Shots at the drug pub: A controversial clinic's scheme reopens the debate on how addicts should be treated, says Mark Handscomb

BEHIND an anonymous blue door in Widnes High Street, Cheshire, stairs lead up to a room secured by a coded lock. A young woman wearing a crushed velvet hat, plenty of denim and jangling bracelets is puffing steadily on a reefer.

Jackie is a heroin addict and visits the drug dependency clinic every week for a prescription. But soon she will be abandoning the upstairs room and smoking her reefer in a cellar called 'The Black Dragon', Britain's first legal 'drug pub': in effect, a 'shooting gallery' where addicts can inject themselves under the supervision of the clinic's drug workers.

'We want to install cubicles with a sink so that everything can be done in a hygienic way,' says Andrew Palombella, the unit's general manager. 'At present, the addicts are taking their prescriptions into the park or public toilets. At least if they took their drugs here and anything did go wrong, we have medical staff on standby.

'It will be like a pub where people get their ration of the drug they are addicted to, in the way others go to the pub across the road to get their beer. As I see it, if you got a pint of lager and had to carry it home on the bus before you could drink it, you would soon go somewhere else. We want to attract people more often to the centre, and we came up with the name The Black Dragon, after the Chinese opium dens.'

The Widnes clinic has always been controversial. As one of the first to maintain, rather than attempt to cure, addicts, it was labelled a 'drug supermarket' when it opened in 1985. Ratepayers were angry about paying for a 'junkie's habit' at a time when local authorities were threatened with spending cuts. Addicts unable to get a maintenance prescription in their own area came from all over the country and gave false addresses in order to get taken on; heroin dealers, who felt their business threatened, robbed them when they emerged from chemists with their prescriptions.

Many of these difficulties were resolved, but now the drug pub is rekindling old fears.

'Objections to the scheme revolve around funding,' Mr Palombella says. 'But treating drug users in this way, reducing crime and preventing the spread of HIV means that you are making a vast saving for the health authority in the long term. We don't get a lot of people off drugs immediately, but there is steady trickle.'

For Jackie, an addict for six years and a client of the clinic for the past three, her visit is the highlight of the week. 'But it's a bit like being back at school,' she says. 'It's so strict. If you are five minutes late or don't turn up for meetings, you lose your prescription.'

In addition to smoking 22 heroin reefers a week, she has a spoonful of methadone linctus a day. 'If people have got nowhere to go and inject themselves, the best place they could do it is at a drug unit. It's better than using a public lavatory and throwing your needles away in the street where people can pick them up. People in the clinic see what you're doing and make sure you're not taking too much.

'There was a time when we thought the clinic was going to be closed down. It would have been disastrous. Drugs users would have lost their children, their jobs, all kinds of things. Everyone who uses the clinic is grateful for it. I can lead a normal life now.'

Jackie is one of about 130 drug users who pop in to the clinic to collect their prescriptions, replace dirty needles, watch television and keep themselves fit in the gym. A rummage in her shoulder bag produces another cigarette, and she talks about how she had financed her addiction by prostitution, fraud and deception. After a nine-month prison sentence for stealing chequebooks, her daughter was placed in Jackie's mother's custody. Jackie started drinking to top up the effects of the drugs and blot out her misery.

'When I was using street gear, my last thought before I went to sleep would be, 'Where am I going to get my street gear from?' And my first thought when I woke up would be to go and do it. Now I know that the drugs are there for me, without having to commit crime.'

Jackie now dreams of being able to move out of her bedsit and regain legal guardianship of her daughter. 'I look at some of the people who have been into drugs for 25 years, and I think I don't want to be like that at all. I really don't'

The Widnes clinic's policy of maintaining addicts is still a rarity in Britain. Most drug rehabilitation centres employ heroin substitutes such as methadone, intensive therapy and residential care to wean addicts off their addiction and stabilise their habit. But at Widnes and its sister clinic in Warrington they believe it is better that addicts consume pure pharmaceutical drugs instead of illegal street versions - many of which have been adulterated with chalk dust, ground glass or bleach - and encourage addicts to take drugs orally, thus minimising the risk of HIV transmission.

Counselling and advice is on hand from drugs workers and Dr Heather Parker is there to assess arrivals' suitability for a prescription. 'When we first see clients, they are offered a hospital place to come off drugs, or a detoxification programme in the community,' Dr Parker says. 'Then we find out what their drug preference is. There's no point in giving them something they are not going to use, because they will sell it to buy what they prefer.

'Once they are accepted on our programme, technically we are not treating them. We are just giving them a prescription, and a drugs worker is making sure they are not abusing it.

'We do try to take dealers on at the clinic because then they stop dealing. We think about how much we give them. If they are rumoured to be selling their drugs, they will have their prescription cut or be thrown out of the clinic.'

It was the dealers who proved a big factor in the downfall of the Sixties version of the drug pub. London had several so-called 'fixing rooms', but they were phased out in the early Seventies.

David Turner, director of the Standing Conference on Drug Abuse, who once ran a 'fixing room' in London, says the idea was to have a more hygienic setting in which addicts could take their drugs. But increasingly it became used as a dealing facility.

'Another large factor in its closure was that addicts began to use barbiturates and often overdosed,' he says. 'In the end, we were not providing a beneficial service, and several addicts told us that having the 'fixing room' made them less likely to change.'

The Widnes clinic's regime has succeeded in reducing crime in the area. The manager of Marks & Spencer in Liverpool was so impressed by the reduction in shoplifting from his store that he sponsored a local drugs conference.

However, fighting drug-related crime by giving addicts all the drugs they need has alarming implications. At the Merseyside Drug Unit, 15 miles from Widnes, Dr Sue Ruben, clinical director of Liverpool's Drug Services, prescribes methadone instead of giving addicts their preferred drug. And she questions the need for a drug pub where addicts can be kept under

supervision.

'It's a bit of a zoological approach to drug misuse. My experience of drug users is that they will not want to be seen publicly using their drugs. We have a policy which says that drug users should be treated in the privacy of their own home. A shooting gallery is dehumanising. I do not see myself as a legal drug dealer. My primary concern is to offer high quality medical care. If people want to deal out legal drugs, that's not a doctor's job, it's a publican's'

Dr Ruben fears that drug misuse may become part of normal behaviour for those in squalid housing, with little money and no hope of legitimate employment. In some cities in the United States, it is not uncommon for elderly addicts to draw their pensions at the same time as their prescription. 'I don't want to see ghettos of stoned people shuffling along on their zimmer frames,' she says. 'You can't base a prescribing policy on crime reduction.

'I am medically responsible for my patients, and I am not prepared to prescribe drugs if I believe they will make their situation worse. Addicts are often unable to make a free choice about their best options for treatment, because they are entrapped by a drug culture. Just because they are adults does not mean they behave responsibly.

'If society says the best thing to do is to give drugs to addicts, why don't we give shoplifters open access to Marks & Spencer? Why don't we say to child abusers who can't stop abusing children, 'Let's make it legal'? What do you do with the 12-year-old who starts using (drugs) because that's what the parents do?'

(Photograph omitted)