Sunday, November 11, 2012

Addiction is not a moral issue - on Rennie, the Record and Labour

On Thursday afternoon, the Scottish Parliament debated the Scottish Government's Drugs Strategy, which has been in place since 2008. In general it was a pretty intelligent debate as you can see from the Official Report. The Government even accepted amendments from the Liberal Democrats and Conservatives, which passed. They would not, however, accept a Labour amendment after the opposition party has been supporting the Daily Record's campaign against methadone prescription. Because pharmacists who dispense methadone have extra costs in so doing, they get extra payments to help them with that. It's a maximum of £2.49 a prescription, so for Labour's Jenny Marra to describe the pharmacists as "methadone millionaires" is a bit much. 

Labour and the Record seem to have gone for full scale demonisation, not only of addicts, but also the health professionals on the front line who dispense their medication or who make judgements about care. Labour's attitude seemed to be more about trashing methadone than recognising it as part of the tool kit for treating people with addiction. It can stabilise lives, and to suggest that the heroin substitute was solely responsible for half the drugs deaths is wrong.

I was pretty unimpressed with Jenny Marra's rhetoric on this, and so, to be honest, was the Parliament. Very few speakers, even Labour ones, agreed with her line. Not, of course, that you would have guessed from the  Daily Record's coverage the next day which failed to point out that Liberal Democrats, SNP and Tories all spoke against Labour. When you can't even get the Tories to agree with your ill-judged and prejudiced stance, then surely you know you are on a hiding to nothing.

The paper edition of the paper (which I actually went out and bought), had a special section on Willie. It accused him being out of touch for, get this, suggesting that health professionals and not politicians should be making the decisions on appropriate treatment for people. If I go to see my MSP Angela Constance, I don't expect her to give me medical advice, or to tell me what my doctor should be doing for me.And nor would she ever do so.

I guess you can't really expect a sensationalist tabloid to understand the nature of addiction - although it would be good if they tried. You expect a bit more, though, from the people who make the laws that could potentially affect the treatment people are offered. I've become increasingly worried at the way Labour are treating addiction as a moral issue in the same way as the Tories, and, yes, sometimes Labour too, treat poverty and joblessness as some sort of personal failing. Don't swallow Labour's sanctimony on welfare - one of their first acts in Government way back in 1997 was to remove certain benefits from lone parents.

When I was at Liberal Democrat Conference in Brighton, I attended a fringe meeting on civil liberties at which one of the speakers talked about how people with addictions were often handed ASBOs and, then, when the inevitable breach happened, they were carted off to prison rather than given the help that they needed. I tweeted this and Labour MP for Glasgow South Tom Harris started on about how decent people needed to be protected from adults. We then had quite a long conversation on Twitter, some of which has been blogged by Zoe over at Complicity.

I found the distinction between decent people and addicts deeply offensive. I've had people close to me who have really struggled with addictions. If they could have stopped, they would have. Their lives degenerated into a fair bit of chaos but that didn't make them somehow not decent people. The struggle, torment and suffering they went through was immense, over many years. And there was a time when they actually were free for several years before, suddenly, just losing it again. It was horrible for us and horrible for them.

But, no, Tom took pride in how he'd had an addict evicted because they were making a constituent's life hell. He didn't seem to realise that the addict was his constituent too and was quite happy to see them made homeless rather than given help to recover. I just found that lack of compassion astounding, and very worrying.

Contrast with Willie Rennie's people-centred contribution to the debate:
There are about 60,000 drug users in Scotland. I met one of them, whom I will call Mary, when I visited Turning Point Scotland’s facility in Glasgow. She had a young son and her ambition was to be able to take her young son to school in the morning after giving him breakfast. That was her lofty ambition—something that for us would be quite normal. If we have kids, we do such things every day, but for her it was an amazing ambition, because she did not see in what circumstances she could achieve it. Her son was getting looked after by her brother on an almost permanent basis.
I said that about Mary because we talk about big numbers and big programmes, but at the end of the day people like Mary are normal people who deserve a chance like anyone else. Some of the ways in which we talk about them and whether they do or do not contribute to society demonise them but, for me, they deserve a chance. They would love to go back and have another chance, and we should respect them for the tremendously difficult challenges that they go through. They go in and out of drug use; sometimes they are in remission and sometimes they relapse and go back into serious drug use. Such is the chaotic life that those people lead.
Mary was on methadone, along with 24,000 other people. However, for me the central methadone issue is about health professionals choosing the right way to proceed. It is not for politicians to decide which treatments can and cannot be used; it is about giving the health professionals the tools. They have the evidence and the know-how and are the best people to make decisions to help people out of their circumstances. Recovery means different things for different people. Sometimes it is about being able to stay alive; for other people it is about getting back into work. For Mary, it is about being able to take her son to school in the morning. That is why it is regrettable to see some of the stuff that has been happening in the Daily Record, supported by some in the Labour Party. Demonising pharmacists just for doing their job is deeply regrettable.
Often, we focus only on the medical aspects of drug use, but much of the issue is to do with a person’s whole life experience. Perhaps they have mental health problems, housing problems or debt. Perhaps they have a chaotic family life and have been divorced. Perhaps they have had experiences in the military that have led them into drug use or alcohol use. We must sort out those issues as well if we expect people to recover long term. However, we must also recognise that sometimes people will have a chaotic lifestyle for some time. The simplistic view is that somehow we can get people into recovery automatically, if only we change one little thing, but that is just not going to happen.
I have been to some projects, including the Lothian and Edinburgh abstinence programme—LEAP—in Edinburgh. I saw its abstinence regime. It is not right for everybody, but it is right for some people. They brought the whole family in to share the experience and ensure that people were able to recover on a long-term basis.
It is a shame on this country that we have such a high proportion of drug users when we have such wealth. Poverty—the pockets of poverty that we have in many communities—is the root of much of the situation. Again, we must deal with that if we are to expect any longer-term benefits.
On methadone, the HIV rate among drug users in Russia, where they do not have the same kind of programmes as we have in Scotland, is about one in three. In Scotland it is less than one in 20. I do not know what more evidence we need than that simple statistic. In addition, lots of scientific studies show that hepatitis C is reduced by about 80 per cent as a result of needle-exchange and methadone programmes. Elish Angiolini’s report on Cornton Vale shows that when a lot of the women sent to the prison were taken off the methadone programme, the self-harm rates shot up. That is no coincidence, because significant benefit can be got from methadone.
Annabel Goldie is right when she says that the treatment is not necessarily right for everyone and is not perfect, and I accept that. However, we should not say that methadone is the reason why so many people are dying, because it is not. Other drugs were involved in 60 per cent of the cases in which someone’s death was connected to methadone, and alcohol was involved in 40 per cent. 
 Further, in many of those cases, the methadone was illicit, rather than being part of a programme. To simply say that all of those people are dying because of methadone is wrong. Methadone is part of the solution, not part of the problem. We need to be careful about demonising the programme and the pharmacists, because we might undermine the good work that is under way.
Almost every subsequent speaker expressed some sort of agreement with Willie. Maybe there's hope for this Parliament yet.

Later on, in his closing remarks, Willie talked about how hard it was to persuade people that addicts were people who needed help and compassion, not condemnation:
There is a big divide between drug users and the communities in which they live. I put up a Facebook posting about drug use the other day, and the response showed that a lot of people believe that drug users should be cut off. We need to recognise that there is a huge divide. People do not understand why drug users receive support, and we have a big job to do to convince people about the merits of providing support.
The approach by some members of the Labour Party is quite disgraceful in fuelling the lack of understanding. Politicians are supposed to show leadership, not pander to people's ill-informed prejudices, whether they're on human rights, immigration or addiction. Having a wide range of treatment options and not imposing the sort of one-size-fits-all approach that Labour is instinctively so keen on, is going to get more people better. That will benefit everyone, including their communities.

Making policy based on rational evidence is always a better option than subjective moral judgement. Labour would do well to learn that.

1 comment:

Indy said...

Agree. I think part of the problem is that people perceive that there is a lack of personal responsibility from people who have been addicted or are addicted and I can understand that because at some point you do make a choice to start taking drugs. But I think a lot of people don't understand enough about the process of recovery.

Because the first thing that hits people when they start to come off drugs is a massive wave of guilt. Guilt at what they have put their families and friends through, guilt at some of the things they may have done to get drugs, guilt at their own weakness in succumbing to addiction and also guilt and regret at all the opportunities they have missed and the chances they have thrown away.

Such is the level of guilt that it could drive people straight back into addiction unless they are reassured and told over and over again you are not a bad person, you are not a pathetic failure, you have been suffering from an illness called addiction and now you are recovering.

I would recommend Jenny Marra goes to visit some recovering addicts and she might get a better grasp on that element of it.


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