Addiction Management

by asifemily

As a heroin user that has experienced both the system in the U.K and here in Germany, I was interested to hear about the new system trialing in England at the moment, namely offering financial incentives for a) taking a vaccination against Hepatitis B or b) staying clean. These ‘financial incentives’ are actually shopping vouchers and are being offered, as far as I understand from the BBC and Independent, weekly in return participation in the vaccination programme or for clean urine samples. As far as I am concerned, here are two separate issues. The first is the issue of clean injecting practice and the second is that of abstinence; I don’t believe the two can both be solved by financial incentives.

Let’s look at the use of financial incentive in return for hep B vaccination. Putting aside for a minute the well-known risk of HIV, I believe that vaccination runs the risk of creating a false sense of invincibility. To then provide something that can easily be converted to cash and then to spoon filling is risky behaviour at best. At worst, it’s downright irresponsible. I believe that the best ways to help people intent on using drugs to stay as healthy as possible are choice and a sense of responsibility. In Germany, there are injecting rooms that provide clean kit and a safe space to inject in. In England, you have to find a pharmacy with a needle drop in your area in order to receive new or exchange needles and with that comes the risk that your pharmacist is a sour faced old cow who would rather spit in your face than give you a safe route to your drug of choice – she doesn’t care if you’re a junkie or a diabetic. The people who work in the injecting rooms in Germany are almost all sympathetic, cheery and fully trained and who respond to every user as an individual. This makes the rooms a by far preferable choice to sharing a second hand needle in the street. The freedom of choice and knowing that you have made a safer decision is meaningful.

With regard to the model of abstinence, I am afraid I am going to have to upset all of the non-users out there – it’s not worth a tenner at Tesco. The first issue I have is that of the urine sample. I’ll let you into a secret: if you’ve never done it before, taking a whizz in front of someone is quite daunting. If you are with a social worker who you like and who treats you with respect, the embarrassment factor can be minimised with light humour or simply talking about something else. If, however, you are with a worker with whom you don’t get along, it can be degrading and painful. I would expect at least a crisp twenty bill in my hand for this weekly torture.

The second issue, which I briefly mentioned, is assigning a worth to abstinence. What sum is too high, when one considers that it ultimately saves lives? I am not so enamoured with the drug that I fail to recognise the dangers of it. Anyone who has contact to the community that uses, knows either personally or of someone that has overdosed. I won’t go into too much detail, but the person I lost was so much more than any trivial sum of money. There is a danger that this assignment of worth is actually devaluing addicts; making them less of a person and more of a statistic.

On the other hand, there is the benefit of enabling people to improve their own situation. Every addict, no matter how rich they start off being, will eventually have financial issues. For long term addicts, this shopping voucher could be a god send – the chance of nourishing a suffering body. However, when so small a sum is enough to make a difference then further questions must be answered: where is this person living? How are they funding their habit? These questions bring then further concerns for the safety and well being of the individual.

I would propose a multi-pronged approach and a potentially better way of spending NHS money. Firstly, make clean kit easier to get hold of. Make sure that the people who are able to provide this kit are trained to work with people with addiction problems. Secondly, make it easier to get help when addicts ask. If that means increasing the number of treatment centres then do it! A six month wait is a question of life and death. Thirdly and finally, reconsider the type of incentives used in regard to abstinence. I believe the motivation of perhaps a flat of their own or even the chance of a place of work would be a far more effective system. Apply a touch of German efficiency to the system and maybe the U.K would start to see a similar trend of positive results