Dealing with sex offenders; does chemical castration work?

The Big Question: How do you deal with sex offenders, and does 'chemical castration' work?
By Jeremy Laurance, Health Editor
Published: 14 June 2007
Independent UK

Why are we asking this now?

John Reid, the Home Secretary, announced a "radical" package of proposals yesterday to protect young people from paedophiles. As part of the package, he announced trials of drugs to be given to paedophiles to reduce their sex drives. Some have described this as "chemical castration".

Would this be an alternative to prison?

No. Mr Reid made it clear that nothing should be allowed to interfere with the legal process. It was what happened after any sentence handed down by the courts had been served that mattered. "Prison and punishment should take place when people are guilty of child offences but in addition to that we need to treat them, to supervise them and to share information." The treatment would be voluntary, he said.

Is this new?

No. Drug treatment for sex offenders is already available and prescribed. The proposals announced yesterday would involve an expansion of treatment.

Is this a good idea?

Depends who you talk to. Donald Findlater, the director of research and development at the child protection charity the Lucy Faithful Foundation, said: "We have this notion that sex offenders want to do bad things all the time. Some of them are desperately struggling with what is going on in their lives and want help to be stopped. [They] would happily take pills if that will help."

Sara Payne, whose daughter, Sarah, was murdered by the paedophile Roy Whiting seven years ago, said: "These are people that rape, molest our children, take photographs of what they are doing. They have already shown that they are the nastiest people in the world because of what they do to children. You are placing an honour-based system [to take the drugs] on people who have already shown they have absolutely no honour."

For how many sex offenders might drug treatment be appropriate?

Very few, but more than are currently being treated. There are almost 30,000 people on the sex offenders' register, but figures show a minority reoffend - about one in five over 20 years. Most of those who commit incest, for example, do not reoffend. Those with an uncontrollable sexual drive, whom drug treatment might help, are a minority. Paedophiles are often driven by emotional rather than sexual needs, having intimacy problems which make relationships with adults difficult. Removing their sex drive might not change their behaviour towards children at all.

What are the drugs?

They are part of a class of hormone antagonists used in the treatment of prostate cancer and other conditions and which have been available for about 20 years. The one mentioned yesterday, leuprorelin (Prostap), is used to treat prostate cancer in men and endometriosis in women, a hormonal condition in which the cells lining the womb migrate to other parts of the body where they may grow and cause pain.

How does the treatment work?

Leuprorelin switches off the production of testosterone, the male sex hormone, through its action on the pituitary gland, situated just below the brain, which controls the other hormone producing glands in the body and is sometimes known as the leader of the endocrine orchestra. High levels of testosterone are linked with the abnormally high sex drives in paedophiles. Other drugs, such as cyproterone, work in a different way, by opposing the action of testosterone in the body instead of interfering with its production. The effect is the same - a lowered or absent sex drive and an inability to have sex.

Should we call this 'chemical castration'?

No, according to Professor John Guillebaud, the emeritus professor of reproductive health at University College London. Although the term is in widespread use, he says it is stigmatising. "It is a pharmacological way of diminishing an abnormal sex drive. There is a reverse kind of sexism here which fails to recognise that all men, like women, are driven to some degree - and some men to a dangerous degree - by their hormones. As a gynaecologist, I am often asked by women to manipulate their hormones, to help them, for example, with severe period pains. Male sex offenders could choose to have an injection which would enable them to have a fairly normal life without this dominating sex drive."

Are the drugs effective?

The jury is still out. There are some published studies that suggest they may be - but these are based on giving sex offenders the drugs and observing what happens. This is not a reliable way of establishing anything in medicine. The gold standard of medical research, the double blind randomised trial, in which some patients are treated with the active drug and some with a placebo, and neither researchers nor patients know who has received what until the end of the trial, has not been conducted because sex offenders are not the sort of patients you can give a placebo to and wait to see what happens.

Is there any other treatment?

Yes. Some sex offenders are treated with fluoxetine (Prozac), the anti-depressant that is also prescribed for obsessive compulsive disorders, in combination with psychological therapy. It is only appropriate for men who have strong sexual fantasies and show signs of "obsessive rumination" on them. The aim is to give them a "window" when, instead of being focused on sex all the time, they can concentrate on the therapy. Don Grubin, a professor of forensic psychiatry at Newcastle University, said: "It is a matter of damping down their libido a bit, rather than suppressing it."

What happens in other countries?

When the American President, George Bush, was governor of Texas he signed a law giving sex offenders a choice between compulsory injections or having their testicles removed.

Similar laws had already been passed in Florida and California, which introduced castration for rapists. The Texas law was inspired by the convicted child molester Larry Don McQuay who, on the eve of his release from jail in 1996, publicly pleaded to be castrated.

The use of drugs to curb the sex drives of offenders has been introduced in Germany, France, Sweden and Denmark.

Does drug treatment have side effects?

Yes. The main side effects of the hormonal antagonists, such as leuprorelin, is osteoporosis (thinning of the bones), breast growth, heart problems and hot flushes. Professor Grubin, who has three or four patients on the treatment, said: "This is a pretty heavy-duty measure to prevent reoffending. It is only appropriate for people who say, 'I am out of control - please help me'. But it is probably under-used because psychiatrists lack experience and don't see sex offending as a psychiatric condition."

Less than 10 per cent of sex offenders would be suitable for treatment with fluoxetine, and less than 5 per cent with leuprorelin, he said.

Should drug treatment be extended to more sex offenders?

Yes...

* Anti-libido drugs to reduce sex drive and antidepressants to control obsessive fantasies have helped some sex offenders

* Drug treatment for sex offenders is prescribed in other countries, including the US and several European nations

* Sex offenders would still be punished for their crimes - treatment would not be an alternative to prison

No...

* The treatment is only suitable for the minority of sex offenders with an overwhelming sex drive - less than 10 per cent

* Some of the drugs can cause serious side effects, including osteoporosis and heart problems

* No gold standard double blind randomised trials have been carried out to prove that the treatment is effective