Sir, - The heading "Almost half detox prisoners back on heroin" (The Irish Times, August 3rd), referring to 41 per cent of the 88 prisoners who had undergone the detoxification programme in Mountjoy jail, prompts the question: how does this outcome compare with published experience elsewhere? Studies published in 1988 in the British Journal of Addiction and 1989 in the British Journal of Psychiatry reported relapse rates of 46 per cent at six months and 97 per cent at one year, following inpatient detoxification.
Addictive drugs produce changes in the brain which endure even after the person has stopped taking them. Continued psychosocial and drug treatment is necessary to help addicts cope with recurring environmental cues and internal mental compulsion. It is important to keep the objective of detoxification firmly in focus. It is to minimise the physical and mental consequences of the removal of the addictive substances. It is unwise to expect that detoxification will bring lasting changes in drug use because there is considerable evidence to the contrary.
Given that 20 per cent of the detox prisoners in Mountjoy have started injecting heroin while in prison, clearly harm reduction programmes should be instituted immediately. The call by Dr Crowley for the introduction of such a programme must be supported, and the ever deepening pool of hepatitis C and HIV carriers in the prison population is clear evidence of the consequences of inaction.
Prejudice among the general public against the medical treatment of drug addicts is common. However, it should be remembered that only 20-30 per cent of those who receive treatment for nicotine dependence have not resumed smoking at the end of one year. Furthermore, despite being bombarded with medical advice, fewer than 30 per cent of patients in treatment for diabetes and high blood-pressure comply with the recommended diet and/ or behavioural changes. Thus, more resources should be put into the therapeutic efforts in Mountjoy jail which are highly cost-effective. Just consider the potential savings from one patient avoiding infection and hepatitis C and HIV. The economic benefits of harm reduction policies are no longer in doubt. - Yours, etc., Dr Bill Tormey,
Glasnevin Avenue, Dublin 11.