Wednesday 15 November 2006
Deborah Orr: It is undeniably cruel to force 'cold turkey' on prisoners, but this legal action is wrong
It won't puncture the arrogance and self-pity that assist addicts in justifying their behaviour
Since I've had the misfortune to have observed a human mind and body undergoing the privations of "cold turkey", I'm under no illusions about how punishing the process is, even when it's voluntary. What must be involved in subjecting a person to such an experience against their will, though, I simply cannot imagine.
Trespass? Definitely. Assault? Assuredly. Cruel and degrading treatment? Unarguably. Anyway, this has already been established. A precedent was set not by the class action that resulted yesterday in a £750,000 compensation pay-out to 197 forcibly detoxed prisoners, but in a similar case brought before the European Court by an imprisoned heroin addict in 2003.
It may seem bizarre to many people that an addict who ends up in prison has the right to complain when his self-inflicted cravings are not attended to in a way that is agreeable to him. But the fact remains that addicts are ill, and that even in prison people should be given a proper standard of medical treatment. Punitive regimes can no more be applied to addict prisoners than they can to prisoners who turn up with gangrene.
Descriptions of withdrawal managed through the complete denial of methadone to prisoners who were reliant on the synthesised heroin substitute before sentencing, or of dosages being reduced at an extremely fast rate, contradict entirely the guidance issued last year by the Royal College of General Practitioners.
This guidance also warns that "enforced reductions in the methadone dose and putting pressure on patients to become abstinent from methadone are associated with poor outcomes". If one can't swallow the idea that the way these prisoners were treated was morally wrong, it has to be accepted at least that it was highly likely to have been a waste of time, energy and resources for all concerned.
Nevertheless, it is a pity that we do not know more about the individuals whose interests are being represented in the case. The six men whose treatment came under scrutiny appear to have been forcibly detoxed in the early 1990s, and nothing is known of the pattern of their recovery since then. Perhaps others have received similarly barbaric and counter-productive treatment more recently. But they should not have, not least because the NHS took over responsibility for drug treatment in prisons in 2004. Further, all prisoners have had since 1999 the option of accessing Carat, or Counselling, Assessment, Referral, Advice and Throughcare Teams, who help prisoners to plan recovery programmes.
Certainly, drug counsellors working in prisons talk of the frustrations they often face when attempting to get the theory and the practice to resemble each other (and often burn out very quickly). For sure, problems with moving prison drug policy forward further remain, and projected funding for new programmes has been cut viciously. But if these prisoners are, as their barrister, Richard Hermer, would have it, acting in the public interest to challenge the Home Office on principle, it remains difficult to see exactly what beyond their personal compensation they could be aiming to achieve.
A nagging worry is that a legal action such as this feeds the very psychological problems that hamper the ability of addicts to recover from a condition that is as much a complex mental illness as it is a simple matter of chemical dependence. Addicted prisoners unwilling to tackle their dependency problems will have been following this case with interest. The message it sends to them is unlikely to puncture the arrogance, self-importance and self-pity that typically conspire to assist them in justifying their behaviour.
Although some credence is given to the idea that addiction can be treated as a psychological rather than a medical illness, most professionals remain wedded to the concept of management rather than abstinence. The latter is largely seen as overly rigid and judgmental, even though at the same time the preferred method of methadone prescription itself can be argued as being mired in similarly loaded judgements. Many would argue that methadone is favoured over diamorphine (medical heroin), even though it is more toxic and more addictive, for reasons related more to the policing of the line between legal medicaments and illegal drugs than to successful outcomes. A policy brought in by the Home Office in 2002, when David Blunkett was in charge, aimed to increase the number of GPs licensed to prescribe diamorphine to addicts from 50 to 1,500. But it just never happened.
No wonder GPs are chary of becoming involved. A few days ago retired addiction expert Colin Brewer was struck off the medical register by the General Medical Council, after a vast two-and-a-half year investigation. He was judged to have over-prescribed drugs in his efforts to manage the addiction of his patients at two private clinics, as well as having prescribed drugs in inappropriate combinations.
Despite the clear and long-standing reluctance of the medical establishment to become involved in getting heroin addicts off the streets and out of prison by the simple expedient of providing them with heroin, the idea remains beloved by the liberal intelligentsia. Many ardent reformers will prate on endlessly about the beauty of this particular treatment, and the ability of addicts given legal heroin to be fully functioning members of their family, community and workplace. All this is true up to a point, as it is true up to a point for those who function on methadone.
Both are better than chaotic drug use, for sure. But it's quite wrong to suggest that people on these drugs are okay. They are far from being so. They are emotionally absent, and detached from reality. The very idea that people can be so dependent on a drug that does not alter their interface with the rest of the world is a nonsense.
On Monday night I had the privilege of hearing a 36-year-old man called Spencer standing before a large crowd at a fundraiser for Rapt, a trust that supports addicted prisoners. He told of his own years of addiction - the family he abused, the child he abandoned, the business he destroyed. He was merciless in his description of himself as having no concern for other people and no morals. He'd been in prison three times before he got his act together, and all of his convictions resulted from his need to pay for drugs.
Referred by a Carat team to Rapt, he embarked on a 12-step programme of abstinence and hasn't touched drugs or alcohol for four years. He owns and runs a garden centre in south London, and is engaged to be married. How did he do it? By taking responsibility for his own recovery and his own life. Legal actions such as this one against the Home Office, however much they should be supported in the name of our own civilisation, may be telling addicts, unfortunately, that this is something they need not do.
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