Picture this. Me in the airing cupboard with an unfiltered embassy No.1 with a damp rizla wrapped around it and a damp towel over my head.
In a perfect world, most addicts believe they would not need prescriptions because prohibition would not exist (and genetically engineered opium poppies/coca leaves would grow in Elysian fields behind the cannabis factory).
An attempt to access further specialised know-how via the pharmacists of the Swiss heroin trial got no further than ‘This is the property of the Swiss Government’. The accepted wisdom on diamorphine reads; base formulations (brown, scag) oily; good for smoking. Hydrochloride (white, no.4) refined, for reasons associated with its behaviour under comparable temperatures is preparation better suited to injecting or snorting. One thing is for sure, diamorphine hydrochloride is not really a smoking formulation and diamorphine base is very difficult to acquire from commercial pharmaceutical companies.
There is an enduring problem (my second difficulty) around finding dose levels. You remember that scene in ‘Oliver’, where the eponymous hero asks for an increase in his script from Mr Bumble the workhouse counsellor? ‘More?’ he roars. ‘The boy wants more?!’ Things haven’t changed much and dose levels still provide a neat divide between patient and professional drug worker. The area is so sensitive that a sympathetic prescriber interviewed for the Big Issue in 1994 was (mis) quoted as allowing patients to ‘dictate their scripts.’ A hasty apology drew attention to the doctor’s habit of allowing patients input into their script levels rather than deciding the dose but lawyers for the Home Office were
Already preparing to use the piece as part of a prosecution for ‘irresponsible prescribing’. As far as Heroin is concerned, the root of all the problem lies with the old misconception that 1mg of methadone = 1mg of diamorphine (heroin). It cannot be overstressed how inaccurate this equation is. Over a 24 hour period, a cautious conversion would be 1mg of methadone = 3mg diamorphine (I think 1:4 is closer).
All prescribing initiatives rely on finding the right dose level for the individual in question. However, the two experimental research protocols on diamorphine over the last 25 years in the UK, have loaded the dice heavily against a successful outcome for Heroin. Hartnoll and Mitcheson at University College Hospital in the 1970’s, used an average heroin dose of just over 40mg daily (?!) and Chelsea and Westminsters recent experiment again relied on a 1:1 equivalence with methadone for dose assessment (ceiling a very low 200mg daily). Diamorphine is expensive (although cheap in the scheme of things) and politically sensitive but it is the drug of choice option that is arbitrarily granted (in sufficient doses) to far too few.
Black Poppy would be interested to hear from anyone whose experienced using the drugs/treatment/prisons, etc of other countries, we could all do with a bit of drug advice when thinking of travelling. Drop us a line
Being on diamorphine (I have since switched from the cigarettes to injectables) has made a big difference to the quality of my life. Productivity, mood, energy, and libido are all active ingredients that I had lost on methadone and pills. The Home Office feels that heroin should be prescribed with extreme caution as users are likely to sell their supplies. If anyone can tell me why I would want to swap a legal, free, clean, regular supply for money to buy an illegal, expensive, adulterated bag from a dealer with the added dimension of arrest, rip off or infections, I would suggest they go and see their local consultant psychiatrist……….
The doctor seemed relieved, he removed his half moon specs and handed the small pink form across the table. I hesitated, then lent forward and accepted it. Suddenly, I was the lottery winner – or a long term jobbing actor turned Oscar nominee winning the admiration of his peers, the goal he had worked for and craved more than any amount of money or boundless love. I clutched my new prescription to my bosom. I felt a speech coming on.
This,” I said ” is the happiest day of my life”. My audience – the consultant, a keyworker and a student with a stutter were so affected by this announcement they produced an impromptu synchronised shoe inspection and a nervous smile. I noticed the doctor had no socks on. I left them still staring at the floor as I floated out the door. I caught the pure euphoria of heroin forever and I sensed the old life receding. Bye bye powder power and ‘I’m so grateful to be kept waiting in cold carparks to unload my giro in support of your habit Mr Dealer’. Goodbye sick days and slow dawns yawning in the morning.
The taxi office brought me back to reality. Situated just opposite the clinic next to a bankrupt drycleaner it was an 8×10 gas chamber. Strapped into the chair was a plump scouser scoffing what seemed like a last supper and smoking ten fags simultaneously. ‘I’m on drugs and it’s fucking legal!’ I wanted to tell him. However the code of silence to which I’d adhered to for years censored the impulse. I couldn’t see him sharing my excitement. The cab came, the road roared by until every traffic light saw us coming and conspired to delay my arrival at the pharmacy.
Between the idea and the reality, Between the motion and the act, Falls the shadow (T.S Eliot).
Life on heroin maintenance for me was not the instant consummation of desire I expected. From the nipple to the bottle never satisfied. Initially I opted for diamorphine reefers (supporters of heroin prescribing should always refer to heroin as diamorphine as it has more medical and less sensational connotations, particularly for the media). Diamorphine ‘reefers’ (dig the hipster parlance!) are not popular with the medical establishment. The ‘medistab’ are a queer mob. A weighty work could be written about the amazing dynamic of the addict/doctor relationship. (A much thinner volume on ‘What doctors understand about drug addiction’, would make less rewarding reading). In case readers believe they can perceive bias in these words, I will add that prescribers are on a hiding to nothing in this field. You are only as good as your last ‘script as far as most addicts are concerned. Talk, as they never say in counseling sessions, is cheap
In a perfect world doctors believe they would not have to prescribe because people wouldn’t need drugs. In a perfect world most addicts believe they would not need prescriptions because prohibition would not exist (and genetically engineered opium poppies/coca leaves would grow in Elysian fields behind the cannabis factory). So the clinics have done no evaluation on smokable heroin (one excellent essay – ‘Chasing the Dragon’ by Gossop/Strang appears in ‘The British System’ Oxford University Press 1996). As a consultant once said to me ” We don’t in all conscience feel that we can condone handing out a product that is actively carcinogenic”. As the vast majority (so it seems) of opiate addicts also smoke this seems a question of the clients needs being subjugated to a dubious ethical absolute. At my last place of employment, out of a random sample of 77 clients, 72 smoked and 2 had ‘just given up’. As long term addicts go, our caseload would, I suggest, be very typical.
Once I was ‘stablilised’ on reefers (ie; I had been on the prescription one month), I found other ciggies unsatisfactory and cut my ‘non medical’ smoking down to 2 or 3 fags daily. An overall reduction of around 40% – an unexpected bonus that might complicate the ethical equation. After 18 months, I felt that the reefers failed on two fronts. The transition from the needle can be a complicated journey. I began to miss the ‘rush’ that concerted accumulation of relief that follows a fix and the ritual that precedes it. I began to feel I was being cheated. Somehow I just wasn’t getting stoned to order. Smoke one fag – nice, smoke two