Everyone in the field of drug treatment knows that the majority of addicts want to overcome their addiction and get off drugs. Mark Johnson is right to highlight this ambition, but wrong to imply that health professionals and others who are providing publicly-funded recovery services are somehow conspiring to prevent it (Rattling out prescriptions writes off addicts, Guardian Society 16/12/09).
Addiction is a complex condition, and the other certainty that unites practitioners is that there are no easy, simple answers. At the National Treatment Agency, our role is to promote a balanced treatment system in which every drug misuser is able to access a range of services which are clinically appropriate for their personal needs and circumstances.
This applies equally to drug misusers in prisons, which is why we are rolling out the Integrated Drug Treatment System (IDTS) in England. It is intended to ensure not only that drug misusing offenders are properly catered for in jail, but also that when they leave they are cared for by community treatment services. Some providers of drug treatment services don’t like the competition implied by this policy. Some critics of the policy fear it is developing a state-induced dependency on prescribed substitutes like methadone. Some recovered addicts, like Mr Johnson, take the view that prisons should be the place where addicts are introduced to total abstinence.
Together they give a misleading impression that the issue at stake is choosing between the extremes of abstinence-only or mainly-methadone. As Mike Trace of the Rehabilitation for Addicted Prisoners Trust recently acknowledged, the debate is about the balance of services - in a system where at any time about half of prisoners are heroin and crack users subject to high health risks around injecting, withdrawal, and death.
Most offenders arriving in prison will be there for three months or less, either serving short sentences or on remand for a few weeks. In these circumstances, it is good clinical practice to either continue the treatment the prisoner had before arrest, or prepare them for the treatment they will receive on release. This accounts for most of the 19,632 individuals who received maintenance prescriptions last year.
For those serving longer sentences, prison offers an opportunity to become drug-free. Last year 45,135 prisoners went through detoxification programmes to prepare them for the rest of their sentence, where they could access the sort of abstinence-based talking therapies advocated by Mr Johnson.
It is ironic that Mr Johnson now argues methadone provision is an abuse of human rights, since the heroin substitute was made consistently available after a class action by several hundred drug-addicted prisoners who claimed that its absence breached their human rights.
Following this legal challenge the Government put in train the reforms we see today to ensure that prison drug treatment is compatible with that available in the community. The upshot is a prison system which is increasingly releasing offenders who have been successfully engaged in drug treatment, and therefore do not need to revert to a life of drug misuse and crime.