So because it worked for him, Russell Brand is persuaded that abstinence-based recovery, rather than reliance on methadone, is the best way to help those with the “greedy disease” of opiate dependence. Funny, I didn’t have the madcap comedian down as a conservative with a small c but if the acres of media coverage around his BBC 3 programme From Addiction to Recovery are anything to go by, he’s certainly a lot less progressive than he likes to make out.
Abstinence-based approaches to drug dependency have a wide appeal to policymakers, parents, governments, medical professionals and some former and current drug users. People will always want drug users to stop using drugs, and many drug users themselves will want to stop using drugs.
However, these programmes are costly and only have a modest success rate, as many people start using or injecting drugs again once they have been through a detoxification and rehabilitation process. Dependency on opiates is a chronic, relapsing condition according to the World Health Organisation. Relapse rates are particularly high in programmes that compel people to stop using drugs which suggests that it is only when individuals reach a point in their lives where they are ready and able to stop using illegal drugs that abstinence-based programmes can succeed. When people are at that point, let’s make sure that excellent detox and rehabilitation programmes are available for them.
In the meantime, at the International HIV/AIDS Alliance we’ll keep advocating for a harm reduction approach. Ensuring people inject safely, and supporting people with methadone so that their injecting reduces or stops is the only proven way to stop HIV transmission among people who use drugs.
Russell Brand is uniquely privileged to be able to afford high quality abstinence-based support and care, and he can anticipate a life full of opportunities and choices. A big and bright future.
Millions of other people are dependent on opiates in developing countries. If only they were as lucky as him. Far too many drug users are bribed or beaten by police or gangs and end up in jail for years for carrying small quantities of illegal drugs. These interventions – safe injecting programmes, methadone, HIV treatment, overdose prevention, access to justice – are relatively low cost, and are proven to work. Providing methadone is a crucial part of that picture. Many people are desperate for the health and social benefits that methadone brings and are fighting long and courageous battles for their right to get it.
Where we would agree with Brand is when he says that what’s needed is a major “attitudinal shift” in the way people who use drugs are viewed and that treating them as criminal is not the way forward.
The criminalization of drug users in Ukraine and other countries in Eastern Europe and Central Asia is currently fuelling the HIV epidemic in these regions, driving people away from seeking safer sex counselling, HIV treatment and care. Just last month, the World Health Organisation announced that new HIV infections are spiralling in these regions, largely due to most at risk groups such as people who inject drugs not having access to HIV prevention and treatment services. Repressive drug policy is neither cost effective nor efficient in overcoming drug dependency or the HIV, TB and hepatitis C epidemics.
A balanced approach to drug use is one that focuses on reducing supply by targeting the large-scale drug suppliers, while educating communities, including people who use drugs, about preventing HIV and promoting health. It would provide drug treatment such as methadone while attending to the health and social care needs of dependent drug users.
If Brand really wants to influence the policy makers who deal with the treatment of drug dependence, he could put his gift of the gab to good use by campaigning for a range of drug treatment options for people who use drugs. Science is on the side of methadone and millions of drug users want methadone. Abstinence-based treatment might well be the choice of Russell Brand, but let’s not reduce the choices of people less privileged than he is.
To find out more about the International HIV/AIDS Alliance’s work on harm reduction and the Support Don’t Punish campaign, visit http://www.aidsalliance.org/