Anders Ulstein: Beware fake news about the wonders of doling out free heroin to addicts

Following Chief Constable Mike Barton's recently published plan to hand out free heroin to addicts in Durham, drugs legalising lobbyists have been at pains to demonstrate that this is indeed a rational approach to dealing with extreme addiction and the criminality that accompanies it.

Mr Barton’s approach has widely been justified on the basis of  British heroin prescription trials in which free heroin has been handed out to addicts at great expense to taxpayers, funded by the Department of Health since 2007. The Lancet reported (29 May 2010) their first stage  - officially designated as the Randomised Injectable Opiate Treatment Trials (Riott). As I wrote at the time, this paper was widely promoted as evidence of their success.

It was misleading. A detailed reading of the data presented revealed very limited gains. Only five out of 43 clients – who received a 450 mg of legal heroin twice a day plus a nightly oral methadone supplement over a 26 week period – managed to get off street heroin.

The remaining 38 decreased their consumption of street heroin while on the  prescribed heroin but remained involved in the illegal heroin market; that is they were still involved in the crime, harm and misery related to it.

Ignoring these results, the authors made the following recommendation based on their study: "UK Government proposals should be rolled out to support the positive response that can be achieved with heroin maintenance treatment for previously unresponsive chronic heroin addicts.” It  prompted the Department of Health into further action, who awarded  three-year contracts to South London and Maudsley NHS Foundation Trust (SlaM) in 2010 and two mental health trusts in 2012 to provide supervised heroin treatment in London, Darlington and Brighton.

However, the really significant and surprise finding of these trials was that, even when offering free heroin, the programme had such a limited impact on the use of street heroin. It was also far costlier than rehab – up to five patients could go to an abstinence based rehab with a possibility of becoming drug free for the cost of each one still on drugs and with unchanged lifestyles in the Riott trial.

The cost of heroin prescription per client was then - nearly a decade ago - estimated to be about £15.000 a year, far more than for other treatment options. As Kathy Gyngell has pointed out, the trials' authors have had to concede that the huge costs, in return for the restricted  benefits, would not be acceptable to public policy makers.

But the original misleading media coverage of this report have remained in the public domain and is once again being invoked.

Even Reuters fell victim to the prescribers' interpretation. "Prescribing heroin to addicts who can't kick their habit helps them stay off street drugs, British researchers said", under the headline: "Prescription heroin helps addicts off street drugs". It was and is misleading.

Associated Press reported: "Some heroin addicts who got the drug under medical supervision had a better chance of kicking the habit than those who got methadone, a new study says", under the title "Study: heroin better than methadone to kick habit".

First of all, to "kick the habit" means to get off the addiction. The aim of the trial was not to get people off addiction, and it did not even measure that. Second, the study did not say that heroin is better than methadone, it suggested that for some hard to treat clients (5-10 per cent of the heroin addicts) heroin might give better results.

Such inaccurate and misleading reporting by the world's two most serious news agencies should worry everyone who is interested in how science is translated.

For what this trial illustrated was the limitations of such harm reduction measures rather than the strengths. It also illustrated how scientific results may be distorted and misleading, possibly intentionally.

Finally, the researchers who constructed these trials displayed a profound lack of understanding of what addiction is. The report's lead author Professor John Strang said  the results shows they have "turned around" the users' drug problem. All that was in fact "turned around” was but  a small aspect of the symptoms of addiction in a small group of people. The drug problem was not turned around and neither was the root addiction problem.

The study is called Supervised injectable heroin or injectable methadone versus optimised oral methadone as treatment for chronic heroin addicts in England after persistent failure in orthodox treatment (Riott): a randomised trial, written by John Strang and colleagues.

Anders Ulstein is the former General Secretary of EURAD, a network for prevention treatment and recovery

(Image: Cristian C)

Anders Ulstein

  • Colkitto03

    The real win for society here is the potential for a significant reduction in crime that funds addiction. Burglary, shoplifting, theft etc.
    In addition it is also known that the vast amount of street prostitution is due to heroin addiction. Surely getting these ladies off the street is a possible good outcome?
    We have tired prohibition for 50 years and how is that working out?
    Heroin is a horrible destructive drug, giving it to addicts is distasteful but in the absence of any present successful solution why not give it a try? We can always stop again.

    • Coniston

      Will it indeed reduce crime – or drug taking? See Theodore Dalrymple’s article “Don’t legalise Drugs”
      https://www.city-journal.org/html/don%E2%80%99t-legalize-drugs-11758.html

      • Colkitto03

        No one is suggesting legalisation. I agree that legalisation would wrong. This is more about addiction management for the good of society and individuals.
        After all we already prescribe addictive antidepressants to hundreds of thousands of people through our medical community. This is not a direct comparison but it does show that we can manage something similar.

        • The prescription of antidepressants is something that needs to stop too – they are ineffective at stopping depression and are found to be about as good as a placebo – something the drug companies kept hidden. The medical model of treatment for ‘depression’ does not work and is wrong.

          • Colkitto03

            I agree, they are vastly over prescribed. And I struggle to see the any benefits.

          • Then maybe you might be aware of the over-prescribing that could take place with morphine for ‘addicts’ then. Because this ‘therapeutic’ morphine will be open to the same abuses and misinformation as antidepressants.

          • Colkitto03

            One would have to balance the reduction in crime (and its vast cost) and the huge impact on victims of crime against the downsides you highlight.
            It is a case of the lessor of two evils. Time to give pragmatism a try.

            As I said in my original post we have had fifty years of the status quo.

            In that time i would suggest that hundreds of thousands of people have been burgled an 100s of millions spent on Policeing. In all that time also many thousands of women have suffered the cruelties and indignities and dangers of street prostituion.

          • davidraynes

            50 years of the status quo?

            Wrong.

          • Colkitto03

            Sorry, I don’t understand you.

          • davidraynes

            The current regime and the RIOTT trials are obviously not a regime we have had for 50 years.. Everything has not been static.

          • Gaol will prevent them from committing crime – because if you give them “free” morphine they will soon find that this is not enough (tolerance levels will change meaning they need more, not less) and return to stealing to fund more. This happens with the methadone program now and will be the same with morphine.

          • Colkitto03

            As I said above the lessor of two evils.
            The human and financial cost of heroin addiction is simply vast. Medical management would shift many users into the sphere of authority and out of the sphere of criminals. From there tactics for rehab can be deployed when the user is ready.

          • Colkitto03 wrote:

            From there tactics for rehab can be deployed when the user is ready.

            You see? That’s what the Nanny State hates: people who won’t do what they are told when they are told. Nanny knows best and her subjects will go into rehab when she tells them to, for their own good.

          • Charles Dawne wrote:

            Gaol will prevent them from committing crime … ‘

            Hanging was once thought to prevent that, as was transportation. When Charles Dickens, within whose lifetime the last public execution was carried out in England, was a small boy there were more than six hundred (600) crimes for which one could be hanged in England, including stealing a loaf of bread.

            It doesn’t take a great deal of brain to understand that people who have little if anything to lose are not deterred by the possibility of apprehension, conviction and punishment.

            Gaol prevents criminals from offending only while they are in gaol. How are they to be dissuaded from ‘offending’ when they are at large?

            That aside, drugs are more easily available in prison than on the street, and without the risk of arrest. How do you propose to address that particular problem?

          • Bik Byro

            Yeah, maybe people could have one of your whackjob religious therapy sessions instead.

          • Bik Byro wrote:

            Yeah, maybe people could have one of your whackjob religious therapy sessions instead.

            You’ve evoked an amusing memory: what you’ve written is that when one belief fails another might do just as well. That chimes with a scene in Withnail and I in which Danny asks ‘why trust one drug and not another?’

        • Coniston

          A wider issue is why, in our advanced, prosperous society, do drug taking and the use of antidepressants keep rising? Why is family break-up increasing all the time, leading to ever higher welfare bills?

    • We have tried ‘prohibition’ of theft for hundreds of years and people still steal – perhaps we should try curbing thieves by setting up ‘clinics’ whereby they can take a smart phone or alloy frame mountain bike…

      Or we can make the police do some preventative work instead of reacting to crime and pontificating on laws they don’t like enforcing. Rehab in the form of cold turkey in gaol works and keeps them off the street so they are not a nuisance to the rest of society.

    • davidraynes

      There is no such “win” or even much potential of a “win”. More than that administering an addictive drug to patients and continuing them in their addiction, “to reduce crime”, even were it possible, would be the wrong social reason. Addicts deserve better than that.

      A moments thought will tell you that street prostitution, burglary and shoplifting have numerous causes, they existed way before heroin addiction. Other causes include poverty, homelessness, mental illness and other addictions like for example crack cocaine.

      No one is suggesting giving addicts crack. Maybe you are?

      Most addicts want help to get free of addiction, so that is where society should focus money and effort. Maintaining addiction, maintaining dangerous injecting practices, does nothing for addicts and the evidence is that most addicts receiving such treatment do not abandon street drugs. If they are dealing to support their drugs habit, they will be able to continue dealing.

      Even Professor Strang, who led the RIOTT trials, told me that he does not think it has a very wide application. We should therefore be very suspicious of drug legalisation campaigners who seek to extend the applicability.

      • Colkitto03

        Neither I not the Durham Police are suggesting legalisation, with respect that is a straw man.
        Also society can choose to provide heroin and also rehabilitation. It is not a matter of only having one or the other. We can do both.

        When Steve Wright killed five women (all addicts) in Ipswich in 2006 we saw that the women in question were driven by thier addiction onto the street despite knowing the terrible danger they were putting themselves in.
        I would suggest that if they could have had access to free heroin then possibly they may have been alive today.

        • davidraynes

          Yes they are, I have debated the P&CC. More than once.

          I have also debated with their noisy supporter the Transform Drug Policy Foundation the single issue drugs legalisation/normalisation pressure group, financed by George Soros.

          “Free” Heroin is of course NOT “free”, it is enormously expensive to provide, The heroin itself is relatively cheap but the surrounding infrastructure is hugely expensive and ties the addict to their clinic in a way that longer lasting methadone does not, since it has to be available for so much of the 24 hour period. and seven days a week, 365 days of the year

          Your “free heroin” to addicts (or any other drug) is a continuing open ended and inevitably growing commitment for NHS resources, with huge “opportunity costs” for the staff resources involved.

          Better surely to spend funds on genuine treatment.

          • Colkitto03

            The infrastructure is already in place. Pretty much every GP in the UK will give out methadone ( which is addictive) at the moment to a couple of their patients.. So what would be the big additional cost of replacing that with heroin?
            In fact in the USA about 250,000 are on Methadone (I don’t know the UK figure)
            As I said above, why not try it out? Nothing is set in stone.

          • davidraynes

            “why not try it out”.

            Did you read Ulstein above?

            You also appear to be unaware that the UK has more experience of providing heroin to addicts than any country in the world, internationally it is even called “the British System”.

            We did it from the 1920s Rolleston Committee through to the 60s, it was largely abandoned then because it was not achieving objectives. That system just about coped with up to 2000 registered addicts. It could not cope with drugs sue as a lifestyle choice.

            After the abuses of the 60s, only Home Office Certificated Doctors are allowed to provide heroin to addicts, none of the 100 or so show much enthusiasm.

            You imply giving it out like aspirin through existing infrastructure i.e. ordinary GPs.

            Heroin cannot just be prescribed like that, it talks a lot of time, care and understanding of the patient. Including what their toleration might be.

            That all costs a huge amount.

          • Colkitto03

            You are talking about 90 and 50 years ago respectively. Because something may have failed in the past then that does not mean it cannot be approached.
            In those 50 years how many addicted prostitutes were murdered? How many were beaten or raped? How many addicts died through overdoses? How many died because of wrongly cut heroin? How many got AIDS through dirty needles? How many people were burgled, robbed or mugged? How many spent years in prison? (not actually expecting you to answer these)
            At the moment criminals control the world of heroin. Maybe the state should try and take some element of control away from them? Rehab only deals with those who want help. It cannot stop the supply of new addicts that appear every year.

          • davidraynes

            One of the reasons the British System was largely abandoned was because although it had been suggested that prescription destroyed the criminal market, in practice it was found it did not.

            A criminal market existed alongside a legal prescribed market and there was also some spillage from the prescribed heroin into the illegal market.

            Now it is true that leakage can be restricted (although there will be corrupt Doctors) by ensuring addicts use the heroin on the premises where it is prescribed, that does not prevent the addicts still accessing the illegal market or the parallel market existing.

            As you (almost) point out. New addicts do not get that way by access to legal supply. New users get into heroin by being turned on to heroin by existing users. The more continuing addicts there are, the more use is normalised the more new users there are likely to be.

            Normalising heroin use through prescribing on a large scale, enlarges the local market. The heroin market in Liverpool and about, really took off when John Marks was prescribing on the Wirral.

            Of course that is not what revisionist legalisation advocates will tell you about the John Marks prescribing. My perspective is different because I was working in law enforcement there at the time, I witnessed Liverpool and about, becoming the drug trafficking capital of the UK in the 80s.

            The suggestion you make that the market can be taken from criminals is a very silly unjustifiable old canard, when the UK prescribed heroin to almost anyone who wanted it, that did not stop a growing criminal market., supplied in the 60s, by Chinese Triad criminality.

            An interesting feature of that Chinese criminality is that under pressure from the Turks it moved its main target from the Netherlands and UK to Canada and specifically Vancouver, giving Vancouver its huge heroin problem.

          • Colkitto03

            When the USA ended prohibition in 1933 it destroyed the illegal market within weeks.
            When the UK made Abortion legal in 1967 the amount of illegal (and dangerous) back street abortions slumped.
            Now I’m sure that there is still some moonshine made in rural states and quite possible back street abortions still happen in the UK. The incidence of both was massively reduced.
            But both are very good examples that contradict what you say. Markets can be taken away from criminals.

            Incidentally Morphine was perfectly legal over the counter drug in the USA until 1925. Criminalizing it handed it over to the criminals.
            As recently as the 1950s, heroin was a medicine prescribed by family doctors in the UK.
            Now yes in both countries opiates caused addiction and misery, but it does sort of blow a hole in your argument.

          • Under-the-weather

            Why would a party offering illegal abortions prosper now?, sure ‘moonshine probably is still made but there’s a much reduced market available for it because people simple don’t want to buy it (health implications). While peddling drugs is a viable means of creating income – still, and when drug users have reduced any opportunity open to them in employment, peddling drugs is one way to live. Women who have boyfriend users in the US will get themselves pregnant so they can use a form of Buprenorphone deemed accepted for pregnant women (but which is injectable in solution). So they’ll get themselves pregnant – just so they are eligible for a certain type of prescription..everything revolves around the drug.

            Bup vs methadone cost
            http://www.drugandalcoholdependence.com/article/S0376-8716(03)00169-8/abstract

          • Under-the-weather

            My understanding is that success in the US revolves around Bup – counselling, and gradually moving people off Bup once they are at a stage when they’re ready to get off drugs. Bunavail helps in that regard as it gradually adjusts addicts to normality. Cold turkey as I understand it – according to the experts is a potential killer for somebody multiple years addicted and existing on a heavy dose.

          • Colkitto03 wrote:

            ‘ … it does sort of blow a hole in your argument.

            Logical thinking based on hard experience has never been known to influence believers.

          • “When the USA ended prohibition in 1933 it destroyed the illegal market within weeks.
            When the UK made Abortion legal in 1967 the amount of illegal (and dangerous) back street abortions slumped.”

            Only the sale and transportation of alcohol was illegal, NOT the consumption of it.

            And indeed back street abortions decreased because the state picked up the responsibility and the bill of 200,000 abortions each year.

            It is about time people in this country took responsibility for their actions, submitting to subjective conditions such as “addiction” and not asking the state to bail them out because they lack the willpower.

          • Colkitto03

            The consumption of drugs is not illegal in the UK today. It is the possession and sales of drugs which breaks the law. So the comparison stands up well.

          • Colkitto03 wrote:

            At the moment criminals control the world of heroin. Maybe the state should try and take some element of control away from them? Rehab only deals with those who want help. It cannot stop the supply of new addicts that appear every year.

            Quite apart from the money made by those corporations supplying equipment for ‘enforcement’, and the predilection of those working in ‘enforcement’ for playing with the equipment without supervision, the billions of pounds of drug money passed through the City of London, which I’ve been told is not constitutionally part of the ‘United’ Kingdom and is actually independent in a way the once notionally independent town of Berwick-upon-Tweed thought it was, is too much of a carrot for the ‘British’ government to mash with a drug problem solving stick.

            Even were that otherwise, government has a bad record of running anything and I’d rather it simply allocated taxes and left the implementation and management of worthy schemes to people with some idea of what they are doing.

            I am all for giving drugs to addicts in order to reduce crime but I am certain that doing so requires an approach like that of the workhouse (in which my consumptive, alcoholic and perhaps also pox ridden great grandfather breathed his last, having been thrown onto the streets by my great grandmother because she was sick of his philandering).

            Like you I am interested not in saving individuals who wish to destroy themselves but in reducing the harm done by them to others.

          • Colkitto03

            Good post.
            I cant help but think that the established order in ‘war against drugs’ stays the same for decades because it suits the establishment.
            Like the perpetual war that is the background theme to the novel 1984 the powers that be don’t really want to see an end to it.
            You can see from the opposing posts in this particular blog nobody wanted to really engage in the issue of the victims of crime induced by drug addition. They wanted to focus on cost (again and again) and the likelihood of failure (again and again)

          • The heroin will fail as did the methadone program – you see more of the same does not work. I have witnessed this as a HCA at a hospital. It masks the problem rather than solves it.

          • Kathy Gyngell

            Your are quite right

          • Thanks. But whos koolaid has most of you readership been drinking? Seems like a change of heart has happened with some of the regular commenters.

          • Charles Dawne wrote:

            But whos koolaid has most of you readership been drinking?

            Are you reduced to that?

          • Nope, but I was upbraided on this site for suggesting that legalisation will eventually happen – I think the comments on this blog post prove that my suggestion was correct. There are a few commenters here who were for small state, now it seems ok to expand the state to feed abusers with more drugs.

          • Charles Dawne wrote:

            The heroin will fail as did the methadone program … ‘

            I doubt that you’ve seen much of the problem as an HCA in hospital: few of the problems end up in hospital; most end up either at odds with or dependent upon officials with no idea how to deal with them.

            You’ll never understand that belief in the redemptive power of an invisible friend cannot make frail people strong or broken people whole. Society is not perfectible and sometimes all we can do is bite the bullet and accept the fact.

          • If abusers don’t lose their lives before arriving in hospital, then hospital is where they eventually end up. From overdose, blood disease, actions they did from being ‘high’ or ‘withdrawal’ – eventually they end up in hospital – it is how for many, they find out it isn’t all fun and games.

          • Kathy Gyngell

            The cost is enormously higher – from circa £3000 a year to £15,000 at £2010 prices – for the same price, as Anders argues that addicts could have the chance of three months or more abstinence based rehab – not sadly part of the DoH’s addiction treatment portfolio – but which unlike heroin or methadone prescribing has a success rate and respects human dignity.

          • Kathy Gyngell

            and the point is- that Anders makes – it has been tried and failed. some of these addicts are parents. Locking them in addiction hardly does a favour to their children.

          • Colkitto03

            I think ‘locking them into addiction’ has never been the objective.
            These people are by definition already ‘locked into addiction’
            Right now most of them have to steal or prostitute themselves to pay for it, making criminals very rich.
            Lets interact with these addicts and when the opportunity arises lets get them the best most affective rehab available.

          • Kathy Gyngell

            I have done a lot of interacting with addicts in my life and count several recovered addicts – including former heroin addicts – amongst my friends. And visited many rehabs. They work 50 – 60% of the time if they are good and tied in with subsequent 12 step programmes. Most addicts want to get clean – see Neil McKeganey’s research. There is one route – abstinence – and it works. Would you keep plying an alcoholic with more booze?

          • Colkitto03

            On one doubts the benefits of abstinence rehab Kathy. But you imply above that 40% of the time they may not work. That said it I appreciate may take several attempts.
            For rehab to be successful we need addicts to come forward and engage with authorities.
            Your comparison with alcoholism does not stack up, because, as an addiction is does not cause anything like the equivalent crime wave.
            Also you are comparing an illegal activity run by organised crime with a legal activity sanctioned by society.
            Of course when alcohol was illegal in 1920s America it did cause a huge crime wave and the birth of crime syndicates.

          • Kathy Gyngell wrote:

            Would you keep plying an alcoholic with more booze?

            Yes, if that meant saving the tax payer the broader and less tangible costs of the alcoholic’s addiction: costs such as families living in poverty or fear of eviction, or people of any sex wondering when their significant other is going to borrow even more money to buy booze that cannot be paid back, or end up in a distant hospital at some anti-social hour.

            Abstinence is by far the best way (it’s how I gave up my addiction to tobacco, coffee and biting my nails, amongst other things) but the addict has to have the desire to give up and the strength of character to do so, which is not always a characteristic associated with addictive personalities. I’m not one for indulging weakness but, as with so many punishments or treatments, there are too often others who suffer as much, if not more. Those who cannot or will not abstain might more effectively be helped to indulge.

            I would far rather continue to lubricate an alcoholic than have to fund the rehousing of his homeless family or pay someone to deal with the chaos he’s made of the household finances.

            Twelve cans of lager can be bought in Lidl for £5.97, a cheap bottle of vodka for less than a tenner. C £5k/annum to keep a family from the loan shark, the debt collector, the B&B or the hostel, with all of the associated NHS and Social Services ‘professional’ help, must be cheaper than the alternatives.

          • Colkitto03

            The argument here seems to be based around a false dichotomy. This goes not have to be either/or. There can be a multi pronged approach.
            Just as every addict is different, the approach to dealing with them has to be different.
            Any form of rehab is useless if the state does not even know who the addict is. Rehab is useless if the addict is not ready to stop. The challenge is to bring them out of the sphere of influence of dealers and into the sphere of influence of authorities. Consistent interaction with addicts would radically improve the opportunities for Rehab to be engaged.
            As for cost, there is a wonderful return on investment case for ploughing much more into combating addiction in every way but no Government to date has had the moral courage to make the argument.

      • Sargv

        > Most addicts want help to get free of addiction

        Most addicts want a shot. I’ve seen a lot of heroin junkies during heroin wave in 90s’ Russia. They’re not people. They’re animals driven by overpowering physiological need. They should be treated as such.

  • What these many studies mask is their selectivity of candidates. In the same way pharmaceutical companies selected (Goldacre, 2013) candidates that would yield the favourable result – so do drug charities.

    They deliberately select candidates who actually want to stop the habit, and ones they know who can participate in trials regularly. This selectivity is what makes these trial results look so compelling to people who do not follow the debate – the biased media know this too.

    Notes
    Goldacre, B. (2013) Bad Pharma, London: Fourth Estate.

  • Russell

    Helping addicts – not punishing them is the civilized, decent, compassionate, Christian thing to do.

    • Sargv

      If you reward bad personal choices, people will make more bad personal choices. And to bail them out of their stupidity, we’ll have to penalize decent law-abiding citizens by additional taxes.

      If you feel for an addict – help him, but with your own time and your own money.

      • Russell

        Criminalization is a cost to Government – hence the taxpayer. If you insist that the addict must be punished – you spend your own time and money doing it.

        People are most helped not by Governments, but by society.

        • Sargv

          > Criminalization is a cost to Government – hence the taxpayer.

          Law enforcement is indeed a big cost to government, but one of the few that can be validated.

          > If you insist that the addict must be punished

          I think that people involved in illegal activity should be punished. What constitutes illegal activity is up for society to decide: after all, society decided to punish tax avoiders, although they cause no harm to anyone, just lost profit for treasury; society decided to punish people for having doubts in Holocaust (to be clear: I have no specific interest in this topic besides it paving the way to curbing free speech); society decided to segregate smokers. Why should we tip-toe around addicts then?

          • Russell

            It does more harm than good.

          • Sargv

            What does? Criminalisation of users? How exactly did you measure this?

  • The_Mocking_Turtle

    Logically prescribing Heroin to addicts should reduce crime (since they won’t be tempted to sell drugs, burgle, rob or prostitute themselves to get their next fix), reduce diseases transmitted by bodily fluids (like hepatitis and AIDS), and curtail the activities of drug dealers by curbing the market for proscribed substances.

    Society would face less criminal activity, disease and organised crime if addicts were prescribed pharmaceutical grade heroin and supplied with clean syringes and needles to self-administer it rather than sourcing it illegally themselves.

    A policy, logically, good for society and good for addicts alike.

    Win-win.

    • Sargv

      The best way to beat alcoholism is free booze. Logically.

      Jokes aside, addiction often makes person unable to hold a job. She wouldn’t have to became prostitute for a hit, she wold’ve to do that for a slice of bread.

      • Colkitto03

        That is only addressing one side of the issue. Maybe is alcoholism had caused a huge crime wave affecting millions of innocent people for decades society might consider it?
        When the USA banned alcohol for over a decade it caused a huge crime wave and many argue brought into existence the very being of organised crime.
        Society decides to combat poverty by giving millions of people ‘free’ money every week (which some decide to spend on drugs and alcohol)
        I think we need a pragmatic approach to a dire problem. This is about the lessor of two evils.

        • Sargv

          Sorry, I can’t get it.

          > Maybe is alcoholism had caused a huge crime wave affecting millions of innocent people for decades society might consider it?

          Consider what?

          > Society decides to combat poverty by giving millions of people ‘free’ money every week

          Society pays people for being in poverty. This creates more poverty.

          > I think we need a pragmatic approach to a dire problem.

          Of course.

        • The USA only banned the sale and transportation of alcohol, NOT the consumption of it.

          And legal cigarettes has a large black market too.

      • The_Mocking_Turtle

        Non sequitur. I didn’t mention anything about “curing” addiction. Besides alcohol, which is actually, probably, the most damaging drug of all, isn’t proscribed and alcoholics don’t have to deal alcohol or commit criminal activity, usually, to get hold of it although they will ruin their own health in the long run.

        • Sargv

          > I didn’t mention anything about “curing” addiction.

          Neither did I. My point was: it’s not addiction that turns people to criminal behaviour, but lack of money to meet their needs – i.e. through not being able to hold a job.

          Addiction makes people unemployable, and drugs-on-tap is not the only need they have. They’ll still have to meet other needs, and they will probably do that by criminal or immoral means.

          > alcoholics don’t deal alcohol or commit criminal activity, usually, to get hold of it.

          Alcohol is significantly less addictive than heroin. Consuming alcohol bears no social stigma as everybody knows that it might be used in moderation for decades, so does not prevent one from having a job and providing for himself.

          Alcohol is extremely harmful due to being widespread and destigmatized. It’s a scale, no impact, that makes it bad. Now, imagine heroin being as available as booze. It’ll be ten times worse – not only society will suffer, but individuals as well.

          Can heroin be used moderately by majority of the users? Can heroin be used for years without affecting one’s job performance and social skills? If the answers to these questions are “Yes”, and “Yes” – there is indeed a case for decriminalisation. But I think it’s “No” to both.

    • Colkitto03

      hear hear, its may be distasteful but it is the lessor of two evils.