A long-simmering struggle between anti-drug hard-liners and doctors specializing in treating addicts is heating up. Next week, seven doctors prescribing maintenance doses of the heroin substitute methadone for their addict patients must appear before the General Medical Council, British medicine's disciplinary body, after the British government's Home Office filed formal complaints against them. More than 200 heroin addicts now face the prospect of being cut off from their methadone if the doctors are found to have engaged in professional misconduct.
Under attack is the prestigious Stapleford Center in London, whose founder and medical director, Dr. Colin Brewer, is a globally recognized leader in the treatment of heroin addiction. Brewer and six doctors with ties to the center are all charged in Home Office complaints of inappropriate prescribing of methadone.
At the root of the complaints is the belief shared by the Home Office and some doctors that the goal of treating drug users should be to force them to abstain from drugs. Thus, methadone should be prescribed only temporarily and in rapidly-reduced doses under close supervision.
But at Stapleford, Brewer and the other doctors supplied "maintenance prescriptions" to some patients, which, they said, would allow patients to escape the black market and lead normal, healthy, crime-free lives.
British law allows for maintenance prescriptions, but, as the Guardian newspaper drolly noted, the rules for such prescriptions "are unusually complex." Brewer and the Stapleford Center had avoided problems by working closely with the Home Office and encouraging users to detox, but have recently run afoul of high National Health Service officials over the maintenance prescriptions and over his pioneering use of naltrexone in providing painless detoxification. Now, the Guardian reported, Home Office inspectors are poring over prescription records in search of violations of the complex rules.
The Guardian quoted a source close to the Home Office as saying: "They have been talking about getting rid of every private doctor who prescribes for heroin users."
"This is a very poor development, a very negative development," said Bill Nelles, executive director of the Methadone Alliance. "We are very worried about the patients who may end up with no care if these doctors are not allowed to prescribe. This could also have a serious knock-on effect on other doctors who work in this field."
"This is so crass," said Labor MP Paul Flynn, vice-chair of the all-party drugs group. "These are people who would be knighted if there was a decent honors system for their courage in prescribing in a way that is of enormous benefit to the drug users and to their communities who may otherwise suffer from their crime."
Instead of being knighted, though, the good doctors are being hounded.