Theodore Dalrymple

Withdrawal from heroin is a trivial matter

Theodore Dalrymple is outraged by the mollycoddling of drug addicts coming off heroin and the notion that their predicament is a matter of human rights

Text settings

We live in Keynesian times: the answer to the economic problems created by a mountain of debt frittered away on trifles is clearly a whole mountain range of debt frittered away on trifles. In the circumstances it is good to know that a judge has done his bit to stimulate the general improvidence — sorry, the British economy. He has awarded £11,000 each to three prisoners in Winchester Prison who underwent withdrawal from heroin without benefit of further doses of heroin or of methadone and other heroin substitutes. It was against their human rights, he said.

This is indeed odd. It is doubtful whether anyone ever dies from withdrawal of opiates alone. In reviewing the medical literature between 1875 and 1968, the doctors and researchers Glaser and Ball were unable to find a single case of death from withdrawal of opiates, despite the fact that the literature covered many thousands of cases.

Indeed, such withdrawal is medically triv-ial, unlike that from alcohol and barbiturates (and sometimes even benzodiazepines such as valium). Let me quote Niesink, Jaspers, Kornet and van Ree’s book, Drugs of Abuse and Addiction: Neurobehavioral Toxicology: ‘[Withdrawal] is time limited... and not life-threatening, thus can be easily controlled by reassurance, personal attention and general nursing care without any need for pharmacotherapy.’

By contrast, 2,845 people died of methadone poisoning in Great Britain between 1996 and 2005. In 2006, 241 died of methadone, and 713 of heroin or morphine poisoning. In 2007, the figures were 325 and 829 respectively. In Dublin, more people die of methadone poisoning than of heroin poisoning.

I repeat, no one dies of opiate withdrawal. I might add also that doctors have a very long history of treating the trivial condition of withdrawal from opiates in a dangerous, indeed fatal fashion.

It goes without saying that we are all furious at Mr Putin’s treatment of Georgia, but few of us realise that the drug addicts of the country whose president brokered a ceasefire between Russia and Georgia — France — have caused far more harm to the population of that country than Mr Putin’s Russia.

They have systematically diverted the drug with which their heroin addiction is ‘treated’, buprenorphine, to Georgia (as well as to Finland, incidentally), where scores of thousands of Georgians have addicted themselves to it. The fact that the French addicts have diverted it in this fashion is eloquent testimony to how much they needed it in the first place, and how easily they were able to deceive doctors.

It might, I suppose, be argued that such drugs as heroin, methadone and buprenorphine are potentially safe when given under strict medical supervision; but such supervision is extremely difficult to enforce, given the levels of duplicity, deviousness and dishonesty among the population for whom they are prescribed. In one Canadian case, for example, a woman in a prison prescribed methadone for her withdrawal symptoms vomited it to sell it to another prisoner, who then died of an overdose. Guess whom the relatives of the dead woman sued?

The evidence is pretty conclusive that the great majority, though not quite all, of the suffering caused by withdrawal from opiates, insofar as it is real and not feigned, is psychological in origin and caused by the mythology surrounding it. In the 1930s, experiments were done demonstrating that morphine addicts could not reliably distinguish between injections of water and morphine: when they received water thinking it was morphine, their symptoms abated, but when they received morphine thinking it was water, they grew worse.

It has also been established that the distress of withdrawal is not correlated with the physical severity of withdrawal symptoms, and is often at its worst before, not during, withdrawal.

Even accepting the ludicrous, corrupt and corrupting doctrine of human rights, it is difficult to see how it can be a human right to have a non-life-threatening condition transformed into a life-threatening one by supposed (and ineffectual) treatment. The old medical adage, first do no harm, ought to take precedence, and therefore the presumption must always be against, not for, treatment for withdrawal. That so evident and unassailable a point did not prevail in court, instead landing the British taxpayer with a total bill that no doubt ran into hundreds of thousands of pounds, is deeply emblematic of the moral and intellectual decadence into which we have fallen.

This is not an isolated instance of it, either, even in the relatively small question of how we conceive of heroin addiction. The Sentencing Guidelines Council last week suggested that first-time offenders who steal from the vulnerable should be given stiffer sentences than they currently receive, but that courts should not send drug addicts who steal to ‘feed their habits’ to prison, but should consider instead drug or alcohol treatment programmes.

The Sentencing Guidelines Council was attempting, as it has so often done in the past, to mislead the British public into thinking that the law has become harder on criminals when in fact it is becoming more lenient. The class of the former type of offender — the first-timers who target the vulnerable — is of course very much smaller than the second class, the addicted thief, robber or burglar.

Thus, despite the impression given by headlines that say ‘Stiffer sentences for first-time offenders’, what is being proposed is a reduction in severity of sentencing.

Now it does not follow from the fact that many thieves and burglars are drug-addicted that they are thieves and burglars because they are addicted. In fact, the evidence suggests that the relationship is the other way round: that whatever causes them to become criminals causes them to become addicts.

In a survey in the prison in which I worked, I found that the great majority of heroin addicts sentenced to imprisonment had been imprisoned for the first time well before they ever took heroin. Since most people are convicted about ten times before they are sent to prison, and the clear-up rate of crimes is about 5 per cent (and even that, thanks to police dishonesty, is an exaggeration), it is likely that many of them had committed dozens, perhaps hundreds, of crimes before they ever took heroin. Therefore, it cannot be that they are criminals because they are addicted.

Heroin addicts are not ‘hooked’ by heroin, as fishermen take fish; they ‘hook’ heroin. Most of them take it intermittently for quite a time before they take it regularly and become physiologically addicted to it. Moreover, taking opiates by injection is not incompatible with normal working. In the 1930s, the majority of morphine addicts in America went to work normally.

Moreover, the Sentencing Guidelines Council must know that the Audit Commission recently found that 75 per cent of addicts did not even comply with the kind of community sentences that they recommend, and that Home Office research found that the re-conviction rate within two years of people given such sentences was 90 per cent, i.e. the re-offending rate must be close to 100 per cent.

The Sentencing Guidelines Council is therefore aiding and abetting crime on a huge scale, and ought to be disbanded forthwith. Addiction should be treated as an aggravating circumstance, and an automatic additional five or ten years ought to be added to addicts’ sentences: that is, if the peace of the poor, who are the primary victims of crime, is to be protected by the government and the criminal justice system.