, to spend a few months at her mother's in Colchester and pick up her prescription from a local chemist, so long as she visited the doctor every fortnight.

Her immune system strengthened, and two years on she is on a reduced dosage and aims to come off heroin completely.
As she looks to the future, there is a trace of anger about the years spent on and off treatment programmes.

"Why did I have to wait until I'd finished selling my young body to men, until I'd got sick and deeply depressed, until I'd used every vein in my body from my neck to my feet, until I'd contracted both HIV and Hep C?"

But she is optimistic that the government has begun to move in the right direction and listen to what drug users want.

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Thursday, 8 April, 2004,

'I get my heroin on the NHS'

By Tom Geoghegan
BBC News Online
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Link

This is good to see. At least the UK is heading in the right direction when it comes to drug addicts. The US just likes to shove these people into overcrowded jails.

Wake up George W

~VD

Give us our heroin!

Crazeee said:

They also argue that clean heroin like diamorphine is not in itself dangerous, just incredibly addictive.

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so what negative effects does clean heroine have on your body? i dont really know much about heroine so i'm interested in finding out a little more about it. if any current users have any comments about their own experiences health wise, i'd be thankful

i think heroin doesn't harm your body if its 100% pure stuff. it's just addictive in this form.

the only negative things i've heard about heroine are just the basic ones that everyone knows. that you could od(not really a negative but just something out there), that its addictive (again not really a direct negative effect on your health but it could lead to some i guess), get diseases such as hiv if u share needles and that it could do some substantial damage to your veins. but other than that i havent read/heard anything about braindamage or it being bad for your heart etc. i guess i'ma have to start researching. but i would still very much appreciate first hand experiences from real users.

other than chronic constipation, opiates and opioids (clean and measured ones of course) do not harm the body in any way. Yes, vicodin can harm your liver, but only because there is APAP mixed up in there with the hydrocodone (which won't cause any damage at all). Any health problems caused by heroin, other than a deadly overdose (which is by definition entirely preventable), are all negative externalities to prohibition (dirty chemicals, dirty needles, unmeasured quantities) and not to the drug itself. Heroin is no more worse for you than morphine, which it metabolizes into within your body in a few short minutes after administration.

^ I consider myself "healthy", yet I know that I have a mild physical dependence on caffeine - I experience withdrawal symptoms if I don't have it every day. I think we need to get away from the "addiction = disease" paradigm. Heroin dependence is a problem if you have trouble getting your heroin - a pharmaceutical supply at cheap prices removes that. There may be other problems associated with prescription heroin - do you need to visit the same pharmacy every day, or can you get takeaways. Do you get treated well by the health professionals you need to interact with to get your dose, or are you still treated like scum - etc etc. Maybe if you could buy a jar of heroin like you buy a jar of coffee, then you could truly have a hassle-free habit. I don't think repetitive behaviour should be seen as automatically problematic - it's very human. For example - do you always tie up your shoe laces in the same way, or always sleep on the same side of the bed? How hard is it to change these things? Are you unhealthy if you can't or won't? How different is this to substance dependence?

^ Here's an interesting story about heroin consumption in Australia. For the first half of the 20th century, heroin was freely and legally available in a range of medicines and tonics, including cough mixtures and teething mixtures for babies. There is no doubt that some of this heroin was used recreationally, and that some people became dependent as a result of that use. At the time heroin was made illegal in 1953, Australia was the biggest per capita consumer of heroin in the world. As a nation we consumed about 5kg of heroin that year. Since prohibition, use levels have climbed steadily - we currently consume about 300kg of heroin a year. Curious, isn't it? Now, don't get me wrong - simply putting heroin back on the supermarket shelves is potentially disastrous. I think it is fair to say that this is because years of heroin prohibition have fostered an abstinence/addict dichotomy towards this drug within society (Zinberg talks about this in "Drug, set, setting"). In my ideal future, heroin and other drugs would be freely and legally available - but we have a lot of work to do before we are ready for that scenario. As an aside, I think it is fair to use severity of withdrawal as an indicator to assess level of problem (eg - caffeine vs. heroin withdrawal). But, like any risk assessment, it's probably fair to throw in "chance of experiencing withdrawal" as well. As that chance approaches zero, the significance of severity of withdrawal diminishes. Oh yeah - and sleeping on a particular side of the bed - relationships have foundered on this!

Good article, i have spoke to Erin before. As for getting heroin on the NHS its a joke. Erin is lucky she has one of the best docs i have heard of in the UK who happens to be interested in addiction. Note only 440 ppl are on heroin. I used to be, but i had to pay for mine through private script: cost of what Erin gets per day would = 20ukp. i am not sure whether tax payers should front that.

diacetylmorphine is less harmful physiologically than paracetemol.

if you discount the problems related to dependence, it really does have no adverse affects. and most of the health problems chronic users suffer stem from a combination of an unhealthy lifestyle and impure drugs / bad administration technique.

for a definitive treatment of heroin's physiological, psychological & societal impact, i recommend Jara Krivanek's excellent 'Heroin: Myths and Reality', published by Macquarie University Press, in 1988 iirc.

fruitfly said:

^ You've spoken to her? Could you try to find out if Black Poppy is on the web anywhere?

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Havent spoken to Erin since she launched BP. i wrote and got published in their first edition.

their site doesnt seem to be finished. i'd send her an email, i am sure she will send you the magazine free, she used to send me them. That was about 5 yrs ago.


have pm'd some of her email addresses, not sure which one she uses now.

Diamorphine is without doubt the most benign drug in terms of toxicolgy to the body. I was on it for about 6 yrs. It never caused any problems other than addiction. Whereas methadone amps (the alternative to diamorph amps the gov. wants to prescribe, cuz they last longer) these really do cause vein damage.

^i agree. although i am sure if the BBC had aired this article on it "have your say long enough........ Only about 6 replies were printed. I would imagine many would have been unprintable.

Regarding the wider issue of heroin being prescribed. Its a political joke. 440 people out of about 40,000 registered users = not many.

Also the criteria only applies to those who are the worse criminals, not those at the most risk. Erins case is so rare. she was just very lucky to have a gr8 GP.

I think this wont happen generally as GP's generally have to fight local, usually crap, drug services to get drug patients - how many actually would want them?

Then it comes down to who would work 3 x 8 hour shifts 7 days a week to administer the diamorph, or would they let the person go home with weekend take homes - enough to kill 50x the amount Dr Harold Shipman managed with his diamorphine. Its also upto the drug addicts themselves (like Erin) to pretition their doctor/drug worker - this is much harder for many than one might think. Power features a lot in drug services.

It just aint gonna happen. Although it should. My veins would be happier chappies if i had stayed on diamorphine, although the cost privately was too prohibitive.