Further Confessions of a GP

Crackhead Kenny had come back to see me. He bashfully apologised for storming out on me last time he was in; I told him that I accepted his apology, and I meant it. There’s no room in this job for holding grudges and I was pleased that Kenny had decided to stick with me as his GP rather than move to another practice in an attempt to find a doctor who would prescribe him what I had refused.

Kenny was here to ask me for a sick note and it was a timely request as that very morning it had been reported that the government was threatening to stop heroin addicts from being able to claim incapacity benefit. About a hundred of my patients are heroin users and they are all signed off work. The government spokesman pointed out that it was unfair that hardworking taxpayers were paying for the addictions of others. This may well be true, but is an attempt to force heroin users such as Kenny into gainful employment really a viable option?

We recently advertised for an admin assistant at our surgery. It is a low paid, unskilled, part-time position that requires no previous experience and no great physical exertion. Such is the nature of the times, we had more than 60 applicants, most of whom were greatly overqualified for the post. None of the applicants were intravenous heroin users, but if any were we wouldn’t have shortlisted them. If we wouldn’t consider employing a heroin user, who does the government think will? With the exception of the odd ailing rock star, I am yet to hear of a gainfully employed injecting heroin addict.

Heroin is an awful, all-consuming drug that destroys the personality of the person behind the habit. The next fix becomes more important to the user than food, shelter and, most sad of all, the people who care about them most. It is not a lifestyle that can easily coexist with a nine-to-five job. As Kenny sits in front of me, I don’t even consider not signing his sick note. There is no way in the world that he could hold down a job in his current state. The government is very welcome to switch Kenny and addicts like him from incapacity benefit to jobseeker’s allowance, but it would simply be an expensive and time-consuming PR exercise.

If the government chooses to take it one step further and remove all drug users’ benefits, the result would be an almighty hurrah from some, but it would simply mean a large number of the most vulnerable members of our society being made homeless and pushed further into crime, prostitution and begging as they looked for alternative ways to feed their habits. The extra burden placed on the criminal justice system would almost certainly end up costing far more than the relatively meagre hand-outs that heroin users currently receive in the form of incapacity benefit. It is much too simplistic to think that if we took Kenny’s benefits away from him, he would be forced to stop taking drugs, find a job and instantly become a more positive and worthwhile contributor to society.

Our local drug and rehab services are very good, but although most of my patients who use heroin are actively enrolled within substance misuse services, very few will successfully turn their lives around. Treating heroin addicts punitively with prison sentences doesn’t seem to work either, so it would appear to me better to try to work out why people fall into heroin addiction in the first place. Most of us experiment with drugs to some level or another in our youth, but even during my own sustained and enthusiastic period of adolescent experimentation, I never got anywhere near a place where injecting a syringe full of heroin into my arm jumped out as being a good idea.

Kenny had a 10-minute appointment with me that day and it took less than one minute to fill in a sick note. I decided that it might be an opportunity to ask him how he became an addict. The story Kenny told me was a familiar one. As with many of my patients who use heroin, he seemed to take those extra few steps into harder drugs and full-scale addiction after a fairly miserable start in life. Heroin is often an escape from the grim realities of life, and among my patients child abuse and growing up in care seem to pop up time and time again as the most damaging experiences addicts are trying to escape from.

As a doctor, I try not to get carried away with the emotion and morality of what I see because it interferes with the practical aspects of the job. Many of my patients have self-inflicted injuries and illnesses and whether they are due to heroin, alcohol, smoking or falling off ponies, offering my indignation benefits no one. In my eyes politicians have no option but to take the same approach. I am dealing with addiction on an individual basis while they have to consider it on a more national scale, but ultimately the realities are the same.