There's nothing like the zeal of a convert. So it is with Russell Brand's documentary Russell Brand: From Addiction to Recovery which aired on BBC3 last night.
Widely trailed in the press, the programme saw Brand chart his own experiences in recovery from drug addiction and describe with compassion and sensitivity the addiction and problems faced by drug users. But he also used his documentary as a means to attack 'harm reduction', which includes prescribing heroin users methadone (a synthetic opioid medication) to help them recover from their addiction. Abstinence-based recovery (going 'cold turkey'), the star's own route, was relentlessly pushed as the superior alternative. But while there are many contentious things to be said in the field of drug treatment, one uncontroversial truth is...not everyone is like Russell Brand.
Treating his personal experience as a basis for the Government's approach to drugs treatment, and as the only acceptable form of recovery, could have devastating consequences.
Abstinence-focused recovery may be the right approach for some people, but it is not always the best approach for everybody - and indeed it fails many. Research shows that abstinence programmes have significantly higher rates of relapse. Once a patient returns to illegal drug use, they are far more likely to engage in harmful behaviour, such as criminal activity or needle sharing, with the significant risk of HIV infection that brings. Relapse increases the risk of overdose too, which is why abstinence programmes have also been consistently linked with higher death rates.
Methadone may not be a perfect solution, but it continues to help tens of thousands of people in the UK. The medication consistently results in long-term decreases in illicit drug use, criminal activity, deaths due to overdose and the sharing of needles (and thus rates of HIV infection). On average, patients are far more likely to find a job, live longer and have improved health. People are not 'parked' on methadone as an end in itself - it is used as a means to help them work towards improving their health, employment and family life. To blithely talk down methadone as Brand has done is irresponsible and genuinely unhelpful to people in need of treatment options.
Unfortunately, the Government has become a fan of Russell Brand. Harm reduction was the settled policy of consecutive Governments, from Mrs Thatcher onwards. It has played a crucial role in keeping rates of HIV among injecting drug users in the UK extremely low. But the current Government has clearly signalled its intention to move away from harm reduction towards abstinence.
Crucially, this shift means that a significant chunk of public funding for drug treatment is now conditional on increased rates of exit from treatment (abstinence, in other words), while retention on OST programmes will not be equally rewarded. As local authorities assume control of drug treatment services and budgets from 2013, clear evidence-based policy has never been more essential. Instead we have evidence-free ideology from central Government - hardly the best guidance for local councils as they take on this new role.
Internationally, as the UK worryingly moves ever closer to Russia and the US on drug treatment issues, this approach risks threatening the UK's well-earned reputation as a leader on HIV. As Damon Barrett, Deputy Director of Harm Reduction International said 'on the international stage, at the UN and the EU, there is the real sense that the UK has 'changed sides' on harm reduction. That is unbelievably damaging to the HIV debate and to the legitimacy of life saving programmes paid for with UK foreign aid.'
A person's recovery path should be a clinical decision reached between patient and professional, on a case-by-case basis. Placing structural or financial biases towards abstinence (or against harm reduction) could have catastrophic consequences.
One may easily gain the impression that the approach favoured by Brand is a radical new alternative. But in fact, his documentary merely served to reinforce an emerging policy agenda that threatens to increase the harms of drug use in our communities. Neither is this agenda anything novel. Pushing drug users off methadone towards abstinence has been tried before, and it has failed before. One of the most authoritative studies documenting this, written in New York 2001, was called 'Lessons Learned, Lessons Forgotten, Lessons Ignored'. That title now reads like a grim prophecy of our own country's direction on drug treatment.
Whatever the personal experiences of one man, a one-size fits all approach is seriously ill-judged. Treatment paths should be offered impartially to patients as options, not institutionally pitted against each other or favoured from on high. Only through such an approach, a more balanced one than envisaged by both Brand and the Government, will we effectively address the damage of drug addiction in our society.