Tim Worstall

Prescribing Heroin

Very weird piece indeed in The Times.

Those who seek to legalise narcotics cry “the war on drugs has been
lost”. One might as well also argue that “the war on murder has been
lost” or that “the war on rape, theft, fraud, larceny and pyromania has
been lost”. Like drug abuse, these are malaises that will always be
with us, and no sane person believes they will ever be totally
abolished. Rather we just do our best to ensure that they are minimised
— and we do this by enforcing the law and the threat of punishment.
Just because you can’t eradicate a crime doesn’t mean you have to
surrender by legalising it.

If the police really want to stop heroin addicts committing
crime then the best method would not be a ready supply of heroin on the
NHS but to arrest heroin users. The frequently employed language of
“compassion” is misplaced and misleading in this case; the most caring
and the practical thing to do would be to prosecute and imprison users
— to stop their habit.

There’s two potential answers to this nonsense. The first is the liberal one. My right to do as I wish stops when my excercising that right impacts upon your similar rights. Absent the illegality of heroin usage, what impact does my taking heroin have upon your exercise of your rights? Quite, so why is it illegal?

The second is that it is the very illegality which is the problem. There’s some fairly heavyweight backing for this view:

In Oliver Cromwell’s eloquent words,
"I beseech you, in the bowels of Christ, think it possible you may be
mistaken" about the course you and President Bush urge us to adopt to
fight drugs. The path you propose of more police, more jails, use of
the military in foreign countries, harsh penalties for drug users, and
a whole panoply of repressive measures can only make a bad situation
worse.

The idea that we’re losing the war on drugs because we’re not jailing enough people is not just laughable, it’s repellent. The problem is that we have a war on drugs at all, something that is inconsistent with the maintenance of a liberal society at all.

Legalize it and yes, that does mean prescribing it on the NHS. As to the idea that it will cost £15,000 a year per addict:  sorry, that’s simply bollocks. £ 41 a day for a legal supply of a drug that can be made in bulk from the hundreds of tonnes of opium coming out of Afghanistan? Give over, I’d be amazed if it actually cost more than the standard prescription charge.

In

19 responses

  1. Jock Coats Avatar
    Jock Coats

    Actually I go one stage further and say that the law, the “war on drugs”, and those who wish to pursue it are knowingly causing deaths – right down the whole chain from grower to user and victim of user’s drug funding crime spree, but most especially to the user. Culpable homicide. The law, therefore, is uterly immoral as it stands.
    (I wouldn’t even prescribe it necessarily – I’d legalize it, period, and make Bayer or whoever wants to supply it responsible for safer delivery mechanisms).

    Reply
  2. dsquared Avatar
    dsquared

    we would probably get our diamorphine from the Balkans (Alkaloid Skopje AG is one of the biggest producers – it’s just about the only significant company on the Macedonian Stock Exchange) rather than Afghanistan as it’s more convenient and we don’t really have all that many heroin addicts. It’s not superduper cheap – although it can be made in bulk from opium, it’s a two stage refining process and the opium-morphine stage requires quite a bit of care and some volatile chemicals (which is why heroin labs often blow up).
    I don’t understand why the NHS would be involved though. If the idea is that it’s to be prescribed to addicts, then that surely isn’t the same thing as legalising it, unless you can become a “heroin addict” for the purposes of the healthcare system simply by announcing that you are one. Otherwise, the process of becoming addicted would require heroin from outside the NHS system, which means that most of the bad consequences of prohibition would still be with us. If you’re going to “legalise” a recreational pharmaceutical, then surely it would need to be available OTC.

    Reply
  3. Lysias Avatar
    Lysias

    It was always my understanding that the vast majority of the cost of heroin was associated with the distribution chain rather than manufacture. As this article claims, http://opioids.com/heroin/heroin-inc.html , the factory gate price is less than 1% of the final wholesale price. Legalizing it probably would make it cheap enough not to need to steal to fund a habit.
    I don’t know what the NHS has to do with it either, unless unbeknownst to me they’ve been perscribing alcohol to alcoholics all these years.

    Reply
  4. Dr Dan H. Avatar
    Dr Dan H.

    All that has happened here is that over the past few decades, we’ve proved conclusively that a War on Drugs only serves to keep the price high. Recent research in Italy (and some “me too” stuff in London) analysing sewage for cocaine metabolites have put the usage levels at a quite staggering level; the War is clearly not actually doing much more than round up a few idiots.
    So let’s try a different tack. Let’s supply the registered addicts with an opiate substitute; either heroin or a synthetic like fentanyl. Do that, and several interesting things will happen:
    Firstly, the street price of heroin will drop like a stone. Supply and demand; cut the demand and the supply chain will keep lurching along for a while but the dealers won’t be able to shift it. Better build a few new prisons; you’ll be catching more people for intent to supply at this point.
    Secondly, the low-level thieving will drop right off when addicts don’t need to thieve to feed habits. Police won’t have as much time wasted by addict crime, so will be able to catch more serial offenders of other sorts. Again, this will increase the prison population so make SURE you have those extra places.
    Thirdly, there will be an international glut of heroin. All along the supply train, people will get stuck with drugs they cannot move on. The money supply to the Afgans will dry up over the course of a couple of years.
    This will have a very interesting effect. Afganistan is effectively financed by drug money; there’s little else there except the Labis lazuli mines and a lot of low-level farming. Cut the income from drug money, and you cripple the region’s finances.
    No money also means the locals won’t have the money to buy guns and other weapons. They’ll fall back on local weapons, and quite quickly won’t have as much to fight with. This will not make them easier to conquer, but will shut down any international terroristic ambitions. Paying the local warlords to police areas and boot out foreign terrorists would also help, especially if the warlords were feeling the financial pinch.
    So, all things considered trying to kill out the consumption end of the heroin market is a really worthwhile project, and one that won’t actually cost all that much money to try. It would also have the lovely effect of making one type of crime economically non-viable, which is usually a much better trick than making it illegal since economic non-viability usually stops an activity.

    Reply
  5. dsquared Avatar
    dsquared

    I don’t agree that prescribing heroin to addicts would necessarily be all that damaging to the illegal trade. It is possible to get Guinness prescribed to you on the National Health, but nobody gets it this way since the NHS prescription system is really not a particularly attractive retail chain. Even if it was the case that you could rock up to the doctor’s and get a prescription, there would still be substantial demand for illegal heroin from:
    1) casual heroin users who were not addicts
    2) heroin addicts who had full-time jobs (surprisingly common) and did not wish to jeopardise them by becoming officially designated addicts
    3) people who could not get their act together sufficiently to get through the bureaucracy of becoming an addict (which would of necessity be substantial)
    4) non-UK citizens living in the UK, and other people who aren’t registered with a GP to give them the necessary chit
    5) addicts who just happened to get up in the morning not fancying a trip down to the clinic when the local crackhouse is more convenient and friendlier.
    6) prostitutes with pimps and similar, where the provision of heroin is part of a complicated work relationship
    7) under-18’s, who would presumably not be able to get heroin prescriptions
    You would clear up a few skid-rows and junkie communities, but I doubt you would do more than halve the UK demand for heroin.
    Since the UK demand for heroin is a pretty small proportion of global demand and since Afghanistan is not the only or even the biggest supplier of opium base to the UK market, I don’t think that all these geopolitical consequences would actually take place.
    [It would also have the lovely effect of making one type of crime economically non-viable]
    It wouldn’t. Even at lower margins, it would remain viable. Alcohol and tobacco are legal, but there is still a thriving black market.

    Reply
  6. dsquared Avatar
    dsquared

    by the way, this:
    [Secondly, the low-level thieving will drop right off when addicts don’t need to thieve to feed habits]
    is usually called the “lump of output fallacy” when applied to macroeconomic issues.

    Reply
  7. zorro Avatar
    zorro

    Almost /all/ the negative effects of drug use are a direct result of the illegal status of drugs.
    The Marijuana ‘gateway’ effect for instance. How on earth does a pretty harmless herb cause people to become crack addicts? Could it have anything to do with the fact that smokers are forced to black market dealers to buy their herb and there come into contact with other drugs?
    And given the fact we all /know/ that Marijuana is less harmful than two legal, highly taxed drugs, and yet is still illegal, perhaps some people think – ‘all this stuff about illegal drugs being bad is /utter bollocks/’ so they try out a crack pipe or something and are hooked.
    All drugs should be immediately legalized. Users of ‘hard’ drugs like Opiates and crack cocaine should be offered as much help as possible to quit their habit, in the same way as smokers. As stated in previous posts, /almost all/ of the cost of illegal drugs is an effect of the illegality and a number of people in the supply chain wanting to make a good profit to cover their own risk. Take away the illegality, buy drugs direct from source, make them available to anyone over 18 and you would immediately reduce crime by about 75%.

    Reply
  8. dearieme Avatar
    dearieme

    Although my instinct is agin it, I do see the case for repression. But not when it doesn’t work.

    Reply
  9. Serf Avatar
    Serf

    If you accept the idea that Heroin should be illegal, the argument actually makes sense. I am sick of hearing how innocent people are lured into drugs by unscrupulous dealers, and how the dealers should be punished but the users not. The drugs supply chain works like Avon, with users selling to their friends.
    Supply happens because there is demand, its a very basic idea. Unless you destroy demand, you can never choke off supply.
    On the other hand, if you believe in the liberal view that everyone owns their own body, then the argument against illegality is overwhelming.

    Reply
  10. johnnybonk Avatar
    johnnybonk

    zorro – “Almost /all/ the negative effects of drug use are a direct result of the illegal status of drugs” … er no. Heroin is dangerous whether legal or not (like motorbikes). It may or may not be the case that legalising supply and possesion will reduce accidental deaths, but it is and will remain dangerous and there will still be accidental deaths.
    In fact it is difficult to see how making it more easily and cheaply available will reduce deaths. Consider, if the government subsidised the purchase of fast motorbikes, that is likely to increase the number of bike accidents.
    On the suject of cost – if current black market price is about 60 GBP per gram for 30 percent purity, then that is about 200 GBP per gram of pure H. Kinda suggests to me a genuine factor cost of about 2 GBP per gram.

    Reply
  11. Squander Two Avatar
    Squander Two

    > Alcohol and tobacco are legal, but there is still a thriving black market.
    That’s a little disingenuous. There is a thriving black market in untaxed alcohol and untaxed tobacco, both of which are thoroughly illegal. There is no black market whatsoever in taxed alcohol and taxed tobacco, unless you count pub lock-ins.
    > One might as well also argue that “the war on murder has been lost” or that “the war on rape, theft, fraud, larceny and pyromania has been lost”. Like drug abuse, these are malaises that will always be with us, and no sane person believes they will ever be totally abolished.
    The issue isn’t merely that they remain with us, though. If the author would suggest a mechanism whereby police action against one murderer causes other murderers to make more money, then I’ll admit that they’re on to something. Otherwise, it’s a crap parallel.

    Reply
  12. dave heasman Avatar
    dave heasman

    If the UK legalised heroin, would the US bomb us? Or just close us down like they threatened at Suez?

    Reply
  13. dsquared Avatar
    dsquared

    [That’s a little disingenuous. There is a thriving black market in untaxed alcohol and untaxed tobacco, both of which are thoroughly illegal. There is no black market whatsoever in taxed alcohol and taxed tobacco, unless you count pub lock-ins.]
    well this is sort of my point. People are assuming that there is a halfway house between prohibition and legalisation, with this funny NHS-prescription-only scheme. I don’t think that there is. Under the sort of thing that people are discussing on this thread, non-prescription heroin will remain thoroughly illegal. If you want to legalise heroin, then you need to be talking about the consequences of legalising it, not pretending that the benefits of legalising it could be obtained by having it under some draconian regulation scheme.
    Johnnybonk is quite right on the dangers, by the way; opium and heroin legalisation is a social experiment that has been tried, in pre-war Vietnam and Iran. It led to substantial social problems in both cases.

    Reply
  14. Squander Two Avatar
    Squander Two

    > well this is sort of my point.
    Well, fair enough.
    >opium and heroin legalisation is a social experiment that has been tried, in pre-war Vietnam and Iran. It led to substantial social problems in both cases.
    Opium and heroin prohibition is a social experiment that has been tried, in Europe and America. It has led to substantial social problems in both cases.

    Reply
  15. Mark Wadsworth Avatar
    Mark Wadsworth

    Yup, legalise it. Just like other dangerous activities that don’t affect third parties like horse-riding, pot-holing, motor racing, parachute jumping, walking through Brixton at night etc. Just because something is legal doesn’t mean that it is a good thing to do.

    Reply
  16. David Gillies Avatar
    David Gillies

    You have to wonder if there was any prospect of drugs being legalised whether the cartels wouldn’t whack a few politicians.
    Tim Adds: That was the subject of more than a few Bloom County cartoons.

    Reply
  17. Tim Almond Avatar
    Tim Almond

    The Dutch government pay about £6 for a gram of diamorphine (http://www.ukhra.org/statements/diamorphine_shortage_uk.html).
    Hard to find numbers, but it sounds like the daily use intravenously is 50-100mg/day (http://www.lacity.org/LAPD/traffic/dre/heroin.htm).
    Add in some inefficient NHS overhead, of say 100% and the cost is still only something like £50/month.

    Reply
  18. towcestariantowcestarian Avatar
    towcestariantowcestarian

    The best argument for legalising hard drugs is to cut crime rates. Deaths of users will rise (so what), government costs will probably stay about the same (+ve health & social, -ve criminal justice) and big league crime will move on to find another avenue for exploiting the economy.
    My concern would be that thousands of junkies would decide to sue the government (ie us taxpayers) for irresponsibility in legalising the drug – after all, it can’t be their fault they fucked their lives up, can it.

    Reply
  19. James Avatar
    James

    Johnybonk,
    It’s still the case though, that the illegality of drugs such as heroin makes them dangerous. This is because users are not offered the full and frank advice and guidance on how to use their drug in the same way that motorcyclists are with their bikes, and so must rely on anecdotal information from other users and tentative advice from drug support services.
    I don’t think it’s that easy to say ‘heroin is dangerous’, just because it is. I think most things can be dangerous, if you want them to be. Eggs are dangerous. Staying in bed is dangerous. Going for a walk is dangerous.

    Reply

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