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The increasing problem of illicit drug use worldwide required some countries to introduce special maintenance programs for people with addiction. For example, the United Kingdom initiated needle exchange and oral methadone replacement therapy in the 1970s to combat the expansion of infections among drug users (MacGregor 220). For example, methadone replacement therapy is part of opioid maintenance treatment (OMT) prescribed to people with opioid addiction (Shapira et al. 2). Healthcare in the UK is free because it is financially supported by taxation; thus, OMT is available to everyone as part of the public intervention (Kalk et al. 184). An additional reason to continue this program was HIV/AIDS epidemic in the 1980s when the government further encouraged the intensification of needle-exchange services and opiate replacement therapy to stop the infection from spreading among injection-drug users (Kalk et al. 186). Indeed, HIV transmission due to needle sharing reduced from 55% to 20% in the 1990s (Kalk et al. 187). Addictive drug maintenance programs are moral from the standpoints of utility, rights, and ethics of care; however, OMT should be tightly supervised to achieve abstinence among a more significant number of people with addiction.
Utilitarian ethics claims that actions are right if they result in happiness in a group of individuals. The United Kingdoms policy of maintenance programs for drug users promotes gradual and less painful rehabilitation. Therefore, from the utility ethics perspective, this program can be considered morally right. This policy fosters happiness for the groups of drug users, and it is beneficial for society. For example, the number of crimes associated with illicit drug use dropped by 75%, and overall involvement in criminal acts among users decreased by 50% (Kalk et al. 192). Many addicted people search for additional doses or replacements for the drugs, which results in thievery, robbery, murder, and other crimes. Therefore, the legalization of drug replacement therapy as a medical service reduces unlawful acts, creating an advantage for drug users and society.
Access to healthcare is a fundamental human right regardless of a persons social background. Addiction is a psychiatric disease that results from alterations in brain chemistry, causing constant drug-seeking behavior (MacGregor 217). As mentioned previously, the UK maintenance program for drug users is provided by general practitioners as part of a free medical service. From the legal perspective, this program is moral because it gives people in need access to the fundamental human right to health, helping them to overcome addiction and prevent infections associated with injection drug use. Moreover, the citizens have the right to security; thus, the government should focus on crime reduction to ensure safety for people. For example, in England, the National Treatment Outcomes Study identified that about 30,000 crimes associated with illicit drug use were registered several months before the maintenance program was started (Kalk et al. 192). A significant reduction of felonies after the implementation of OMT indicates improved safety for civilians.
Ethics of care claims that people should take collective responsibility for those in need. Therefore, from a care ethics perspective, the legalization of OMT in the United Kingdom is moral because it ensures supporting people with psychiatric illnesses. Furthermore, treatment for addiction in the UK is not simple detoxification from drugs because this program also includes a long-term rehabilitation program that allows overdose risk reduction and achieving abstinence (Kalk et al. 195). This cooperative help to people with addiction is a benevolent act for the good of society.
The criticism of the UK maintenance program for drug users claims that this policy is unethical. The idea of the immorality of this program was further reinforced by the media representation (MacGregor 226). The opponents of this policy state that some replacement drugs, like methadone, are more addictive than illegal substances, resulting in a delay in proper recovery for users (Kalk et al. 193). Nevertheless, data from scientific reports show a significant improvement in infectious disease prevention among injection drug users after the initiation of needle exchange and oral opiate replacement therapy (Kalk et al. 196). Furthermore, crime reduction was achieved with a maintenance program, resulting in monetary benefit for the country by saving three pounds on crime for every pound spent on treatment (Kalk et al. 192). However, the healthcare workers who provide a prescription for replacement therapy should supervise these patients for appropriate and moderate use of the drugs substitution.
Overall, the UKs maintenance program for illicit drug users can be viewed as a practical action that provides care to patients with addiction and supports the universal human right to health and safety. Implementing this policy resulted in illegal drug-related felony reduction, ensuring security for the civilians; it also decreased HIV/AIDS transmission among injection-drug users. However, replacement therapy is addictive and does not solve the nature of the problem. Therefore, the prescription of these drugs should be carefully monitored to prevent overdose, and proper rehabilitation programs should be obligatory for drug users to achieve complete abstinence.
References
Kalk, Nicola J., et al. Treatment and Intervention for Opiate Dependence in the United Kingdom: Lessons from Triumph and Failure. European Journal on Criminal Policy and Research, vol. 24, no. 2, 2018, pp. 183-200.
MacGregor, Susanne. Drug Policy in the United Kingdom. European Drug Policies: The Ways of Reform, edited by Renaud Colson and Henri Bergeron, Routledge, 2017, pp. 217-237.
Shapira, Barak, et al. The Switch from One Substance-of-Abuse to Another: Illicit Drug Substitution Behaviors in a Sample of High-Risk Drug Users. PeerJ, no. 8, 2020, pp. 1-25.
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