大象传媒

Warning: Depictions of drug use

Lisa used to be married. She had two jobs and was a mum to five kids. She calls it her normal life.

Now there鈥檚 only one thing on her mind. It鈥檚 all Lisa has been thinking about since she woke up.

Heroin.

Sitting in a friend鈥檚 house, she unwraps the foil carefully. 鈥�0.2g in weight, 拢10 in money,鈥� she says, her eyes fixed on the brown powder. Reaching for a syringe, she wipes away a tear.

Staring straight at the heroin, she admits: 鈥淚 put it before my children.鈥�

We have no idea where Lisa got the money for her latest fix, or where she bought it from. We don鈥檛 ask.

In complete silence she unwraps the foil, reveals the brown powder, and gets the syringe ready. Next the injection - she鈥檚 breathing heavily as the heroin courses through her veins.

After a while, her eyes drop. She has a moment in her own world.

This is Lisa鈥檚 life. It鈥檚 the same routine day after day. And in a few hours, she鈥檒l be searching for more.

Lisa calls it 鈥渞attling鈥� - the feeling she has without heroin. 鈥淟egs aching, body sweating, hallucinations, diarrhoea, sick.鈥� And in that moment what does she need more than anything?

鈥淏rown powder to put everything right, automatic fix.鈥�

The desperation never ends. Even with her prescription of methadone, which is supposed to be a longer-acting substitute for heroin, to help addicts stabilise, she still craves the real thing.

Lisa鈥檚 life has been this way for 12 years, on and off. She shakes her head as she describes the panic of waking up every morning addicted to heroin.

鈥淚 think, 'Where am I going to find the money today to score?' Money to get a bag [of heroin] to get myself better.鈥�

鈥淚t controls everything, it controls every part of your day,鈥� she says. 鈥淚t is a disease, all of addiction is a disease.

鈥淚 said to the woman at the job centre I haven鈥檛 got time to get a job - being an addict is a full-time job. It鈥檚 ridiculous.鈥�

As Lisa talks she looks down, mumbles. Her face is hollow, gaunt - the effects of years of addiction. She describes how she ended up here. She faced violence and, struggling to cope, she turned to alcohol, heroin, and then the final despair.

鈥淚 lost my oldest daughter and I鈥檝e been on it ever since. I haven鈥檛 really dealt with her death - I鈥檝e just buried my head in the sand.

鈥淧eople that don鈥檛 know me might find it hard to believe that I had a normal life. I would want nothing more than to have a boring life again, just to wake up in the morning and have it all back.鈥�

Lisa is no stranger to death. In her small County Durham town she has lost many addicted friends over the years.

鈥淭here is loads, aye there鈥檚 loads鈥� at least 20,鈥� she says.

Lisa is typical of the kind of people who are at risk of dying from heroin overdoses. Long-term users in their late 30s, 40s and even 50s.

The problem north of the border is even more acute than in the North East.

According to National Records of Scotland, there were 473 deaths related to heroin or morphine in 2016 - more than double the figure from 2011.

, according to the European Monitoring Centre for Drugs and Drug Addiction.

From 1993 to 2000, heroin and morphine deaths in England and Wales rose dramatically. Then they slowly declined.

But in 2010 death rates started to rise sharply again.

There has been a fundamental change in how drug treatment services are organised. Before 2012 they were jointly commissioned by the NHS and local authorities, but the Health and Social Care Act changed this.

The new law made local authorities solely responsible for commissioning drug treatment and their spending was no longer ring-fenced.

With reduced central government funding, councils were having to make savings across the board. That meant cuts.

The government鈥檚 Advisory Council on the Misuse of Drugs (ACMD) warned this year about funding of drug treatment falling.

The ACMD said if resources were spread too thinly, there could be increased levels of blood-borne viruses, drug-related deaths and drug-driven crime.

A lack of spending on drug treatment is short-sighted and a catalyst for disaster,鈥� said Annette Dale-Perera, who chairs the ACMD鈥檚 Recovery Committee. 鈥淓ngland had built a world class drug treatment system, with fast access to free, good quality drug treatment.鈥�

The government says every drug overdose death is a tragedy and that it has made it easier for addicts to receive naloxone, a medicine that reverses the effects of a heroin overdose.

鈥淪ince 1 October 2015, a regulation came into force to make this life-saving medicine more widely available."

To feed her habit Lisa borrows money but she also steals. Admitting to being a notorious shoplifter, she says she used to be good at it.

Not any more.

Lisa is in a police station, arrested on suspicion of theft. The effects of heroin are long gone, the rattling about to begin.

How does she feel? 鈥淪ick,鈥� she says, and she looks awful. How many times has she been arrested? 鈥淥ver a hundred鈥� for shoplifting, driving, possession.鈥�

She is at her lowest, locked up in a cell, alone. She is later to be released without charge, but what is it she wants in her life more than anything else?

There is a long pause. She looks away before she answers.

鈥淚 want my kids back.鈥�

But how can she when this is her life?

The Home Office estimates between a third and a half of all acquisitive crime is committed by offenders who use heroin, cocaine or crack cocaine. This covers crimes such as theft, burglary or shoplifting.

The cost of these crimes reverberate across communities - stolen property, insurance claims, courts costs, prison costs, it all mounts up.

The average fix costs Lisa 拢10 and she says she can get it in minutes. She makes it sound as easy as popping out to a corner shop. The only problem is getting the cash - the drugs are easy to buy.

鈥淵ou can get it from any back street in any colliery village.鈥�

In County Durham, as in the rest of the UK, the chances are the heroin she鈥檚 taking right now will have made its way from Afghanistan.

A map of where discarded needles have been found - put together by the campaigning drugs charity Transform - clearly shows hotspots in towns and villages across the county. Many of them are former mining areas.

These are places where lives depended on the pits, but years after they closed, the communities are still in desperate need of new jobs and investment.

Much has been written about the link between deprivation, poverty, unemployment and the prevalence of drugs. Figures from the Office for National Statistics, showing deaths from drugs misuse for 2014-16, back this up. The top five areas in England and Wales are Blackpool, Neath/Port Talbot, Middlesbrough, Burnley, and Gosport.

On a side street in Geneva stands an unremarkable looking building.

Chantal makes her way to reception, having taken the same journey hundreds of times before. An addict on and off for 30 years, she is 53 and is walking into the place where she is given heroin.

She stops at the window to chat to the nurse and to sign in.

鈥淏onjour, bonjour.鈥�

How鈥檚 she feeling today? Everything OK? She heads down the corridor and into a room that has the feel of a dental surgery.

Along one wall, coloured plastic cups sit in rows on the shelves - the sort you鈥檇 find in a nursery. Each has a name on - Mario, Michel, Helene, Alfred... and Chantal. Hers holds everything she needs to prepare her daily fix of heroin.

Isabelle Guillaume is the nurse supporting Chantal today. She watches as Chantal starts her regular ritual. Washes her hands, takes a seat, pulls the desk lamp towards a chair, and sits down. She鈥檚 ready.

Lost in the job in hand, she moves her leg on to a stool and searches meticulously for the place that this afternoon鈥檚 needle will go.

With a click she secures a tourniquet below the knee and picks up the syringe of heroin that the nurse has placed there.

鈥淓very patient has his or her dose of treatment,鈥� says Dr Rita Manghi, deputy chief medical officer at the University Hospital of Geneva.

鈥淭he patient can say, 'Today the weather is hot, I take a little less,' or, 'It鈥檚 cold, I take a little bit more.' They have a capacity of how to determine what鈥檚 best for them.鈥�

Chantal cleans her leg thoroughly before finding a spot near her ankle - where she carefully puts in the sterile needle.

At first it doesn鈥檛 work - blood fills the needle but there is no sense of panic. Isabelle smiles, provides a clean syringe and Chantal begins again and finally injects the heroin.

Within minutes Chantal is finished and the next addict is waiting. Chantal wipes down the table, disposes of the syringe and returns her pink plastic beaker to the shelf. It鈥檚 business as usual.

鈥淎gainst this treatment, people say if we give heroin to them, they will ask [for] more and more and more,鈥� says Dr Manghi.

鈥淭his is not true, they generally ask [for] less. Because it鈥檚 always the same substance, it鈥檚 pure.鈥�

As she leaves the clinic, Chantal speaks of her hopes for the future - to live with her daughter and to have a play she鈥檚 written performed in a theatre.

Dr Manghi says that the priority here is not to get addicts off heroin but to stabilise their lives. This kind of treatment is controversial, but the staff are adamant about the benefits.

鈥淓very morning that I come here I know I help," says the nurse. "I know that I don鈥檛 only give heroin 鈥� we give life.鈥�

When it has been floated before there has been staunch opposition. Trials in the UK in 2009 were criticised by campaigners Europe Against Drugs. 鈥淭his perpetuates addicts' maintenance on the drug when the goal should always be abstinence,鈥� said the group鈥檚 vice-president Mary Brett.

And there has been opposition in Switzerland too. Before a referendum on the policy in 2008, Sabine Geissbuhler, of the Parents Against Drugs group, said it was ludicrous to think of the programme being 鈥渢reatment鈥�.

鈥淭reatment means the goal should be people get off drugs eventually - they stop being addicts - and that's just not happening. It's an outrage that the state should give addicts heroin - it's poison. You don't give people poison to make them better.鈥�

There would be similar opposition in the UK today, but Mr Hogg is undeterred.

Before his election as PCC, he was a police officer - he says he鈥檚 dealt with victims of fatal heroin overdoses, and has had enough of the never-ending cycle.

鈥淭he first thing is to decriminalise personal use of all drugs.鈥� This would allow a 鈥渕edical solution鈥� for the problem, he says, citing the example of Portugal where drugs were effectively decriminalised in 2001. 鈥淲e鈥檙e seeing a reduction in drug use and we鈥檙e seeing a reduction in cash going to organised crime groups.鈥�

Change might come first in Scotland. Glasgow Health and Social Care Partnership has said plans for heroin-assisted treatment have been confirmed in principle.

They also want to provide what鈥檚 called a consumption room or safe injecting facility (SIF), a place where addicts can bring their own street heroin and inject safely. The Home Office opposes this, saying SIFs are likely to lead to a range of criminal offences being committed and that they are costly to run and divert money away from better treatment options.

There is small but growing support for heroin-assisted treatment clinics among local politicians and PCCs across the UK but with the potential controversy, it seems many are waiting for someone else to set up the first permanent programme.

Despite the government鈥檚 supportive tone, many politicians are wary, worried about the headlines. And they will have to find the money themselves at a local level out of stretched budgets. It takes a big financial commitment to set up a heroin clinic. The proposals in Durham are yet to go before the council for a decision.