Two-thirds of heroin and crack addicts come off street drugs or reduce their use after six months of treatment, researchers report today.
The findings of the largest-ever study of heroin and crack cocaine treatment programmes, published in The Lancet, will come as a relief to drug agency workers who feared their efforts were having little impact. Heroin and crack addicts often lead chaotic lives, fuelled by the proceeds of crime, which are among the hardest to turn around.
However, the findings came with caveats over the robustness of the results, in the absence of a control group, and the length of time the benefits were expected to last. Drug addiction typically follows a relapsing and remitting course and many addicts take years to shake the habit.
There are an estimated 330,000 problem users of heroin and crack cocaine in the UK of whom 180,000 receive treatment each year. Heroin addicts are given methadone on prescription, a non-euphoric opiate that removes the craving for a fix but allows them to stabilise their lives. Some also receive cognitive behaviour therapy or counselling. There is no pharmacological substitute for crack cocaine and these addicts receive only psychosocial treatments.
The study involved 14,656 patients from 1,000 community treatment agencies across England who received at least six months' treatment in 2008. The findings showed 42 per cent of the heroin users reported having stopped using the drug and 29 per cent reduced their use in the month prior to their assessment. Among the crack users, 57 per cent stopped and 8 per cent reduced their use. Success rates were lower among addicts who used both drugs. The researchers said this could be because they were the most hardened addicts or that crack may reduce the effectiveness of methadone treatment.
"Heroin and crack cocaine corrupt the way we think, remember, make decisions, plan and behave," said John Marsden, of the Institute of Psychiatry, who led the study. "These people have had their lives messed up big time. This is the largest study of the most commonly available drug treatments in England and unequivocally concludes that present drug treatment for heroin and crack addiction is very effective in the first six months."
Colin Bradley, of the National Treatment Agency for Substance Misuse, which funded the study, said treatment had expanded hugely in the past eight years and waiting times had plummeted from over a year to a few weeks. "We have doubled the numbers in treatment, there is a greater choice of services and psychosocial treatments are much more widespread," he said. "But it's a first step – people do not respond in a uniform way."
Treatment with methadone costs £3,000 to £5,000 per year per addict and the average period in the programme is 10 months. The total national cost is £800m a year.
Thomas McLellan, deputy director of the White House Office of National Drug Control Policy in Washington says in a commentary on the findings in The Lancet that serious addiction is best considered as a chronic condition, like diabetes or high blood pressure. Short-term interventions may not produce long-lasting effects, he warns. "It may be more reasonable to expect enduring improvements through sustained outpatient clinical management with drugs and behaviour therapies," he added.
Case Study: The former heroin addict
Stuart Hagues is a 32-year-old single father of a four-year-old, Ethan, living in Southampton. A drug user since the age of 12, he has been on methadone and off heroin for almost a year. He is studying for a Drug and Alcohol National Occupational Standards (Danos) certificate and volunteers to help with substance-misuse programmes.
"I came from a good background: my parents work, my brother works. It was just a case of the wrong time, the wrong place and the wrong estate where I came from in Hull. I was the youngest in a group of eight or nine and was led astray. I have been taking drugs since I was 12 – cannabis, LSD, speed, and then buprenorphine [an opiate]. I was 15 when I first took heroin. I was taking it weekly at the beginning but it escalated into crime, burglary and drug-dealing.
"I was arrested for burglary, and I have been on and off methadone ever since. I have been in detox 17 times and put forward for rehab.
"Getting off drugs has been hard. It is hard to get a job, as I left school with no qualifications. The physical withdrawal may last only four or five days, but mentally it is a battle for the rest of your life.
"Methadone has probably saved a lot of lives but methadone won't cure anybody unless they want to sort themselves out. This time, they told me, 'Sort your life out or you will lose your son'. At some point, it was die or stop drugs."
Of crack users in treatment give up the drug.Reuse content