Johann Hari

Today is the fifteenth birthday of the Big Issue, the mid-point of its glorious, surly adolescence. For the thousands of people who hit London’s pavements every year, the magazine has provided them with a small umbrella of dignity. Its founder, John Bird, has been using this anniversary to launch a manifesto – ‘A Rolls Royce Service for the Homeless, Please’ – but he has left out the one simple, swift move that has been proven to dramatically slash homelessness all over the world: free heroin prescription.

Meet Erin O'Hara, a heroin addict who just a few years ago was scrambling across our streets for her next fix by selling her abcess-scarred body or by selling drugs herself. Today she is a dazzling success story. She edits an acclaimed magazine called Black Poppy, her veins are healing, she is committing no crimes, and she has “never been happier”, she tells me. Except she isn't a poster girl for abstinence, a "Just Say No" calendar girl. She is still using heroin - but this time, it's legal. She is one of 450 people who are being given the heroin her body is chemically dependent on, free by the NHS.

Sixty percent of the homeless Londoners you toss a few pennies at are addicted to heroin after a childhood of being ignored, beaten or raped. The evidence shows the only way to lift them out of the chaos of scrambling for their next fix – the only way for them to settle away from the streets – is to provide it, safely and securely, in a doctor’s surgery. Heroin is not like, say, crack. Every doctor agrees that once a heroin addict is given a legal, safe supply, they will regulate their use and live normal, happy lives: William Wilberforce, John Halstead (the founder of the Harvard Medical School) and Samuel Taylor Coleridge were all highly-functional heroin-heads.

Giving up heroin didn’t work for Erin, and it doesn’t work for most addicts. Even the very best rehab programmes in the world – far beyond the reach of people sleeping on London’s streets – have a success rate of only twenty percent. Once your body craves heroin, unless you are incredibly lucky it will never stop. To avoid the convulsions, unimaginable stomach cramps, hallucinations and wild fluctuations in your body temperature caused by withdrawal, you will do anything. That’s why half of the burglaries committed in London are by heroin addicts desperate for a fix, and 70 percent of our street prostitutes are junkies.

Until 1971, London’s doctors sensibly acknowledged this reality, and prescribed heroin to the people who needed it. They only stopped because the American government – as part of a global anti-drugs crusade – demanded it. As all the experts warned, the result was a violent spike in our crime rates, and thousands of Erins. The policy has been so disastrous that across Europe, countries are finally shifting back to heroin prescription. In Switzerland, the areas that have given heroin to addicts have seem amazing results: burglary has been halved, addict deaths have simply stopped, and dozens of criminal gangs have been bankrupted.

Here in London, the government has quietly rolled out a massive expansion of methadone prescription since 1997 – and the number of rough sleepers has fallen by an incredible 70 percent as a result. Cardboard City no longer exists because the people who slept and wept there have now been mopped up with a slew of methadone prescriptions. Give them the drug and they get off the streets.

Prescribing heroin itself would have an even more drastic effect. My friend Dr Eliot Albert, a super-smart heroin-addicted academic who has taught at Goldsmith’s, knows how hard it is to get a heroin script on the NHS in this city. He explains, “I have been trying for four years, but there is a postcode lottery. Only four boroughs in London prescribe heroin, the rest don’t.” There is currently a trial run at the Maudsley Clinic, but only a few dozen people are on it. Why do we need another trial? Isn’t the evidence from Switzerland and Spain enough?

Here is the real Big Issue, the one that should be trumpeted by the magazine’s founder today: Do you want to bring London’s burglary, prostitution and homelessness rates crashing down? Do you want to save the lives of some of the most abused, broken people in town? Then why aren’t you calling for heroin prescription on the NHS?