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Scotland needs a fix

The Sunday Times - Scotland,   June 11, 2006

Professor Neil McKeganey, Scotland's leading drugs expert

The controversial drugs expert Neil McKeganey says it's time for radical solutions to the epidemic set to overwhelm this country, reports Gillian Bowditch

  The year is 2020, the time 10.30am. In the centre of Glasgow a man lies slumped in a shop doorway, a needle sticking out of his leg. A couple of yards down the road a prostitute in a drug-induced stupor sways on the pavement. The newsstands in George Square announce Holyrood has passed the controversial "ghettos for junkies bill". There are syringes in the gutter.

This vision does not spring from the pen of Irvine Welsh. According to Professor Neil McKeganey, Scotland's leading drugs expert, this will be the daily reality on the streets of our towns and cities if we do not find an effective way of tackling the drugs problem, which is threatening to spiral out of control.

What makes his vision so chilling is that he is one of the few Scots with a handle on the extent of the drugs crisis facing Scotland.

McKeganey, who founded Glasgow University's Centre for Drug Misuse Research in 1994, has frequently found himself out of step with mainstream thought.

Last year, however, George W Bush's advisers in the White House called on his expertise.
The Scottish executive's lack of understanding of the drugs situation was revealed six months ago when Jack McConnell, the first minister, was forced to admit he did not know how many drug rehabilitation places there were in Scotland and his ministers admitted they had no idea how many addicts were prescribed methadone.

McKeganey is on such intimate terms with the statistics, he could recite them in his sleep. One in 100 Scots is addicted to heroin. Of the 50,000 Scottish heroin addicts, more than half live in Strathclyde, and the drugs trade in Glasgow is worth more than the combined assets of Rangers and Celtic football clubs. In proportional terms, double the number of children live in drug-addicted families in Scotland than in England.

"For many years there has been a perception that society would always be able to accommodate the drug problem," he says over coffee in his bunker-like office on Glasgow's Dumbarton Road. Born in Sussex and brought up in Aberdeen, he measures his words carefully. There is a diffidence in his voice completely at odds with the urgency of his message. He believes we have been fooling ourselves and are sleepwalking to disaster.

Only 2% of the adult population of Scotland is addicted, but their impact is enormous. They are responsible for almost 70% of crime in Glasgow. Five hundred million pounds is spent annually on services for addicts, an average of 10,000 a head. At a time when National Health Service budgets are being cut and patients are going to court to secure access to life-saving cancer drugs, it's a phenomenal amount of money.

"The scale of the problem is small relative to its impact," explains McKeganey. "You are talking about only 2% of the population creating an enormous problem. But what if it were 3% or 4%? That is still a tiny number of people, but the problems they would generate could overwhelm our existing systems.

"In 30 years the drugs problem has gone from nonexistent to an epidemic. If that can happen in a generation, what more can happen in the next 10 or 20 years? If we are at the margins of what our society can cope with now, what would our society look like if instead of 50,000 addicts we had 100,000?"

There is, he believes, no reason to assume drug addiction in Scotland has reached a plateau.
"Just look at the figures for young people who feel disenfranchised," says McKeganey. "I think it is eminently feasible that it will creep up to 3% or 4%, and many of the things we take for granted now will have to change."

McKeganey, always a radical thinker, believes the country must be prepared to contemplate radical solutions. "We might have to create drug-free communities using drug testing or restrict addicts from retail areas between certain hours. It would effectively create ghettos. But if we can't control the addiction, all we can do is control the movement of people.

"We have to consider how sustainable family life would be in our communities if the level of addiction goes much beyond 2%. Already you can go to parts of Scotland where the drug problem is so prevalent it is shaping communities. This gives you a glimpse of what other communities might look like in the future and it is a shocking prospect. I think every aspect of our drugs policy should be aimed at stopping this."
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All of this begs the question: what are we getting for the billions of pounds that have been sunk into drug treatments in the past decade? Listen to McKeganey and the answer is, not a lot. In Strathclyde alone drug deaths are up 70% in a 4-month period.

"We're spending 500m a year on a maximum of 50,000 people," he says. "Most of them are not even in programmes, so we're talking about a massive amount of funding being targeted on a tiny number of people."

McKeganey's research shows that where addicts are enrolled in programmes that focus on abstinence, they do well. If the principal aim is merely to stabilise their drug use, by prescribing methadone for example, the success rates are "pretty meagre". Yet Scotland's response to the drug problem is methadone. One-third of addicts are on it. Last year 411,399 prescriptions were issued. By 2012 the figure is expected to be more than 1m.

The policy is currently under review. McKeganey says it is a legacy of the early 1990s, when politicians, concerned that Scotland faced an HIV epidemic fuelled by intravenous drug users, switched from drug prevention and the treatment of addicts to preventing the spread of HIV.
"People are now beginning to ask how effective these services are in reducing criminality," he says. "The evidence is that they are not effective. I don't think our methadone programme is working.

"When addicts look for help they say they want to be free of drugs. What we are offering them is methadone. We are substituting a drug they buy on the street for a drug we prescribe. In what other area of treatment would the medical profession get away with that approach to patient care?"

McKeganey, who turned 50 this year, says he has not used drugs and wonders whether people will think his lack of experience diminishes his arguments.

A father to Rebecca, 17, Gabriel, 12, and Danielle, 7, he is a strong advocate of discussing drugs and their capacity to wreck lives with children from an early age. He would like to see more recovered addicts visiting schools.

His call, in The Sunday Times last February, for addicts to lose custody of their children caused outrage in some quarters. He remains unapologetic. The treatment of these children is, he believes, one of the biggest scars on our society.

"Simply stabilising addicts is not enough," he says. "You have to get the drugs out of the home or the children out of the home. People don't like that message."

There are 60,000 Scottish children living in drug-addicted families, according to his research, and their experience of childhood is unrecognisable to most of us.

"Their lives are literally being sacrificed to their parents' drug addiction," he says. "These children don't come second to the drugs; they come sixth or seventh, if they register at all. Are we really saying we have no better way of looking after these children than their experience within a negligent, chaotic, addict household?

"There seems to be an unfathomable acceptance of just how bad our childcare provision is. That is intolerable. The only thing worse than having a childcare system that doesn't protect children is knowing you have a childcare system that doesn't protect children and not doing anything about it."

McKeganey believes that at the heart of any debate about drugs policy must be an acknowledgment of the moral dimension of drug use, whether it is Kate Moss snorting cocaine at a party, middle-class professionals smoking the occasional spliff or hardened crack addicts shooting up in squalid dens.

None of these activities is morally neutral, he argues.

"People talk about illegal drug use as if it is a morally free domain," he says. "You get the feeling it is unacceptable to raise the question about morality. In the past 15 years we've said drug use is neither good nor bad but addiction is a problem. Therefore, if you have middle-class individuals whose drug use does not appear to generate addiction, it is not seen as a problem."
Our moral agnosticism is perhaps best seen in regard to policy on cannabis.

Downgraded to a class C drug in 2004 by the then home secretary, David Blunkett, it has been subjected to more U-turns than a motorcycle stunt team. Last week it was announced that those caught with more than 5g could in future be jailed for up to 14 years.

"I think cannabis is one of our most dangerous drugs," says McKeganey.

"That's not because the medical harm is so acute - although it clearly is for some users - but because it has achieved what no other illegal drug has.

It has divested itself of its association with illegality. It has become so commonplace and that has opened up a portal of willingness to consume mind-altering substances way beyond the drug itself.

"Ecstasy is going the same way. It is associated with lifestyle rather than pharmacology. But if you want to tackle the drugs problem, you have to tackle it at source and that source isn't heroin but cannabis. If the 40% of teenagers now using cannabis increases, that is not something we can ignore.

It could be of enormous significance."

He is wary of the clamour of voices, from Lord McCluskey to Ben Elton, calling for heroin to be decriminalised. Last week the former justice minister, Richard Simpson, called for heroin to be made available to addicts on the NHS. "Giving heroin to drug addicts is not a treatment unless it is decreased gradually with a view to their abstinence. Anything else is state-sponsored drug addiction," he says.

He also remains unconvinced it would halt the drug barons. It could lead them instead to seek out new markets, and be the ultimate quick fix with disastrous consequences. So what should we be doing about drugs in Scotland?

McKeganey believes policy should focus on three areas: prevention, treatments that lead to abstinence, and the vigorous pursuit of criminals deriving income from the drugs trade. "Without success on all three fronts this problem is going to escalate," he says.

We are dangerously close to reaching a point where we will be unable to distinguish between the legal economy and the drugs economy, he believes.

"Colombia is a country shaped by its drug trade. People say that could never happen here and they might be right, but where are the impediments?"

As I rise to leave, McKeganey's grim prognosis ringing in my ears, he says
apologetically: "I don't want to be a prophet of doom." But the nature of the problem means he is doomed to prophesise.

Whether he is fated to be a latter-day Cassandra remains to be seen.