AIDS Rate Plunges, Crime Drops After Scots Start Providing Oral Drugs

HARM REDUCTION March 1993

An innovative approach to curtailing AIDS and reducing the harm of drug use by providing a range of oral drugs to addicts in Edinburgh, Scotland is being hailed by many in that nation's law enforcement and medical communities as a humane and practical alternative to strict prohibition (William Schmidt, "To Battle AIDS, Scots Offer Oral Drugs to Addicts," New York Times, 2/8/93, A3).

In 1985, physicians in Edinburgh, Scotland became horrified when surveys revealed that more than half of blood samples drawn from drug addicts in the city's poorest neighborhood were HIV positive, an infection rate rivaling that in New York City. That finding triggered a major rethinking of attitudes towards drug addicts, and ultimately resulted in a radical change in which physicians were permitted to prescribe free and on demand, oral doses of virtually any drug craved by addicts on condition they pledged to avoid using needles and agreed to regular drug and medical counseling.

Although Edinburgh is home to only 1.3 percent of Great Britain's total populace, with 750,000 people, health agencies say that one in every five people in Great Britain infected by dirty needles lives there. Eight years after that horrifying survey, the redirected policy is bearing fruit. After peaking in the mid-1980's, when health officials found 120 new HIV infections yearly caused by dirty needles, by 1987 only 47 new cases were recorded, dropping to 10 new cases in 1990, and only 8 in 1992.

Now, only 22 percent of drug users entering treatment report using needles, compared to 87 percent in 1988, when the oral drug prescribing program was still growing in acceptance. One 37-year-old addict quoted in the story said the ready availability of clean, legal drugs was key to the program's success. He commented that "it wasn't just the fear of AIDS," since a desperate addict would share needles if that was the only way to obtain a wanted drug.

The program has the support of law enforcement officials. The city's assistant police chief told the Times that heroin use and local crime rates had declined, and noted that both the medical and law enforcement communities were positive about the new approach.